内镜下经鼻泪前隐窝入路切除上颌窦及翼腭窝肿瘤  

Endoscopic transnasal prelacrimal recess maxillary sinus approach for tumors in the maxillary sinus and the pterygopalatine fossa

作　　者：杨春伟[1] 王林 刘吉祥[1] 杨相立[1] YANG Chunwei;WANG Lin;LIU Jixiang;YANG Xiangli(Department of Otorhinolaryngology Head and Neck Surgery,The Tianjin People＇s Hospital,Tianjin 300121,China)

机构地区：[1]天津市人民医院耳鼻咽喉科,300121

出　　处：《中国中西医结合耳鼻咽喉科杂志》2018年第5期359-362,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的分析和讨论经鼻内镜下泪前隐窝入路,手术切除上颌窦肿瘤及经上颌窦后外侧壁切除累及翼腭窝和颞下窝神经鞘瘤手术结果,探讨手术方法及适应证。方法病例资料来自2013年至2016年住院接受经鼻内镜下泪前隐窝入路上颌窦、翼腭窝和颞下窝肿瘤切除手术患者13例,其中男性8例女性5例,年龄31~65岁。手术前主要接受鼻窦CT扫描和MRI检查。采用全身麻醉下经鼻内镜下泪前隐窝入路进入上颌窦、翼腭窝和颞下窝。手术后组织病理学确认鼻腔上颌窦肿瘤中,内翻性乳头状瘤8例,腺样囊性癌2例;翼腭窝和颞下窝神经鞘瘤3例。术后定期CT或MRI检查随访观察。结果 13例患者实现肿瘤手术完全切除。随访6~52个月无复发,有1例翼腭窝神经鞘瘤患者在术后第1~2周出现面部上颌神经分布区域较明显麻木感,随后逐渐减轻。结论内镜下经鼻开放泪前隐窝入路切除上颌窦、翼腭窝和颞下窝肿瘤,完整保留鼻腔外侧壁,损伤小,并发症少,疗效满意。Objective To analyze the results of surgical nasal endoscopic removal of Schwannoma in the pterygopalatine and infratemperal fossa through postero-lateral wall via prelacrimal recess approach for discussing the operative methods and indications. Methods Thirteen patients aged from 31 to 65 years old with Schwannoma in the pterygopalatine and infratemperal fossa from 2013 to 2016,who received the tumor resection via prelacrimal recess approach under nasal endoscope,were enrolled in this paper, including 8 males and 5 females. All of them were received preoperative CT and MRI. The pterygopalatine and infratemperal fossa were approached via prelacrimal recess endoscopically under general anesthesia.Schwannoma was histopathologically confirmed after surgery,which including inverted papilloma in 8 cases, adenoid cystic carcinoma in 2 cases,pterygopalatine fossa and infratemporal fossa schwannoma in 3 cases.The postoperative periodical CT and MRI follow up was conducted. Results The tumors were removed completely in these 13 patients. No postoperative recurrence was found during 6—52 months.Only l patient with pterygopalatine fossa schwannoma had obvious altercation numbness in the maxillary nerve distribution area and disappeared afterwards. Conclusions Schwannoma involved pterygopalatine and infratemperal fossa can be removed endoscopically via prelacrimal recess approach. The lateral wall of nasal cavity might be kept intact.It is a novelminimally transnasal invasive approach with less damage and complications.

关 键 词：内镜检查 耳鼻喉外科手术 上颌窦 翼腭窝 

分 类 号：R739.62[医药卫生—肿瘤]