开颅术后骨蜡留置致鼻窦炎11例临床分析  

SINUSITIS CAUSED BY BONE WAX IMPLANTATION AFTER CRANIOTOMY:A CLINICAL ANALYSIS OF 11 CASES

作　　者：蒲珊珊 赵桐 姜彦[1] 庞文会 郑莹 鞠建宝[1] PU Shanshan;ZHAO Tong;JIANG Yan;PANG Wenhui;ZHENG Ying;JU Jianbao(Department of Otolaryngology Head and Neck Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院耳鼻咽喉头颈外科,山东青岛266100 [2]青岛市西海岸新区人民医院耳鼻咽喉科

出　　处：《青岛大学学报（医学版）》2023年第5期779-782,共4页Journal of Qingdao University(Medical Sciences)

基　　金：山东省自然科学基金资助项目(ZR2013HM024)。

摘　　要：目的探讨开颅术后继发鼻窦炎的形成机制、临床特点及手术方案。方法本文回顾了11例开颅术后继发鼻窦炎病人的诊疗过程。病人平均发病时间8.0年,临床表现为额部肿胀感、眼部受累症状,CT表现为鼻窦内类脂肪密度的骨蜡影,MR表现为T 1像、T 2像的低信号骨蜡影。按开颅手术径路将病人分为经额入路组(7例)和经蝶入路组(4例)。11例均行以去除骨蜡、通畅引流为原则的鼻内镜手术,3例联合鼻外进路手术。结果经额入路组发病时间明显长于经蝶入路组,差异具有统计学意义(t=-3.221,P<0.05)。11例病人经治均痊愈,随访1年以上无复发。结论颅底修复术后留置的骨蜡可致鼻窦炎,鼻内镜鼻腔鼻窦或联合鼻外进路手术清除骨蜡并通畅引流是治疗此类病人的有效手段。Objective To investigate the mechanism and clinical features of sinusitis caused by craniotomy as well as its surgical strategies.Methods We reviewed the diagnosis and treatment of 11 patients with sinusitis secondary to craniotomy.The mean time since the onset of sinusitis was 8.0 years.The patients felt forehead swelling and eye involvement,with bone wax sha-dows with fat-like densities in the sinuses on CT images and with hypo-intensities on T 1WI and T 2WI images.Craniotomy was performed through the transfrontal approach in seven cases and through the transsphenoidal approach in four cases.All the patients underwent nasal endoscopic surgery for wax removal and normal drainage,in addition to which,the extranasal approach was performed in three patients.Results The transfrontal group had a significantly longer time since sinusitis onset than the transsphenoidal group(t=-3.221,P<0.05).All the 11 patients were cured after treatment,with no signs of recurrence during a follow-up of more than one year.Conclusion Bone waxes left after skull base repair may cause sinusitis,which can be effectively treated by removing waxes and unobstructing drainage through nasal cavity and sinus endoscopic surgery or the combination with operation via the extranasal approach.

关 键 词：鼻窦炎 蜂蜡 矿脂 异物反应 神经外科手术 病例报告 

分 类 号：R765.41[医药卫生—耳鼻咽喉科] R651[医药卫生—临床医学]