Clinical research on the treatment for benign lesions in maxillary sinus by endoscopic prelacrimal
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摘要: 目的：探讨经鼻内镜泪前隐窝入路治疗上颌窦良性病变的适应证及临床疗效。方法：82例上颌窦良性病变患者中，上颌窦内翻性乳头状瘤37例，上颌骨囊肿45例。按手术径路分为39例采用鼻内镜下中鼻道联合泪前隐窝入路（观察组），22例采用鼻内镜下中鼻道联合下鼻道开窗（对照组1），21例采用鼻内镜中鼻道联合上颌窦根治术进路（对照组2）。观察记录并分析上述3种方法的手术时间、术中出血量、住院时间、术后并发症及术后疗效。结果：82例患者均顺利完成手术，术后随访3~24个月。观察组与对照组1在手术时间、术中出血量、住院时间差异均无统计学意义（P>0.05），手术并发症及术后复发率差异均有统计学意义（P<0.05）。观察组与对照组2在手术时间、术中出血量、住院时间及术后并发症差异均有统计学意义（P<0.05），术后复发率差异无统计学意义（P>0.05）。结论：经鼻内镜泪前隐窝入路适应于浸润上颌窦前壁、前内下壁、泪前隐窝及齿槽隐窝的病变，该术式手术时间短，出血量少，创伤小，术后恢复快，复发率低，可作为处理上颌窦良性病变的理想术式之一。Abstract: Objective: To explore thecomplication and clinical effects of treatment for benign lesions in maxillary sinusby endoscopic prelacrimal duct recess approach.Method: A retrospective analysis of 82 patients with benign lesions in maxillary sinus.Among them there were 37 cases of inverted papilloma,45 cases of maxillary cyst. According to surgical approaches,they were divided into observation group in which 39 cases were treated by combined middle meatus and prelacrimal duct recess approachunder endoscope,contrast group1in which 22 cases were treated by combined middle meatus and inferior meatus approach and contrast group 2 in which 21 cases were treated bycombined middle meatus and Caldwell-Luc approach. Operation time, amount of bleeding during operation, length of hospitalization, postoperative complications and postoperative curative effect,were observed, recorded and compared among the three groups.Result: The 82 patiengs were successfully treated by surgery and followed up of 3 months to 24 months.There were no significant difference between observation group and contrast group1 in operation time, amount of bleeding during operation,length of hospitalization(P>0.05), there were statistical difference in post-operative complicationand recurrence rate(P<0.05).There were statistical difference between observation group and contrast group 2 in operation time, amount of bleeding during operation,length of hospitalization andpost-operative complication(P<0.05),there were no significant difference in recurrence rate(P>0.05).Conclusion: Anterior lacrimal recess with the nasal endoscopyis is useful to the lesions of maxillary sinus anterior wall, anterior lower internal wall, anterior lacrimal recess and alveolar crypt. Theoperation time, bleeding and surgical injuries are less. Patients recover fast with less recurrence. Thus, this method is an idealoperation method to deal with benign diseasesin maxillary sinus.
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