轮廓化后半周膜鼻泪管在治疗上颌窦良性病变中的意义

Significance of contoured posterior semi-peritoneal nasolacrimal duct in the treatment of benign maxillary sinus lesions

摘要:

目的 探讨轮廓化后半周膜鼻泪管在治疗上颌窦病变的临床应用效果以及手术方法和适应证。方法 30例上颌窦良性病变患者均行鼻科常规术前检查及鼻窦影像学检查。患者均采用轮廓化后半周膜鼻泪管手术，该术式通过去除鼻泪管骨管后半周骨质及依附其上的黏膜组织，从而扩大上颌窦自然开口，保留鼻泪管膜部，进入窦腔，去除病变。结果 所有患者术中彻底清除病变，完整保护鼻泪管膜部，术后恢复良好，窦腔上皮化良好，病变均无复发，无鼻周局部麻木、鼻翼塌陷、溢泪等并发症。结论 轮廓化后半周膜鼻泪管手术通过保留鼻泪管膜部，可扩大手术视野，增大手术操作空间，从而减小手术损伤，避免并发症，对于处理上颌窦的良性病变有巨大优势，并可最大限度保留鼻腔、上颌窦的生理功能，防止窦口狭窄，是值得推广的手术方式。

Abstract:

Objective To explore the clinical effect, surgical methods and indications of contoured posterior semi-peripheral membrane of nasolacrimal duct in the treatment of benign maxillary sinus lesions.Methods Thirty patients with benign maxillary sinus lesions underwent routine preoperative rhinologic examination and sinus imaging examination. All patients underwent endoscopic surgery to enlarge the natural ostium of maxillary sinus. For easy entering the sinus cavity and removing lesion, the posterior half of the bony nasolacrimal duct and the attached mucosal tissue were removed to expand the natural ostium and retain the membranous nasolacrimal duct.Results Complete removal of lesion was achieved in all patients with proper protection of membranous nasolacrimal duct. Follow-up revealed well recovery with good epithelialization of the sinus cavity. Neither recurrence nor complications such as local numbness around the nose, nose collapse, epiphora occurred.Conclusion With advantages of expanding the surgical field and increasing the operating space via retaining the membranous nasolacrimal duct so as to reduce surgical damage, avoid complications and maximally preserve the physiological functions as well as prevent sinus stenosis, contoured nasolacrimal duct surgery is a surgical method worth promoting.