内镜辅助个体化手术入路治疗儿童鼻中线囊肿及瘘管

doi:10.6040/j.issn.1673-3770.0.2024.022

摘要/Abstract

摘要： 目的探讨儿童先天性鼻中线囊肿及瘘管(nasal dermoid and sinus cysts, NDSC)切除术的手术效果及治疗经验。方法回顾性分析8例NDSC患儿的临床资料,其中男童5例、女童3例,所有患儿均接受鼻窦CT检查,病变范围大累及颅底患儿同时行鼻窦MRI检查。全部患儿采用内镜辅助手术治疗,根据病变位置和鼻部亚单位参考影像学设计不同手术入路,对患儿病史、临床表现、影像学检查、切口、病变特点、手术方式及随访情况参考相关文献进行分析。结果 8例患儿中,5例患儿伴有鼻骨骨质吸收或鼻中隔软骨吸收,其中2例深达前颅底,2例患儿出现两处瘘管口,1例患儿瘘管深部存在2个分支,全部患儿手术顺利,1例患儿因局部瘢痕增生再次行手术治疗。术后随访3~60个月无复发。结论儿童NDSC应在发现后尽早手术,手术入路应进行个体化设计,采用内镜辅助下手术可以在彻底切除病变的同时减少损伤,同时兼顾美观需求。

关键词: 先天性鼻中线囊肿及瘘管, 儿童, 瘘管, 皮样囊肿, 畸形

Abstract: Objective To explore the surgical effect and treatment experience of resection of nasal dermoid and sinus cysts(NDSC)in children. Methods The clinical data of eight children with NDSC were retrospectively analyzed, including five boys and three girls. All children underwent CT of the nasal sinus and those with large lesions involving the skull base underwent MRI of the nasal sinus at the same time. All patients underwent endoscopy-assisted surgery. Different surgical approaches were designed according to lesion location and nasal aesthetic subunit with reference to imaging. Medical history, clinical manifestations, imaging, incision, lesion characteristics, surgical methods and follow-up were analyzed. Results Among the eight cases, five cases were associated with nasal bone absorption or nasal septal cartilage absorption, two cases were deep to the anterior skull base, two cases had two fistula orifices, one case had two branches in the deep part of the fistula, all children were operated smoothly, and one case underwent surgery again due to local scar hyperplasia. Patients were followed for 3-60 months without recurrence. Conclusion Children with NDSC should be operated on as soon as possible after discovery. The surgical approach should be individualized. The use of endoscopic-assisted surgery can completely remove the lesion and reduce the damage, taking into account the need for cosmesis.

Key words: Nasal dermoid and sinus cysts, Children, Fistula, Dermoid cyst, Deformity

中图分类号:

R765

付圣尧,陈敏,庞文会,李娜. 内镜辅助个体化手术入路治疗儿童鼻中线囊肿及瘘管[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 65-71.

FU Shengyao, CHEN Min, PANG Wenhui, LI Na. Endoscopic-assisted individualized surgical approach for the treatment of nasal dermoid and sinus cysts in children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 65-71.

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