鼻内镜下经鼻改良Lothrop手术随访疗效分析  

Analysis of follow-up outcomes of endoscopic modified Lothrop procedure

作　　者：周兵[1] 黄谦[1] 王成硕[1] 崔顺九[1] 王桂生[1] 张利利[1] 黄振校[1] 叶婷[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教育部耳鼻咽喉头颈科学重点实验室(首都医科大学),100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第9期728-734,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市卫生系统高层次人才专项经费资助（2009-3-36）;卫生部卫生公益性行业科研专项（201202005）

摘　　要：目的通过回顾性总结鼻内镜下经鼻改良Lothrop手术（endoscopicmodifiedLothropprocedure，EMLP）的临床随访结果，分析EMLP的适应证、手术方法和预后因素。方法资料来源于2003--2011年在我院完成EMLP手术的73例额窦病变患者，其中男52例，女21例；年龄14—72岁，平均45．6岁。术前行鼻窦CT扫描，肿瘤患者术前行MRI检查。手术后在内镜下随访。结果73例额窦病变患者中额窦内翻性乳头状瘤21例，鼻窦炎伴鼻息肉合并哮喘16例，额窦炎12例，慢性鼻窦炎伴或不伴鼻息肉9例，骨瘤7例，额窦黏液囊肿4例，变应性真菌性鼻窦炎3例，脑膜脑膨出1例。73例中有前期手术史61例，手术次数1～6次，平均1．8次。术后随访6～122个月，平均25．0个月。随访终期额窦开放良好者44例（44／73，60．3％），狭窄25例（25／73，34．2％），闭锁4例（4／73，5．5％），再手术7例（7／73，9．6％）。无手术并发症。结论EMLP对额窦肿瘤是非常有效的手术方式；对于复发慢性鼻窦炎伴或不伴鼻息肉及哮喘，采用EMLP并结合药物治疗，可获得更好的缓解效果；病变性质、黏膜缺失程度、前期手术及解剖因素等，是重要的预后因素。Objective To sum up the follow-up outcomes of endoscopic modified Lothrop procedure （EMLP） and retrospectively analyze the indications, methods and prognostic factors of EMLP. Methods The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper. The mean age was 45.6 （ranging from 14 to 72 years）. There were 52 males and 21 females. Only patients with follow-up time greater or equal to 6 months were included. Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients. All patients were followed under endoscope. Results There were 21 inverted papilloma in the frontal sinus, 16 chronic sinusitis with asthma, 12 frontal sinusitis, 9 chronic sinusitis with or without polyps, 7 osteoma of the frontal sinus, 4 frontal mucocele, 3 allergic fungal sinusitis and 1 congenital encephalocele. Sixty-one cases had prior surgical history （ 1.8 times on the average）. Their mean follow-up was 25.0 months, （ ranging from 6 to 122 months ） . At the end of follow-up, 44 cases （60. 3% ） had well opened frontal drainage pathway. Twenty-five （34. 2% ） was re-stenosed and 4 （5.5%） closed. Seven cases （9.6%） underwent revision surgeries. There were no surgical complications. Conclusions EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis. Combined with medical treatment, EMLP will have a better results for chronic sinusitis with or without polyps and asthma. The degree of diseases, mueosal loss, anatomic variability and prior surgeries are important prognostic factors.

关 键 词：额窦 治疗结果 内窥镜检查 耳鼻喉外科手术 预后 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]