内镜下经中鼻甲基板入路四步程序化开放蝶窦的疗效分析

Analysis of the therapeutic effect of four-step programmed opening of the sphenoid sinus via the middle nasal methyl plate approach under endoscopy

摘要:

目的 探究经中鼻甲基板入路的手术技巧及临床效果，旨在系统评估一种兼具良好手术视野和微创性的蝶窦开放径路。方法 回顾性分析2019年9月－2023年9月该院收治的35例孤立性蝶窦病变或单侧蝶窦伴毗邻筛窦受累患者的临床资料，均经中鼻甲基板入路的“四步”程序化操作开放蝶窦。观察手术相关情况和并发症发生情况；采用视觉模拟评分法（VAS）评分，评估头痛和流涕等症状改善情况；采用改良隆德-肯尼迪（MLK）评分，评价术腔恢复状况。结果 所有患者术中保留钩突、中鼻甲和筛泡，26例（74.3%）保留上鼻甲；所有患者均达到临床治愈标准，表现为：术腔引流通畅，黏膜完全上皮化，以及蝶窦开口维持良好开放状态。术后病理显示：蝶窦霉菌病19例（54.3%），蝶窦息肉7例（20.0%），蝶窦黏膜慢性炎症9例（25.7%）。所有患者均未发生严重并发症，仅1例（2.9%）于术后12 d出现中鼻甲创面渗血，经电凝止血后治愈。头痛VAS评分由术前的（4.71±1.66）分，降至术后的（0.83±0.39）分，手术前后比较，差异有统计学意义（t = 13.71，P < 0.01）；流涕VAS评分由术前的4.00（0.00，6.00）分，降至术后的0.00（0.00，1.00）分，手术前后比较，差异有统计学意义（Z = -4.47，P < 0.01）；手术前后嗅觉减退VAS评分比较，差异无统计学意义（P > 0.05）。MLK评分由术前的4.50（2.00，4.00）分降至1.00（0.00，1.00）分，手术前后比较，差异有统计学意义（Z = -5.20，P < 0.01）。结论 经中鼻甲基板入路蝶窦开放术，严格遵循鼻窦解剖层次，在最大限度地保留鼻腔生理结构的前提下，可获得理想的术野暴露。该术式对于局限于蝶窦及后组筛窦的病变，具有确切的临床疗效。值得应用于临床。

Abstract:

Objective To explore the surgical techniques and clinical effects of the transnasal methyl plate approach, aiming to systematically evaluate an open sphenoid sinus approach that combines a good surgical field of view and minimally invasive nature.Methods A retrospective analysis was conducted on the clinical data of 35 patients with isolated sphenoid sinus lesions or unilateral sphenoid sinus with adjacent ethmoid sinus from September 2019 to September 2023. All patients had their sphenoid sinuses opened through a four-step programmed operation via the middle nasal methyl plate approach. Observe the relevant conditions of the surgery and the occurrence of complications; The visual analogue scale (VAS) was used for scoring to evaluate the improvement of symptoms such as headache and runny nose. The modified Lunder-Kennedy (MLK) score was used to evaluate the recovery status of the surgical cavity.Results All patients retained the uncinate process, middle turbinate and ethmoid vesicles during the operation, and 26 cases (74.3%) retained the superior turbinate. All patients met the clinical cure criteria, manifested as unobstructed drainage in the surgical cavity, complete epithelialization of the mucosa, and good opening of the sphenoid sinus. Postoperative pathology revealed sphenoid sinus mycosis in 19 cases (54.3%), sphenoid sinus polyps in 7 cases (20.0%), and chronic inflammation of the sphenoid sinus mucosa in 9 cases (25.7%). No severe complications occurred. Only one patient case (2.9%) experienced oozing from the middle turbinate wound on postoperative day 12, which was successfully managed with electrocautery. The VAS score of headache decreased from (4.71 ± 1.66) points before the operation to (0.83 ± 0.39) points after the operation. There was a statistically significant difference before and after the operation (t = 13.71, P < 0.01). The VAS score for runny nose decreased from 4.00 (0.00, 6.00) points before the operation to 0.00 (0.00, 1.00) points after the operation. A comparison before and after the operation showed a statistically significant difference (Z = -4.47, P < 0.01). There was no significant difference in the olfactory dysfunction VAS score before and after surgery (P > 0.05). The MLK score decreased from 4.50 (2.00, 4.00) points before the operation to 1.00 (0.00, 1.00) points. There was a statistically significant difference before and after the operation (Z = -5.20, P < 0.00).Conclusion The method of the inner nasal turbinate is strictly followed by the anatomical level of the sinus dissection, which can be exposed to the ideal of the field in the basis of the maximum limit of the physiological structure of the nasal cavity. This method has definite clinical effect on the lesions limited to the sinus and posterior group. It's worth applying to the clinic.