Clinical research on the surgical treatment of complex maxillary sinus diseases by pyriform aperture extend prelacimal recess approach
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摘要: 目的 探讨经梨状孔扩大泪前隐窝入路切除上颌窦复杂病变的手术方法、适应证和临床效果。方法 21例上颌窦复杂病变患者，术前均行影像学评估，并于术中确认病变基底位于上颌窦前壁、齿槽隐窝、颧隐窝; 均经术前病检或术中快速病检，明确病变为肿瘤性或颌骨囊性病变。均采用经梨状孔扩大泪前隐窝入路上颌窦手术。术后平均随访25个月。结果 21例手术顺利，其中乳头状瘤11例、上颌窦癌4例、中度非典型增生1例、纤维血管瘤1例、神经鞘瘤1例、上颌窦骨瘤1例、上颌骨囊肿及含齿囊肿各1例。经梨状孔扩大泪前隐窝入路能彻底切除上颌窦各部位的病变。术中出血(191.6±44.7) mL; 术后6例面部轻微肿胀，8例面部麻木，无鼻面部瘢痕、塌陷变形、前鼻孔缩小、泪溢等并发症。无复发病例。结论 经梨状孔扩大泪前隐窝入路能提供足够的手术空间，彻底切除基底位于前壁、齿槽隐窝、颧隐窝及各部位的上颌窦复杂病变; 最大限度地减少手术切口，避免严重创伤，术后反应轻，并发症少。Abstract: Objective The aim of this study is to explore the operative method, indication and clinical effect of enlarging anterior lacrimal Fossa via Piriform foramen for complex lesions of maxillary Sinus.Method By imaging and pathology, twenty-one patients with tumors and bone cysts were confirmed that the lesion base was located in the anterior wall of maxillary sinus, alveolar recess and zygomatic recessor even more broadly. All patients were treated with pyriform aperture extend prelacimal recess approach surgery, and followed up for average 25 months.Result All the 21 operations went smoothly, including 11 cases diagnosed with papilloma, 4 cases diagnosed with maxillary sinus carcinoma, 1 case diagnosed with moderate dysplasia, 1 case diagnosed with fibroangioma, 1 case diagnosed with schwannomas, 1 case diagnosed with maxillary sinus osteoma, 1 case diagnosed with maxillary sinus bone cyst and 1 case diagnosed with dentigerous cyst. Pyriform aperture extend prelacimal recess approach can thoroughly deal with lesions located in each part of the maxillary sinus. Intraoperative blood loss(191.6±44.7) mL. After operations, 6 patients had mild facial swelling, and 8 cases experienced facial numbness; There were no facial scar, collapse and deformation, anterior nares narrowing, tears overflow and other complications. None of the patients relapsed.Conclusion The enlarged anterior lacrimal fossa via piriform aperture can provide enough space for complete resection of the complex lesions of maxillary Sinus, which are located in anterior wall, Alveolar recess, zygomatic recess and various parts of the base, the postoperative reaction is light, the complication is few.
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Key words:
- maxillary sinus /
- endoscopic surgery /
- pyriform aperture /
- prelacrimal recess approach
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[1] 董怿, 周兵, 黄谦, 等. 单侧上颌窦鼻腔病变的影像学特征及治疗策略分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(23): 1767-1773. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201823001.htm
[2] Mielcarek-Kuchta D, Simon K, Kondratowicz D, et al. Functional endoscopic sinus surgery(FESS)in unilateral sinus disease[J]. Otolaryngologia Pol, 2017, 71(5): 29-35. doi: 10.5604/01.3001.0010.5314
[3] 崔昕燕, 陈峰, 钱晓云, 等. 微型高频针状电极在鼻内镜下泪前隐窝入路手术中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(23): 1844-1847. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201723015.htm
[4] 周兵. 高级鼻内镜鼻窦手术技术[M]. 北京: 中国协和医科大学出版社, 2016: 6-7.
[5] Healy DY Jr, Chhabra N, Metson R, et al. Surgical risk factors for recurrence of inverted papilloma[J]. Laryngoscope, 2016, 126(4): 796-801. doi: 10.1002/lary.25663
[6] Meng Y, Fang G, Wang X, et al. Origin site-based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery[J]. Head Neck, 2019, 41(2): 1-8. doi: 10.1002/hed.25698
[7] 吴家森, 殷海, 何引, 等. 鼻内镜下泪前隐窝入路治疗上颌窦良性病变的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(11): 902-906. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201611016.htm
[8] Oakley GM, Harvey RJ. Endoscopic Resection of Pterygopalatine Fossa and Infratemporal Fossa Malignancies[J]. Otolaryngol Clin North Am, 2017, 50(2): 301-313. doi: 10.1016/j.otc.2016.12.007
[9] 刘英, 颜永毅, 季青. 鼻内镜下泪前隐窝入路清除上颌窦内病变的观察[J]. 中国内镜杂志, 2016, 22(4): 86-89. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201604024.htm
[10] Nakamaru Y, Furuta Y, Takagi D, et al. Preservation of the nasolacrimal duct during endoscopic medial maxillectomy for sinonasal inverted papilloma[J]. Rhinology, 2010, 48(4): 452-456. doi: 10.4193/Rhino10.015
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