额下入路颅脑术后并发额窦炎的原因及处理  

Frontal sinusitis after transfrontal craniotomy： causes and management

作　　者：李树华[1] 石洪金[1] 董卫东[1] 邹连贵[1] 吴大海[1] 

机构地区：[1]解放军沈阳军区总医院耳鼻咽喉科,沈阳110016

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第4期263-267,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨额下入路颅脑手术后并发额窦炎的原因、临床表现和治疗原则。方法额下入路颅脑手术后出现额窦炎的患者共33例，其中7例合并额窦脓肿，4例前额皮肤破溃瘘道。传统鼻外进路额窦手术23例，术后放置鼻额引流扩张管3个月以上；鼻内镜下额窦手术9例，鼻内镜和鼻外联合进路额窦手术1例，引流扩张管在出院前或出院后1个月内拔除。两种术式均需彻底清除额窦内骨蜡异物和炎性肉芽组织。复习颅脑手术病历结合鼻窦CT影像和额窦手术所见探讨并发额窦炎的原因。结果33例患者均有颅脑术中开放额窦，将额窦黏膜下推或刮除，并以骨蜡填塞额窦的记录，其中5例有发生额窦炎后重新刮除额窦内黏膜并再次以骨蜡彻底封闭额窦的病史。所有患者均在拔除硅胶鼻额引流扩张管后随访半年以上。除2例鼻外进路手术的患者出院后1个月内鼻额引流扩张管脱落，经2次手术外，余31例均为1次手术。33例中30例治愈，3例好转。两种手术方式治疗效果相同。无脑脊液鼻漏等并发症。结论额下入路颅脑术后并发额窦炎与颅脑术中额窦处理不当、额窦内骨蜡异物存留有关，此类额窦炎易形成额窦脓肿、瘘道等严重临床表现，治疗原则以清除额窦内骨蜡异物、清除炎性肉芽组织、开放额隐窝引流为主。传统鼻外进路额窦外科和鼻内镜额窦外科都可以达到治疗目的，但鼻内镜额窦外科具有微创、不必长期佩戴扩张管等优点。Objective To explore the causes , clinical manifestation and therapy of frontal sinusitis after transfrontal craniotomy. Methods Thirty-three patients with frontal sinusitis after transfrontal craniotomy were included in the study. Among them, 7 cases had frontal sinus abscess and 4 cases had frontal sinus fistula. Twenty-three patients were treated with traditional frontal sinus surgery with facial incision. The nasofrontal dilatation tube was positioned for more than 3 months. Nine patients were treated with endoscopic frontal sinus surgery, and 1 patient was treated with combined endoscopic and traditional frontal sinus surgery, with nasofrontal dilatation tube positioned for less then 1 month. In the revision surgery, the bone wax and phlogistic acestoma were cleaned out in both operational methods. The causes of frontal sinusitis after transfrontal craniotomy were discussed by studying the frontal sinus CT image, and prior surgical data. Results All patients were followed up for more than 6 months after the nasofrontal dilatational tube was removed. Among 33 patients, two cases with traditional frontal sinus surgery were operated twice due to nasofrontal dilatation tube fall off in 1 month. In all 33 patients, 30 cases cured and 3 cases got better. There were no curative difference between two operational methods. Conclusions The causes of frontal sinusitis after transfrontal craniotomy were inadequate sinus management in craniotomy and bone wax tamping in frontal sinus. There was more frontal sinus abscess and fistula occurring in frontal sinusitis after transfrontal craniotomy than that in ordinary frontal sinusitis. The therapy included cleaning out bone wax and phlogistic acestoma, and expanding the frontal sinus ostium. The satisfying curative effect was obtained in both operational methods, but endoscopic frontal sinus surgery was better because it is minimally invasive, no facial incision and quick recovery with less nasofrontal dilatational tube posting time.

关 键 词：手术后并发症 额窦炎 内窥镜检查 

分 类 号：R686[医药卫生—骨科学]