单侧额窦入路DrafⅢ借道引流术  

DrafⅢapproach to unilateral frontal sinus for contralateral drainage

作　　者：蒋晓文 赵可庆 张焕康 薛凯 刘全 顾晔 郑实兴 孙希才 余洪猛 JIANG Xiaowen;ZHAO Keqing;ZHANG Huangkang;XUE Kai;LIU Quan;GU Ye;ZHENG Shixing;SUN Xicai;YU Hongmeng(Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University,Shanghai,200031,China;Department of Neurosurgery,Eye&ENT Hospital,Fudan University;Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor,Chinese Academy of Medical Sciences)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031 [2]复旦大学附属眼耳鼻喉科医院神经外科 [3]中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元(2018RU003) [4]华中科技大学协和深圳医院耳鼻咽喉科,广东深圳518052

出　　处：《临床耳鼻咽喉头颈外科杂志》2024年第8期726-731,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海市科学技术委员会科技创新行动计划基础研究项目(No:21JC1401100);上海市徐汇区人工智能医疗院地合作项目(No:2021-008)。

摘　　要：目的:患侧额窦的引流通道解剖变异或瘢痕闭锁,经患侧额窦引流通道开放额窦,可能会导致手术失败。本研究拟探索一种借健侧额窦和额隐窝为通路,磨除额窦底壁及额窦间隔,连通双侧额窦的改良DrafⅢ手术术式,完成患侧额窦的引流。方法:通过对2个头颅骨性标本和2个新鲜冷冻标本的解剖研究,探索手术相关标志及手术路径。回顾性分析4例采用此术式进行治疗的患者。记录患者的相关临床资料,探讨该术式的技术细节和优缺点。结果:通过2例头颅解剖研究,确认手术路径,借健侧额窦和额隐窝为通路,磨除双侧额窦底壁和额窦间隔,将双侧额窦在鼻中隔上方扩大成为一个大的共同腔,完成患侧额窦在健侧鼻腔的中线引流。4例患者因单侧额窦乳头状瘤行DrafⅡb手术,术后发生额窦闭锁、额窦炎,遂采用DrafⅢ借道引流术进行治疗。术后患者头痛症状消失,内镜下检查额窦引流口宽敞、黏膜愈合良好、引流通畅,无其他术后并发症。结论:单侧额窦入路DrafⅢ借道引流术能充分引流患侧额窦。该术式创伤小,成功率高,有临床应用价值,适合单侧DrafⅡb手术失败的患者。Objective Anatomical variation or scar atresia of the drainage channel of the frontal sinus on the affected side,and opening the frontal sinus through the drainage channel of the frontal sinus on the affected side may lead to surgical failure.The purpose of this study is to explore a modified DrafⅢoperation to complete the drainage of the affected frontal sinus by removing the floor wall and septum of the frontal sinus and connecting the bilateral frontal sinus through the healthy side of the frontal sinus.Methods Through the anatomical study of 2 skull bone specimens and 2 fresh frozen specimens,the surgical landmark and surgical approach were explored.Four patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery in Eye&ENT Hospital of Fudan University were retrospectively analyzed.Descriptive method was used to analyze the data.Results The bottom wall of bilateral frontal sinus was removed,and the bilateral frontal sinus was enlarged above the nasal septum to form a large common cavity.The uncinate process and ethmoid bubble were retained,and the midline drainage of the affected frontal sinus in the healthy side of the nasal cavity was completed.From August 2022 to April 2023,4 patients with frontal sinus atresia and frontal sinusitis after DrafⅡb surgery for unilateral frontal sinus papilloma in Eye&ENT Hospital of Fudan University were treated with surgery.The headache symptoms disappeared after surgery,and the drainage of frontal sinus was spacious,the mucosa healed well and the drainage was unobstructed under endoscopy.There were no other postoperative complications.Conclusion DrafⅢapproach to unilateral frontal sinus for contralateral drainage can drain the affected frontal sinus adequately.The essence of this operation is to drain the bilateral frontal sinus in the unilateral nasal cavity,and this operation has short path,less trauma,and a broader prospect,which is suitable for promotion.

关 键 词：DrafⅢ 上颌骨额突 额鼻嵴 单侧额窦 

分 类 号：R765.42[医药卫生—耳鼻咽喉科]