结合影像解剖指导鼻泪管前径路治疗上颌窦病变的研究  

Study on the treatment of maxillary sinus lesions by prelacrimal duct approach guided by the anatomical image of CT

作　　者：王博谦 崔晓波[1] 王向东[2,3] 张罗[2,3] WANG Boqian;CUIXiaobo;WANG Xiangdong;ZHANG Luo(Department of Otolaryngology,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia,010000,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China;Beijing Institute of Otolaryngology,Beijing,100005,China)

机构地区：[1]内蒙古医科大学附属医院耳鼻咽喉科,内蒙古呼和浩特010000 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [3]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2020年第2期71-75,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家重点研发计划(2016YFC0905200);长江学者和创新团队(IRT13082);国家自然科学基金(81630023、81970852);北京市医院管理中心“使命计划”(SML20150203);北京市百千万人才计划(2019A32);北京市属医学科研院所公益发展改革试点项目(京医研2019-10)。

摘　　要：目的探讨结合CT影像解剖,运用鼻内镜下鼻泪管前径路手术方式治疗上颌窦良性病变的临床效果和手术策略选择。方法回顾性分析2016年5月~2019年7月上颌窦良性病变患者共20例,其中男14例,女性6例。年龄32~65岁。术前均行鼻窦CT影像检查并分类评估后,接受鼻内镜下鼻泪管前径路切除鼻腔外侧壁进入上颌窦的手术方试。结果鼻窦CT轴位观察分析骨性鼻泪管与上颌窦前壁之间的关系,融合型6例,分离型14例;外侧型4例,前方型16例。20例手术均顺利完成,术中无严重并发症和副损伤,术后均无出血,无鼻泪管损伤及梨状孔缘塌陷等并发症,未出现下鼻甲萎缩、坏死、鼻腔干燥及面部麻木等表现。1例内翻性乳头状瘤患者术后1年左右复查发现内翻性乳头状瘤复发但无恶变,继续随访8个月至今再无复发,其余术后随访3~18个月均无复发,术后VAS评分较术前均有下降。结论鼻泪管前径路能够充分显露上颌窦腔,彻底清除上颌窦内的病变。结合CT影像明确了鼻泪管与上颌窦前壁之间的解剖关系后,能够更好的发挥该术式的优势,对减少手术并发症,保护鼻腔、鼻泪管及上颌窦的解剖和生理功能具有十分重要的意义,值得临床推广和重视。OBJECTIVE To explore the clinical effect and surgical strategy of endoscopic prelacrimal duct approach combined with the anatomical image of CT in the treatment of maxillary sinus lesions.METHODS Retrospective analysis of a total of 20 patients with benign lesions of maxillary sinus from May 2016 to July 2019,that were 14 males and 6 females.All of them were evaluated with CT axial images of the nasal sinuses before surgery and were classified,and then underwent endoscopic prelacrimal duct approach to remove the lateral wall of the nasal cavity and enter the maxillary sinus.RESULTS Preoperative axial sinus CT was used to observe and assess the relationship between the bone nasolacrimal duct and the anterior wall of the maxillary sinus.There were 4 cases of lateral type and 16 cases of anterior type.All the 20 cases were successfully completed,without serious com plications and collateral injuries during the operation,no hemorrhage after the operation,no complications such as nasolacrimal duct injury and collapse of pyriform aperture margin,and no signs of inferior turbinate atrophy,necrosis,nasal dryness and facial numbness.1 patient with inverted papilloma was recurrence without malignant changes after review about 1 year after surgery,and no recurrence after follow-up for 8 months.The remaining patients were followed up for 3-18 months after surgery,and none of them had any recurrence.CONCLUSION The endoscopic prelacrimal duct approach can fully expose the maxillary sinus cavity and completely remove the lesions in the maxillary sinus.Combined with CT image to identify the anatomical relationship between the nasolacrimal duct and the anterior wall of the maxillary sinus,the advantages of the operation could be better revealed,which was of great significance in reducing surgical complications and protecting the anatomical and physiological functions of the nasal cavity,nasolacrimal duct and maxillary sinus,it was worthy of clinical promotion and attention.

关 键 词：内窥镜检查 上颌窦 解剖 鼻泪管 CT扫描摄影术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]