经鼻内镜开窗治疗上颌骨囊肿  

Application of nasal endoscopy in maxillary cyst surgery

作　　者：吴家森[1,2] 谭汉提[1,2] 殷海[1,2] 刘柏松[1,2] 何引[1,2] 郑文[1,2] 

机构地区：[1]广西医科大学第八附属医院 [2]贵港市人民医院耳鼻咽喉头颈外科,广西贵港537100

出　　处：《中国耳鼻咽喉头颈外科》2013年第6期307-310,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨上颌骨囊肿的的治疗方法。方法根据囊肿的大小、累及上颌窦范围和离上颌窦自然开口距离,采用扩大上颌窦自然口中鼻道开窗3例、下鼻道开窗或鼻底开窗4例、泪前隐窝入路+下鼻道开窗9例,手术切除完全囊肿囊壁或部分切除,囊肿与上颌窦有间隔的将间隔完全去除,使囊肿与上颌窦融合为一个腔,保证囊肿腔与上颌窦、鼻腔引流通畅。结果术后随访6～24个月,平均随访12个月,15例面部胀感消失,未出现面部隆起,定期复查鼻内镜及鼻窦CT,囊肿术腔黏膜均于术后2～3个月上皮化,囊肿均无复发,术腔、鼻窦腔引流通畅。1例因开窗口小致开窗口闭合,但囊肿较前明显缩小,半年后再次开窗后囊肿未见复发。结论经鼻内镜开窗治疗上颌骨囊肿简便、安全、创伤小、恢复快、疗效确切、复发率低,术后便于观察术腔情况,尤其适合侵犯鼻腔底或上颌窦的上颌骨囊肿。OBJECTIVE To explore the new method for treatment of maxillary cyst. METHODS According to the situation of maxillary cysts, the enlaryged ostium of the maxillary sinus was opened in 3 cases, the fenestration of inferior nasal meatus was opened in 4 cases and inferior nasal meatus was opened through the prelacrimal duct recess in 9 cases under the nasal endoscope. With complete or partial removal of the cyst wall （part of the lateral, posterior and inferior wall was retained） , the cyst and maxillary sinus was fused into a cavity. This ensured nasal drainage through the cyst cavity and maxillary sinus. RESULTS Patients were followed up for 6 to 24 months after the operations. The average follow-up period was 12 months. Facial swelling was disappeared in 15 patients. The periodic review by nasal endoscopy and maxillary CT scan showed that the cyst cavity mucosa was epithelied and the sinus cavity drained well with no recurrence after 2 to 3 months. In one case, the window closed due to the small window opened, but the cyst was significantly smaller than pre-operation. After 6 months, cyst fenestration was performed again without recurrence. CONCLUSION Endoscopic marsupialization is a feasible alternative for management maxillary cyst via different approaches. It makes the procedure simple and safe, less traumatic, quicker recovery, definite curative effect, low recurrence. It is also convenient to observe the post-operative cavity and especially suitable for the maxillary cyst involved the nasal bottom or maxillary sinus.

关 键 词：颌囊肿 内窥镜检查 经鼻开窗术 泪前隐窝 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]