鼻窦眼眶区良性占位性病变手术径路的选择  

Surgical approach to benign space-occupying lesions in orbital sinus area

作　　者：梁小军[1] 杨桦[1] 镡旭民[1] 李红[1] 朱先柏[1] 王昶[1] 

机构地区：[1]第三军医大学新桥医院耳鼻咽喉科,重庆400037

出　　处：《第三军医大学学报》2010年第3期288-292,共5页Journal of Third Military Medical University

摘　　要：目的探讨鼻窦眼眶区良性占位性病变手术径路的选择。方法根据良性占位性病变侵犯的部位,将116例鼻窦眼眶区良性占位性病变患者分为额筛眶区、蝶筛眶区和颌筛眶区;其中额筛眶区16例,包括鼻内镜径路6例,联合径路(鼻内镜手术+鼻外开放式手术)8例,鼻外径路2例;蝶筛眶区40例,为鼻内镜径路;颌筛眶区60例,包括鼻内镜径路42例,联合径路12例,鼻外径路6例。结果蝶筛眶区40例良性占位性病变均经鼻内镜径路切除病灶,且手术视野好,病变清除彻底,未见复发,所有患者术后无眶内及颅内并发症;鼻内镜径路对48例颌筛眶区脓囊肿、上颌窦内侧壁良性占位性病变及某些额筛眶区脓囊肿也能较容易的清除病灶,但对28例额筛眶区、颌筛眶区某些特殊的良性占位性病变却很难完成。结论鼻内镜径路是治疗蝶筛眶区良性占位性病变、颌筛眶区脓囊肿、上颌窦内侧壁良性占位性病变及额筛眶区某些脓囊肿的理想选择。Objective To study how to select the surgical approach to benign space-occupying lesions in orbital sinus area. Methods According to the sites of benign space-occupying lesions, 116 patients with benign space-occupying lesions in orbital sinus area were divided into frontal-ethmoidal-orbit area benign spaceoccupying lesion group （ n = 16）, sphenoid-ethmoidal-orbit area space-occupying lesion group （ n = 40）, and maxillary-ethmoidal-orbit area benign space-occupying lesion group （n = 60）. Of the 16 patients in frontal-ethmoidal-orbit area benign space-occupying lesion group, 6 received endoscopic surgery, 8 received endoscopic sinus surgery ＋ open surgery, and 2 received ectorhinal surgery. All patients in sphenoid-ethmoidal-orbit area space-occupying lesion group received endoscopic surgery. Of the 60 patients in maxillary-ethmoidal-orbit area benign space-occupying lesion group, 42 received endoscopic surgery, 12 received endoscopic sinus surgery ＋ open surgery, and 6 received ectorhinal surgery. Results Endoscopic sinus approach to the benign space occupying lesions in sphenoid-ethmoidal-orbit area had a rather good operation field and could completely remove the lesions. No recurrence of lesions and orbital and intracranial complications was found after operation. Endoscopic sinus approach could also easily remove the benign space occupying lesions in maxillary-ethmoidal-orbit area, medial wall of maxillary sinus, and certain frontal-ethmoidal-orbit pyoceles. However, it could not remove some special benign space occupying lesions in the maxillary-ethmoidal-orbit and frontal-ethmoidal-orbit areas. Conclusion Endoscopic sinus approach is an ideal procedure for removal of benign space occupying lesions in sphenoid-ethmoidal-orbit area, maxillary-ethmoidal-orbit area, medial wall of maxillary sinus, and special pyo- celes. However, it cannot remove the lesions in some exposed areas, such as frontal-ethmoidal-orbit area and maxillary-ethmoidal-orbit area. Endoscopic sinus approach ＋ open approach

关 键 词：鼻窦 眼眶 良性占位性病变 手术径路 

分 类 号：R765.405[医药卫生—耳鼻咽喉科] R765.9[医药卫生—临床医学]