鼻内镜下经筛窦眶纸板入路眶内占位病变切除术  

Intraorbital surgery by transnasal endoscopic ethmoidal-lamina papyracea approach

作　　者：姜彦[1] 董频[1] 王杰[1] 徐宏鸣[1] 陈黎[1] 朱宽龙 

机构地区：[1]上海交通大学上海市第一人民医院耳鼻咽喉头颈外科,上海200080 [2]浙江省宁波市象山红十字台胞医院耳鼻咽喉科,浙江宁波315731

出　　处：《中国耳鼻咽喉头颈外科》2007年第10期591-594,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨鼻内镜下经筛窦眶纸板入路切除眶内占位病变的可行性。方法回顾性分析2003年6月～2006年8月以突眼为主要症状的9例眶内占位(2例脂肪瘤、2例海绵状血管瘤、2例炎性假瘤和3例血肿)和1例眶内异物患者。除1例海绵状血管瘤外,均在鼻内镜下经筛窦眶纸板进入眼眶,清除眶内病变。结果眶内异物一次性取出;1例海绵状血管瘤经眶外切开入路切除;突眼和复视症状均完全消除;术前手动视力提高到0.3,光感视力提高到0.1,伤后14天就诊者视力未恢复。随访3个月至2年,炎性假瘤1例治愈,1例复发,再次手术后切除,现随访中;其余8例均一次性治愈,临床症状消失,无复发。结论鼻内镜下筛窦眶纸板入路眶内占位性病变切除术,具有术野清楚、损伤小、恢复快及面部无瘢痕等优点,可以完整切除占位病变,方法切实可行。OBJECTIVE To explore the feasibility of transnasal endoscopic surgery to treatment of intraorbital space occupying by ethmoidal-lamina papyracea approach. METHODS The clinical data of 10 cases who underwent intraorbital surgery via transnasal endoscopic ethmoidal-lamina papyracea approach from June 2003 and Aug. 2006 were retrospectively studied. The patients included foreign body 1 case, cavernous hemangioma 2 case, lipoma 2 cases, inflammatory pseudotumor 2cases and hematoma 3cases. All intraorbital space occupying were operated by transnasal endoscopic ethmoidal-lamina papyracea approach but for one cavemous hemangioma which was dealt with through extra orbitectomy. The inflammatory pseudotumors were prescribed with glucocorticoid after operation.RESULTS Foreign body was removed successfully. One case of cavemous haemangioma was removed completely by transnasal endoscopic surgery and the other by extroorbital operation. All symptoms of proptosis and diplopia disappeared. One vision was enhanced from hand moving to 0.3 and another from light to hand moving. However, there was one hematoma which had been hindered about 14 days after damaged lost eyesight after operation. All cases were cured but one pseudotumor which recurred and was operated again. All cases were followed up 3 to 24 months. CONCLUSION Intraorbital surgery via transnasal endoscopic ethmoidallamina papyracea approach was available and feasible for the advantages of clear operation field, direct vision operation, less damage, rapid recovery and avoiding of facial scar, and intranasal endoscopic surgery can treat the rhino-orbital related diseases and nasal diseases at the same time.

关 键 词：内窥镜检查 眶内容摘除术 

分 类 号：R779.6[医药卫生—眼科]