经额开颅手术后额窦炎的原因和处理  

Causes and management of frontal sinusitis after transfrontal craniotomy

作　　者：刘天聪[1] 于晓峰[1] 顾兆伟[1] 白伟良[1] 王振海[1] 曹志伟[1] 

机构地区：[1]中国医科大学附属盛京医院耳鼻咽喉头颈外科,沈阳110004

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第3期187-189,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金青年项目(No:81200730);辽宁省自然科学基金项目(No:2014021047);沈阳市科技局项目(No:F15-199-1-41)

摘　　要：目的:探讨经额开颅手术后额窦炎的原因及鼻内镜联合传统鼻外切口入路下处理额窦炎的效果。方法:34例经额开颅手术后额窦炎患者,主要表现为流脓涕、头痛和眼睑上方流脓,发病时间平均2.6年;鼻窦三维CT和鼻窦MR表现为额窦炎;27例患者行鼻内镜下手术,7例患者行鼻内镜联合鼻外切口入路手术,2种术式均需彻底清除额窦内骨蜡和炎性肉芽组织。治愈标准是患者术后额窦炎症状消失,额隐窝引流通畅。结果:34例患者均有经额开颅手术史,术中均有骨蜡填塞记录。经鼻内镜手术的27例患者中,25例治愈,2例二次联合鼻外切口入路手术后彻底治愈,经鼻内镜联合传统鼻外切口入路的7例患者均治愈。结论:经额开颅手术后出现额窦炎可能与手术中额窦处理不当有关,一是具有分泌功能的额窦黏膜刮除不净,二是封闭骨蜡后引流不畅。鼻内镜手术是处理额窦炎的一种微创有效的手术方式,彻底清除额窦内骨蜡、炎性肉芽组织及开放额隐窝,能获得良好的手术效果,但部分患者仍需要联合传统的鼻外切口入路方能彻底清除骨蜡组织。Objective：The aim of this study is to investigate the causes and the strategy of frontal sinusitis after transfrontal craniotomy by endoscopic frontal sinus surgery and traditional surgery with facial incision.Method：A total of thirty-four patients with frontal sinusitis after transfrontal craniotomy were admitted,with the symptom of purulence stuff,headache and upper eyelid discharging.The onset time was 2.6 years on average.The frontal sinus CT and MRI images showed frontal sinusitis.Twenty-seven patients were treated with endoscopic frontal sinus surgery,and seven patient was treated with combined endoscopic and traditional frontal sinus surgery.In the revision surgery,the bone wax and inflammatory granulation tissue were cleaned out in both operational methods.The cure standard was that the postoperative frontal sinus inflammation disappeared and the drainage of the volume recess was unobstructed.Result：Thirty-four patients had a history of transfrontal craniotomy,and there was a record of bone wax packing in every operation.Among twenty-seven patients with endoscopic frontal sinus surgery,Twenty-five cases cured and two cases were operated twice.Seven patients were cured with combined endoscopic and traditional frontal sinus surgery.Conclusion：The frontal sinusitis after transfrontal craniotomy may be related to the inadequate sinus management,especially bone wax to be addressed to the frontal sinus ramming leading to frontal sinus mucosa secretion obstruction and poor drainage.Endoscopic frontal sinus surgery is a way of minimally invasive surgery.The satisfying curative effect can be obtained by endoscopic removal of bone wax,inflammatory granulation tissue,and the enlargement of frontal sinus aperture after exposure to the frontal sinus,and some cases was treated with both operation method.

关 键 词：内镜外科手术 额窦炎 手术 并发症 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]