轮廓化后半周膜鼻泪管在治疗上颌窦良性病变中的意义  

Significance of contoured posterior semi-peritoneal nasolacrimal duct in the treatment of benign maxillary sinus lesions

作　　者：孙飞虎 刘永泽[1] 刘丁丁[1] 钱晓云[1] 麻晓峰[1] 陈峰[1] SUN Feihu;LIU Yongze;LIU Dingding;QIAN Xiaoyun;MA Xiaofeng;CHEN Feng(Department of Otolaryngology Head and Neck Surgery,Affiliated Drum Tower Hospital of Nanjing University Medical School,Jiangsu Provincial Key Medical Discipline,Research Institute of Otolaryngology,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科江苏省医学重点学科南京鼓楼医院耳鼻咽喉研究所,江苏南京210008

出　　处：《中国耳鼻咽喉颅底外科杂志》2022年第4期20-24,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金面上项目(82071044);江苏省科教强卫工程江苏省重点学科项目(ZDXKB2016015)。

摘　　要：目的探讨轮廓化后半周膜鼻泪管在治疗上颌窦病变的临床应用效果以及手术方法和适应证。方法30例上颌窦良性病变患者均行鼻科常规术前检查及鼻窦影像学检查。患者均采用轮廓化后半周膜鼻泪管手术,该术式通过去除鼻泪管骨管后半周骨质及依附其上的黏膜组织,从而扩大上颌窦自然开口,保留鼻泪管膜部,进入窦腔,去除病变。结果所有患者术中彻底清除病变,完整保护鼻泪管膜部,术后恢复良好,窦腔上皮化良好,病变均无复发,无鼻周局部麻木、鼻翼塌陷、溢泪等并发症。结论轮廓化后半周膜鼻泪管手术通过保留鼻泪管膜部,可扩大手术视野,增大手术操作空间,从而减小手术损伤,避免并发症,对于处理上颌窦的良性病变有巨大优势,并可最大限度保留鼻腔、上颌窦的生理功能,防止窦口狭窄,是值得推广的手术方式。Objective To explore the clinical effect,surgical methods and indications of contoured posterior semi-peripheral membrane of nasolacrimal duct in the treatment of benign maxillary sinus lesions.Methods Thirty patients with benign maxillary sinus lesions underwent routine preoperative rhinologic examination and sinus imaging examination.All patients underwent endoscopic surgery to enlarge the natural ostium of maxillary sinus.For easy entering the sinus cavity and removing lesion,the posterior half of the bony nasolacrimal duct and the attached mucosal tissue were removed to expand the natural ostium and retain the membranous nasolacrimal duct.Results Complete removal of lesion was achieved in all patients with proper protection of membranous nasolacrimal duct.Follow-up revealed well recovery with good epithelialization of the sinus cavity.Neither recurrence nor complications such as local numbness around the nose,nose collapse,epiphora occurred.Conclusion With advantages of expanding the surgical field and increasing the operating space via retaining the membranous nasolacrimal duct so as to reduce surgical damage,avoid complications and maximally preserve the physiological functions as well as prevent sinus stenosis,contoured nasolacrimal duct surgery is a surgical method worth promoting.

关 键 词：鼻内镜手术 膜鼻泪管 上颌窦 良性病变 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]