内镜经鼻入路眶尖区占位病变切除术（附18例报告）  

Resection of orbital apex lesions through transnasal endoscopic approach （ a report of 18 cases）

作　　者：康军[1] 付继第[1] 史季桐[2] 张家亮[1] 周军[3] 刘浩成[1] 孙思[1] 邱锷[1] 杨澎[1] 吴江平[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经外科,100730 [2]首都医科大学附属北京同仁医院眼肿瘤科,100730 [3]首都医科大学附属北京同仁医院眼外伤科,100730

出　　处：《中华神经外科杂志》2014年第6期582-585,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨内镜下经鼻入路切除眶尖区占位病变的可行性和有效性。方法回顾性分析2009年1月至2013年6月以突眼及视力下降为主要症状的18例眶尖区占位病变（6例眶内异物、4例海绵状血管瘤、3例鼻眶沟通性粘液囊肿、2例炎性假瘤、1例表皮样囊肿、1例神经纤维瘤、1例骨纤维异常增殖症）。全部均在内镜下经鼻筛窦进入眼眶内或眶尖区切除病变。结果眶内异物均一次性取出；4例眶尖区海绵状血管瘤全部切除，2例视力较术前好转，2例无变化；8例沟通性肿瘤4例全部切除，3例部分切除，术后眼球突出及活动障碍症状消失或明显好转。随访3个月至4年，2例炎性假瘤1例症状复发，再次手术后切除；其余病例均临床症状消失，无复发。结论内镜下经鼻入路切除眶内及眶尖区占位病变是切实可行的。Objective To investigate the feasibility and efficacy of resection of orbital apex lesions through transnasal endoscopic approach. Methods From January 2009 to June 2013, 18 patients with orbital apex lesions were analyzed retrospectively, of which the main symptoms were proptosis and vision loss. In this series, 6 cases were orbital foreign body, 4 cavernous hemangioma, 3 trans - nasal - orbital mucinous cyst, 2 inflammatory pseudotumor, 1 cholesteatoma, 1 neurofibroma, and 1 fibrodysplasia. All the patients underwent operation through ethmoid sinus with endoscopic techniques into orbit or orbital apex. Results All the foreign bodies were taken out by one operation. 4 cavernous hemangiomas in orbital apex were totally removed, in two of them the postoperative visions were improved and another two unchanged. In 8 trans - nasal - orbital tumors, 4 were totally removed, 3 partially removed, of which the proptosis and eyeball movement were improved. All the patients were followed - up from 3 months to 4 years. 1 inflammatory pseudotumor recurred and was removed again. There was no recurrence in the rest of cases, and the symptoms were disappeared. Conclusions In carefully selected cases, the lesions in orbit and orbital apex could be removed feasibly through transnasal endoscopic approach.

关 键 词：内镜 颅底外科 眶尖病变 

分 类 号：R739.7[医药卫生—肿瘤]