山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (6): 31-35.doi: 10.6040/j.issn.1673-3770.0.2019.630

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鼻内镜手术治疗上颌骨囊肿的临床分析

王磊1,2,袁英1,2,于学民1,2,韩玉娥1,2,王宁2,李晓2,李龙2,侯妮妮3   

  1. 青岛)耳鼻咽喉头颈外科, 山东 青岛 266035;
    3. 山东大学齐鲁医院(青岛)手术室, 山东 青岛 266035
  • 发布日期:2021-01-11
  • 通讯作者: 袁英. E-mail:yuanying1973@163.com

Endoscopy surgery for maxillary cysts: A clinical analysis

WANG Lei1,2, YUAN Ying1,2, YU Xuemin1,2, HAN Yu'e2, WANG Ning2, LI Xiao2, LI Long2, HOU Nini3   

  1. 1. Department of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Department of Otorhinolaryngology & Head and Neck Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong, China;
    3. Operating Theater, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266035, Shandong, China
  • Published:2021-01-11

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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
[1] 王晓媛, 周华安, 付新海, 等. 颌骨囊肿术后瘘发生原因分析[J]. 现代口腔医学杂志, 2000, 14(5): 351. doi:10.3969/j.issn.1003-7632.2000.05.040.
[2] Sharma V, Lavania A, Mallick SA, et al. Ectopic canine tooth: a rare cause for maxillary antral mucocoele[J]. Kathmandu Univ Med J(KUMJ), 2006, 4(2): 251-252.
[3] 李旭征, 张淑香, 李开元. 鼻内镜下摘除上颌窦囊肿的术式探讨[J]. 中国耳鼻咽喉头颈外科, 2010, 17(9): 495-496. doi:10.16066/j.1672-7002.2010.09.016.
[4] 周健, 杜若鸿. 颌骨囊肿的治疗方法及其临床应用[J]. 口腔颌面外科杂志, 2012, 22(4): 229-232. doi:10.3969/j.issn.1005-4979.2012.04.001. ZHOU Jian, DU Ruohong. Assessment on the treatments for cyst of the jaws[J]. Journal of Oral and Maxillofacial Surgery, 2012, 22(4): 229-232. doi:10.3969/j.issn.1005-4979.2012.04.001.
[5] 陈珂. 鼻内镜下鼻腔外侧壁开窗治疗上颌骨囊肿[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 21-22, 25. doi: 10.6040/j.issn.1673-3770.0.2014.309. CHEN Ke. Endoscopic transnasal lateral wall fenestration in treatment of maxillary cyst[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(6): 21-22, 25. doi: 10.6040/j.issn.1673-3770.0.2014.309.
[6] 汪湛, 何一川, 陈文君, 等. 保守治疗颌骨大型牙源性囊性病变的临床应用[J]. 中国美容医学, 2007, 16(8): 1114-1116. doi:10.3969/j.issn.1008-6455.2007.08.039. WANG Zhan, HE Yichuan, CHEN Wenjun, et al. Clinical application of conservative treatment upon large jaw cystic lesions[J]. Chinese Journal of Aesthetic Medicine, 2007, 16(8): 1114-1116. doi:10.3969/j.issn.1008-6455.2007.08.039.
[7] 樊明文. 口腔医学新进展[M]. 武汉: 湖北科学技术出版社, 2000: 270-275.
[8] Sun KT, Chen MY, Chiang HH, et al. Treatment of large jaw bone cysts in children[J]. J Dent Child(Chic), 2009, 76(3): 217-222.
[9] 武志强, 费洪静, 王秋旭, 等. 应用开窗减压术和2种阻塞器治疗大型颌骨囊性病变的临床效果[J]. 中国医科大学学报, 2017, 46(11): 1048-1051. doi:10.12007/j.issn.0258-4646.2017.11.021. WU Zhiqiang, FEI Hongjing, WANG Qiuxu, et al. Fenestration, decompression, and application of two types of obturators in the treatment of large cysts of the jaws[J]. Journal of China Medical University, 2017, 46(11): 1048-1051. doi:10.12007/j.issn.0258-4646.2017.11.021.
[10] Shigematsu H, Oku Y, Kawamoto Y, et al. Two-channel endoscopic sinus surgery for postoperative maxillary cyst[J]. J Oral Maxillofac Surg Med Pathol, 2014, 26(3): 317-323. doi:10.1016/j.ajoms.2013.11.004.
