鼻内镜下泪前隐窝入路清除上颌窦内病变的观察

Observation of maxillary sinus lesions through the middle meatal antrostomy and lacrimal fossa approach with endoscopic

摘要:

目的 探讨经中鼻道开窗+泪前隐窝入路彻底清除上颌窦内病变的必要性。方法 对30例54侧上颌窦病变，70°鼻内镜直视下经中鼻道开窗，查找并清除病变后，再行泪前隐窝入路，彻底清除上颌窦内残留病变。结果 ①经中鼻道开窗可以窥及，但无法彻底清除上颌窦内病变9例14侧，约占总侧数的25.93%。而且经泪前隐窝入路窥及病变较之经中鼻道开窗所见更为广泛；②经中鼻道开窗清除上颌窦内病变，未窥及残留后，再行泪前隐窝入路，仍然发现18例32侧存有病变，约占总侧数的59.26%。结论 70°鼻内镜下经中鼻道开窗彻底清除上颌窦内病变，不仅困难，而且存在视觉死角，经泪前隐窝入路既能看清上颌窦内各壁，又能彻底清除上颌窦内病变。因此，在可能出现上颌窦病变残留时，有必要采用“中鼻道开窗+泪前隐窝入路”的双径路手术方式。

Abstract:

Objective To explore the feasibility and effectiveness of the approaches and methodology of the endoscopic surgery for maxillary sinus lesions through the middle meatal antrostomy and lacrimal fossa approach. Methods 30 cases of the 54 sides of the maxillary sinus lesions were discussed in the report. Firstly the lesions were located and removed through the middle meatal antrostomy with 70°Endoscopic, and then, the residual lesions were completely removed through lacrimal fossa approach. Results The lesions were located but not completely removed through the middle meatal antrostomy in 9 cases of 14 sides (25.93%). And by lacrimal fossa approach and lesions were seen more widely compared with the way through the middle meatal antrostomy; In 18 case of 32 sides (59.26%) the residual lesions were found through lacrimal fossa approach after the lesions were removed through the middle meatal antrostomy with 70°endoscopic. Conclusion It's difficult to completely remove the maxillary sinus lesions through the middle meatal antrostomy with 70°intranasal endoscopic, and there is visual dead angle in this way. Through lacrimal fossa approach, all the walls of the maxillary sinus were observed clearly, but also the lesions can be removed completely. Therefore, the middle meatal antrostomy lacrimal fossa approach will be used to avoid the probably residual lesions in the maxillary sinus.