DrafⅡb额窦手术及其变通术式的临床应用  

Clinical application of Draf lIb frontal sinusotomy and it＇ s modified procedures

作　　者：周兵[1] 王成硕[1] 黄谦[1] 崔顺九[1] 李云川[1] 王桂生[1] 张利利[1] 黄振校[1] 孙焱[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第5期358-362,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的回顾性总结额窦DrafⅡb手术及其变通术式的临床疗效，探讨和归纳手术适应证及影响预后的因素。方法选择2004-2010年接受鼻内镜下额窦DrafⅡb手术的单侧额窦病变患者32例，其中男25例，女7例；复发额窦内翻性乳头状瘤15例，额窦黏液囊肿6例，复发额窦炎4例，额窦骨瘤3例，额窦脑膜脑膨出伴脑脊液鼻漏2例，单纯脑膜脑膨出和急性额窦炎各1例。术前行鼻窦CT扫描，肿瘤患者同时行鼻窦MRI检查。脑膜脑膨出与脑脊液鼻漏患者同时行磁共振脑池造影。全身麻醉下，主要采用0。内镜、高速鼻钻及动力系统行DrafⅡb及变通方式DrafⅡb1—3型。术后1周行鼻窦CT扫描，作为随访基线，术后在鼻内镜下随访。结果32例患者中行DrafⅡb手术19例，其中额窦内翻性乳头状瘤12例，额窦黏液囊肿4例，复发额窦炎2例，额窦骨瘤1例；DrafⅡb—1型5例，其中额窦内翻性乳头状瘤和复发额窦炎各2例，额窦骨瘤1例；DrafⅡb-2型6例，其中额窦脑膜脑膨出3例，额窦内翻性乳头状瘤、急性额窦炎和额窦骨瘤各1例；DrafⅡb-3型2例，均为额窦黏液囊肿。术后随访8～73个月，额窦口开放良好22例，狭窄7例，闭锁3例。再手术2例，均为内翻性乳头状瘤。无手术中、手术后并发症。结论鼻内镜下额窦DrafⅡb手术及其变通术式DrafⅡb1～3型，适用于额窦复杂病变，并可根据病变和解剖特点加以变化和选择，有较好临床应用前景。Objective To summarize the follow-up outcomes of Draf H b frontal sinusotomy and it＇s modified procedures, and to discuss the surgical indications and prognostic factors. Methods Thirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma （IP）, 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography （CT） scans. Patients with tumor accepted magnetic resonance imaging （MRI）. The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea recieved magnetic resonance cisternography （MRC）. The Draf [[ h frontal sinusotomy and it＇s modified Draf l] b-1 -3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope. Results Among 19 cases of Draf H b, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf ]1 b-1,2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf ]I b-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf lI b-3 were mucocele. The follow-up ranged from 8 to 73 widely opened, 7 were stenosis and 3 were closed. months. Twenty-two cases of the frontal neoostium were Revision surgery was seen in 2 cases with IP. All of them had no complications. Conclusions The Draf IIb frontal sinusotomy and it＇s modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.

关 键 词：内窥镜检查 耳鼻喉外科手术 额窦 选择行为 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]