鼻内镜下两种入路额窦开放术  

Two approaches for the endoscopic frontal surgery

作　　者：王德利[1] 房振胜[1] 杜志华[1] 张岗[1] 宫政[1] 

机构地区：[1]泰山医学院附属医院耳鼻咽喉科,山东泰安271000

出　　处：《中国内镜杂志》2013年第5期530-533,共4页China Journal of Endoscopy

摘　　要：目的观察额隐窝区域临床解剖特点,探讨鼻内镜下最佳额窦手术路径。方法对39例(64侧)患者术前进行鼻内镜检查和CT冠状位、水平位扫描,矢状位重建。根据检查结果选择手术径路:钩突路径或鼻丘路径,行内镜下额窦开放术。结果钩突路径治愈21侧(77.8%),好转4侧(14.8%),复发2侧(7.4%);鼻丘路径治愈29侧(78.4%),好转5侧(13.5%),复发3侧(8.1%)。两种路径手术方式在治疗效果上比较差异无显著性(P>0.05)。结论额隐窝区解剖复杂。CT和鼻内镜检查结果是选择不同手术路径的重要依据。钩突路径或鼻丘路径具有等同的治疗效果。术中可根据情况选定一种路径或采用两种路径结合的方法。[Objective] To observe the anatomic characteristics of frontal recess （FR） and investigate the best approach of endoscopic frontal sinus surgery. [Methods] 39 cases （64 sides） were examined endoscopically and computed tomography in coronal and axial views, some of images were reconstructed in a parasagittal view. The approach of endoscopic frontal sinus surgery either an uncinate or an agger nasi approach was chosen according to examination results. [Results] A 6~16 month follow-up showed that 21 sides （77.8%） were cured, 4 sides （14.8%） were improved, and 2 sides （7.4%） were recurrent in the uncinate approach group; and 29 sides （78.4%） were cured, 5 sides （13.5%） were improved, and 3 sides （8.1%） were recurrent in the agger nasi approach group. No significant differences were found in the surgical outcomes between the two different surgical approaches. [Conclusion] The anatomy in frontal recess is complicated. The operation approach of choice is based on the results of computed tomographic scan and endoscopic examinations. The present study revealed that both surgical approaches could obtain similar outcomes. Thus, either approach or a combined approach can be chosen according to the actual situation in order to meet the satisfaction of the operations.

关 键 词：额窦炎 额隐窝 鼻丘 钩突 CT 内镜手术 

分 类 号：R765.43[医药卫生—耳鼻咽喉科]