蝶窦肿瘤病变并神经系统损害的临床特点和鼻内镜外科手术  

Characteristics of invasive damages of nerve system in sphenoid-sinus-o-tumoropathy and transnasal endoscopic surgery

作　　者：李成君[1] 倪富强[1] 刘丕楠[1] 周晖[1] 吴胜田[2] 李智[2] 

机构地区：[1]首都医科大学附属北京天坛医院耳鼻咽喉科,北京100050 [2]首都医科大学附属北京天坛医院神经外科,北京100050

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第14期625-627,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨蝶窦肿瘤病变并神经系统损害的临床特点和鼻内镜外科手术的要点。方法:回顾性分析13例蝶窦肿瘤病变并侵袭性神经系统损害患者的临床特征,鼻内镜术后随访神经系统症状的改善情况。结果:①侵袭性神经系统损害主要为脑神经受损,9例视神经、7例动眼神经、4例滑车神经、4例外展神经及1例三叉神经损害;其次为3例垂体功能减退,2例偏瘫失语。②鼻内镜治疗后神经系统症状改善。术后当日或次日,4例头痛及眼部症状减轻;术后3～7d,9例头痛和眼部症状明显减轻或消失;术后2周8例视力不同程度好转,9例头痛、1例复视、2例上睑下垂、1例眼球固定、2例面部疼痛、2例眶周麻木消失。随访期间无脑脊液漏、脑水肿、颅内出血等并发症出现。结论:蝶窦肿瘤病变侵袭性神经系统损害特点以脑神经受损为主要临床表现,其次为垂体功能受损。鼻内镜手术治疗可有效遏制蝶窦肿瘤病变的侵袭性神经系统损害。Objective：To explore the relationships between the sphenoid-sinus-o-tumoropathy and local anatomy,as well as the characteristics of invasive damages of nerve system in sphenoid-sinus-o-tumoropathy,and emphasize that it is crucial of early diagnosis and surgery for sphenoid-sinus-o-tumoropathy.Method：Retrospective analysis of the characteristics of invasive damages of nerve system in 13 patients with sphenoid-sinus-o-tumoropathy,and follow-up the outcomes of nerve system after transnasal endoscopic surgery.Result：①The majority clinical manifestations of invasive damages in nerve system are cranial nerves,there are 9 cases optic nerve,7 cases oculomotorius nerve,4 cases trochlear nerve,4 cases abducent nerve and 1 cases trigeminal nerve have been found damage at different levels in this group,and the secondly are 3 cases dysfunction of pituitary and 2 cases central nerve damage.②the improvement of invasive damages in nerve system after transnasal endoscopic surgery are as follow：at the day of operation or the next day,there are 4 cases to be reported that the symptoms of headache and eyes relieve very well;during 3 to 7 days after operation there are 9 cases to be reported that the symptoms of headache and eyes relieve or disappear significantly;2 weeks after operation,there are 8 cases to be reported that the optical sights recovery at different levels,and there are many symptoms such as headache（9 cases）,visual diplopia（1 cases）,ptosis（2 cases）,fixation of eyeball（1 cases）,exophthalmoptosis（2 cases）,face pain（2 cases）,orbital paralysis（2 cases）disappeared completely.No complications of cerebrospinal fluid rhinorrhea,brain edema and hemorrhage to be found during the period of operation and follow-up.Conclusion：The majority clinical characteristics of invasive damage in nerve system with sphenoid-sinus-o-tumoropathy are cranial nerve manifestations,and the second manifestation is dysfunction of pituitary.Transnasal endoscopic surgery could inhibit the invasive damages in cr

关 键 词：鼻肿瘤 脑神经 垂体功能 鼻内镜手术 

分 类 号：R739.62[医药卫生—肿瘤]