鼻内镜手术治疗上颌骨囊肿的临床分析

doi:10.6040/j.issn.1673-3770.0.2019.630

摘要/Abstract

摘要： 目的探讨鼻内镜下经鼻-上颌窦进路切除上颌骨囊肿的手术方法及临床效果。方法回顾性分析自2014年3月至2019年4月收治的上颌骨囊肿患者21例,均为囊壁突入上颌窦内者,根据影像学检查明确囊肿的大小、范围以及与上颌窦各壁的位置关系,内镜下经鼻腔行扩大上颌窦自然口或联合泪前隐窝进路并下鼻道开窗引流,尽可能切除突入上颌窦腔的囊肿囊壁,使囊肿壁与上颌窦壁融合成共腔,建立囊肿-上颌窦-鼻腔相通的引流通道。结果所有患者术后随访6~24个月,术腔黏膜均上皮化良好,鼻面部症状消失或明显缓解,囊腔与上颌窦引流通畅,无复发病例。结论经鼻-上颌窦进路切除或开放上颌骨囊肿联合下鼻道开窗引流,可以彻底切除病变或建立充分的引流通道。相对于传统手术进路刮除或开放囊肿,该进路损伤轻微、恢复快、复发率低,符合微创手术的理念,值得临床推广。

关键词: 上颌骨囊肿, 鼻内镜手术, 泪前隐窝入路

Abstract: Objective To explore the surgical methods and clinical efficacy of an endoscopic transnasal maxillary approach for removing maxillary bone cysts. Methods A retrospective analysis was performed, which included 21 patients with maxillary cysts who underwent endoscopic surgery in our department between March 2014 and April 2019. In all cases, the wall of the maxillary bone cyst protruded into the maxillary sinus. According to an imaging examination such as a computed tomography(CT)scan, the size, range of the cyst, and the relationship between the cyst and each wall of the maxillary sinus were determined. Two surgical approaches were performed. The first approach was through the natural opening of the maxillary sinus. The other approach was through the pre-lacrimal recess, in combination with the first approach. The cyst walls protruding into the maxillary sinus were removed as thoroughly as possible so that the cyst and maxillary sinus could be fused into a common cavity, and a drainage channel was established between the cyst-maxillary sinus and the nasal cavity. Results All patients were followed up for 6 to 24 months after the operation. The mucosae of the operative cavities were well epithelialized. Nasal and facial symptoms disappeared or were significantly relieved. The drainage of the capsule cavity and maxillary sinus was smooth. There was no recurrence in all cases. Conclusions Removal of maxillary bone cysts using a transnasal maxillary approach was reliable and established a smooth drainage channel for the cyst and the maxillary sinus. Additionally, the postoperative cavity could be easily observed. Compared with the traditional approach, it is less traumatic, and results in a quicker recovery time, and lower recurrence rate. These results are in line with other minimally invasive surgeries and show that the technique is worthy of clinical promotion.

Key words: Maxillary bone cyst, Endoscopic surgery, Pre-lacrimal recess approach

中图分类号:

R765

王磊,袁英,于学民,韩玉娥,王宁,李晓,李龙,侯妮妮. 鼻内镜手术治疗上颌骨囊肿的临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 31-35.

WANG Lei, YUAN Ying, YU Xuemin, HAN Yu'e, WANG Ning, LI Xiao, LI Long, HOU Nini. Endoscopy surgery for maxillary cysts: A clinical analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 31-35.

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