鼻腔鼻窦骨良性病变累及眼眶的鼻内镜手术

Endoscopic surgery for sinonasal benign osseous lesion involving orbit

摘要:

目的探讨累及眼眶的鼻腔鼻窦骨良性病变鼻内镜下手术处理方法，分析手术运用特点、手术并发症及疗效。方法回顾性分析南京大学医学院附属鼓楼医院耳鼻咽喉科2014年1月—2018年7月收治的13例累及眼眶的骨良性病变，其中骨瘤7例，骨纤维异常增殖症4例，骨化纤维瘤2例。2例筛窦骨瘤突入眶内，其余11例均有眶壁不同程度受累。所有患者均经鼻内镜手术，部分患者结合运用影像导航技术、鼻中隔开窗及泪前隐窝入路手术，术中准确定位病变界限，对突入眶内病变及受累的眶组织予以彻底切除。所有手术操作均以保护并不突破眶筋膜为原则，除1例突入眶内巨大筛骨骨瘤外，其余术毕均未予眶壁重建处理。结果所有患者均经鼻内镜完成手术，受累眶壁及眶内骨性病变均切除彻底。5例患者术后第1天出现眶周轻度肿胀，取出鼻腔填充物后消除，无眼球功能障碍。术后复查CT显示眶内解剖结构及位置正常。随访11～65个月，所有患者均无复发。相关鼻窦引流通畅、上皮化良好，无远期并发症。结论彻底切除骨良性病变的眶受累解剖结构有利于减少术后复发，鼻眼相关解剖及手术视野和操作角度是手术成功的要点，经鼻内镜手术处理累及眼眶的骨性病变具有微创和疗效好等优势。

Abstract:

Abstract:ObjectiveTo explore the endoscopic surgery for sinonasal benign osseous lesion involving orbit by analyzing the surgical methods, characteristics, complications and therapeutic effect.MethodsA retrospective analysis was completed on 13 patients with sinonasal benign osseous lesions involving orbit hospitalized in our department from Jan 2014 to July 2018. The lesions included osteoma (n=7), osteodysplasia fibrosa (n=4), and ossifying fibroma(n=2). Of them, intraorbital lesions were found in 2 cases with ethmoid sinus osteoma, and the other 11 cases had lesions with orbital wall involvement. All patients underwent nasal endoscopic surgery to excise lesions completely with adoption of image navigation technology, nasal septum fenestration as well as prelacrimal recess approach for exact lesion localization. Taking intact of orbital fasciae as principle, orbital wall was not reconstructed except in one case with intraorbital involvement by giant ethmoid sinus osteoma.ResultsComplete endoscopic removal of lesion and involved orbital wall was achieved in all cases. Mild periorbital swelling was found in 5 patients at the 1st postoperative day, and relieved after removing nasal packing without functional disturbance of eyeball. Postoperative CT showed normal intraorbital structures and position. Postoperative followup for 11 to 65 months showed neither recurrence nor complication in all cases. Adequate sinus drainage and good epithelization were obtained.ConclusionsCompletely resection of orbital structures involved by sinonasal benign osseous lesion can reduce recurrence. Good mastery of rhinoorbit related anatomy, clear surgical field and proper operating angle are the keys for success. Nasal endoscopic management has advantages of minimal invasion and high curative effect.