经鼻内镜治疗孤立性蝶窦病变疗效分析  

Efficacy of endoscopic sphenoidotomy for isolated sphenoid sinusitis

作　　者：来育斌 孙蕾 石照辉 刘永收 王剑 许敏 陈福权 查定军 陈晓栋 LAI Yubin;SUN Lei;SHI Zhaohui;LIU Yongshou;WANG Jian;XU Min;CHEN Fuquan;ZHA Dingjun;CHEN Xiaodong(Department of Otolaryngology Head and Neck Surgery,Xijing Hospital,Medical University of Airforce,Xi'an,Shanxi,710032,China;Department of Otolaryngology Head and Neck Surgery,Xi'an People's Hospital,Xi'an,Shanxi,710032,China)

机构地区：[1]空军军医大学附属西京医院耳鼻咽喉头颈外科,陕西西安710032 [2]西安市人民医院耳鼻咽喉头颈外科,陕西西安710032

出　　处：《中国耳鼻咽喉头颈外科》2021年第7期431-434,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：西京医院自由探索项目(临床研究类)(XJZT19ML46)。

摘　　要：目的回顾总结孤立性蝶窦病变的临床特征和治疗结果,归纳蝶窦病变的手术方式和治疗策略。方法62例接受鼻内镜手术的孤立性蝶窦病变患者中,蝶窦真菌11例(17.7%),蝶窦囊肿34例(54.8%),单纯蝶窦炎10例(16.1%),蝶窦脑膜脑膨出7例(11.3%)。所有患者术前均接受鼻窦CT检查,部分患者补充鼻窦MRI检查,所有患者均在全身麻醉下行经鼻内镜手术。5例脑膜脑膨出患者经翼突入路,2例脑膜脑膨出患者按Messerklinger术式经筛蝶入路,55例患者均行嗅裂蝶窦自然口入路。结果随访2475个月,平均45个月,蝶窦口开放良好58例(93.5%),狭窄4例(6.5%),7例脑膜脑膨出伴脑脊液鼻漏患者,均一次手术成功。临床症状完全消失42例(67.7%),症状缓解9例(14.5%),症状无明显变化6例(9.7%),均为蝶窦囊肿患者,症状消失1年后再次出现5例(8.1%),4例为蝶窦囊肿,1例为蝶窦炎患者。所有患者均无并发症出现。结论经鼻内镜蝶窦开放手术是治疗孤立性蝶窦病变的首选方法,手术损伤小,效果肯定。OBJECTIVE Analysis the clinical features and treatment results of isolated sphenoid sinus disease,and summarize the surgical methods and treatment strategies of sphenoid sinus disease.METHODS Among62 patients with isolated sphenoid sinus lesions who underwent endoscopic sinus surgery,11 cases(17.7%)were sphenoid sinus fungus,34 cases(54.8%)were sphenoid sinus cyst,10 cases(16.1%)were simple sphenoid sinusitis and 7 cases(11.3%)were sphenoid meningoencephalocele.All patients received CT examination of paranasal sinuses before operation,meanwhile parts of patients received MRI examination.All patients underwent endoscopic sinus surgery under general anesthesia.Five patients with meningocele underwent pterygoid approach,2 patients with meningocele underwent Messerklinger’s transsphenoidal approach,and 55 patients underwent olfactory cleft sphenoid sinus approach.RESULTS The patients were followed up for 24-75 months(average 45 months).Fifty-eight cases(93.5%)had good opening of sphenoid sinus orifice,4 cases(6.5%)had stenosis,7 cases had meningoencephalocele with cerebrospinal fluid rhinorrhea.The clinical symptoms completely disappeared in 42 cases(67.7%),the symptoms were relieved in 9 cases(14.5%),and the symptoms did not change significantly in 6 cases(9.7%).All of them were patients with sphenoid sinus cyst.Five cases(8.1%)recurred 1 year after symptoms disappeared,4 cases were sphenoid sinus cyst and 1 case was sphenoid sinusitis.No complications occurred in all patients.CONCLUSION Transnasal endoscopic sphenoid sinus surgery is the first choice for the treatment of isolated sphenoid sinus lesions,with less injury and definite effect.

关 键 词：蝶窦 内窥镜检查 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]