[11] 连冈. 鼻内镜下单纯鼻底开窗术治疗上颌骨囊肿的临床观察[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(11): 489-490, 494. doi:10.3969/j.issn.1001-1781.2011.11.004. LIAN Gang. Treatment of maxillary cyst with endoscopic fenestration in nasal bottom[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2011, 25(11): 489-490, 494. doi:10.3969/j.issn.1001-1781.2011.11.004.
[12] 冀永进, 李青峰, 韩剑星, 等. 鼻内镜下上颌骨囊肿开放术[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(17): 798-800. doi:10.13201/j.issn.1001-1781.2012.17.013. JI Yongjin, LI Qingfeng, HAN Jianxing, et al. Transnasal endoscopic marsupialization for treatment of maxillary cysts[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2012, 26(17): 798-800. doi:10.13201/j.issn.1001-1781.2012.17.013.
[13] 王春雨, 张芬, 张庆泉, 等. 鼻内镜下经鼻内进路行腭正中囊肿微创手术21例临床分析[J]. 山东大学耳鼻喉眼学报, 2017,31(3):84-86. doi: 10.6040/j.issn.1673-3770.0.2014.309. WANG Chunyu, ZHANG Fen, ZHANG Qingquan, et al. Use of an intranasal endoscopic approach for treatment of palatal midline cyst in 21 cases.[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(3): 84-86. doi: 10.6040/j.issn.1673-3770.0.2014.309.
[14] Lee JY, Baek BJ, Byun JY, et al. Comparison of conventional excision via a sublabial approach and transnasal marsupialization for the treatment of nasolabial cysts: a prospective randomized study[J]. Clin Exp Otorhinolaryngol, 2009, 2(2): 85-89. doi:10.3342/ceo.2009.2.2.85.
[15] 周兵, 韩德民, 崔顺九, 等. 鼻内镜下上颌窦手术[J]. 中国医学文摘(耳鼻咽喉科学), 2007, 22(4): 193-195. doi:10.19617/j.issn1001-1307.2007.04.003.
[16] 王磊, 袁英, 于学民, 等. 鼻中隔连续贯穿缝合技术在鼻中隔偏曲矫正术中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 73-75. doi: 10.6040/j.issn.1673-3770.0.2017.390. WANG Lei, YUAN Ying, YU Xuemin, et al. Efficacy of the continuous suture technique in septoplasty[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 73-75. doi: 10.6040/j.issn.1673-3770.0.2017.390.
[17] Yanagisawa E, Mirante JP, Christmas DA. Endoscopic view of maxillary sinus cysts viewed through an accessory maxillary ostium[J]. Ear Nose Throat J, 2019: 145561319882580. doi:10.1177/0145561319882580.
[18] Kondo Kenji,Baba Shintaro,Suzuki Sayaka,et al. Infraorbital nerve located medially to postoperative maxillary cysts: a risk of endonasal surgery[J]. ORL J Otorhinolaryngol Relat Spec,2018,80(1):28-35. doi: 10.1159/000486372.
[19] Sharma S, Chauhan JS. Bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst-A rare case report.[J]. Int J Surg Case Rep, 2019(61):298-301. doi: 10.1016/j.ijscr.2019.07.072.
[20] 许庆庆,段甦,王向东,等. 牙源性上颌骨囊肿1例报告[J]. 首都医科大学学报,2019,40(3):473-475. doi:10.3969/j.issn.1006-7795.2019.03.027.
[21] 李晓宇, 刘磊, 肖金刚, 等. 开窗术治疗颌骨囊肿13例临床及病理学分析[J]. 陕西医学杂志, 2007, 36(10): 1292-1294. doi:10.3969/j.issn.1000-7377.2007.10.007. LI Xiaoyu, LIU Lei, XIAO Jingang, et al. A clinical and pathologic analysis of marsupialization in the treatment of 13 mandilbular cysts[J]. Shaanxi Medical Journal, 2007, 36(10): 1292-1294. doi:10.3969/j.issn.1000-7377.2007.10.007.
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