鼻内镜下改良Denker术式在鼻腔鼻窦内翻性乳头状瘤手术中的应用

摘要

目的 探讨鼻内镜下改良Denker术式在鼻腔鼻窦内翻性乳头状瘤手术中的应用,术中保留鼻泪管和下鼻甲,进入上颌窦的方法.方法 35例住院手术患者,男21例,女14例,年龄39 ～ 76岁,平均45岁.术前均行组织病理学检查确诊为鼻腔鼻窦内翻性乳头状瘤.手术在全麻下进行.在下鼻甲前梨状孔缘弧形切开,暴露梨状孔缘,凿除下鼻道相对应的梨状孔缘,咬骨钳咬除部分下鼻道和犬齿窝骨壁,鼻内镜直视下完成窦内病灶清除,如病变范围较大可扩大骨窗解剖鼻泪管,鼻泪管受累则切除之,同期行鼻腔泪囊造孔术,术终完成下鼻道开窗.结果 35例患者均为单侧发病,鼻腔鼻窦内翻性乳头肿瘤Krouse分期Ⅱ级14例,Ⅲ级20例,Ⅳ级1例.术中见肿瘤起源于鼻腔外侧壁或上颌窦,上颌窦各壁均可受累,前、内壁明显.术后随访12 ～67个月,平均22个月,术腔上皮化,下鼻甲形态良好.1例术后6个月下鼻道开窗口局部复发,清理后再无复发.2例行鼻腔泪囊造孔术,术后无溢泪等并发症.结论 鼻内镜下改良Denker术式梨状孔缘切口进入上颌窦,最大限度地保留鼻腔及泪道的功能,为彻底切除鼻腔及上颌窦病灶提供新的微创入路和方法.%Objective To investigate the application of modified Denker surgical in sinonasal inverted papilloma surgery with intranasal endoscope,nasal canal and inferior turbinate were reserved and the maxillary sinus was open.Methods All 35 cases with sinonasal inverted papilloma were diagnosed by preoperative histopathological examination,all patients received general anaesthesia.Make an piriform aperture arcs incision before inferior nasal concha,expose the piriform aperture edge,chisel the edge of the piriform aperture corresponding to inferior meatus,and part of the inferior meatus and bony wall of canine fossa were removed by rongeur,sinus lesions were cleaned under nasal endoscope.When lesions area became larger and more extensive,canalis nasolacrimalis was removed,and received dacryocystorhinostomy and fenestration in inferior meatus.Results All 35 patients were unilateral invasion,sinonasal inverted papilloma at Krouse stage Ⅱ was 14 cases,Ⅲ was 20 cases,Ⅳ was 1 case.Inverted papilloma originated in outer sides of nasal cavity or maxillary sinus during operation,the wall of all maxillary sinus were invaded.Followed up for 12 ～ 67 months postoperative,epithelization of nasal occurred and the shape of inferior turbinate was well.Local recurrence in 1 patients 6 months after surgery,but no recurrence after remove.Two cases treated dacryocystorhinostomy with no complication.Conclusion Modified Denker surgery can remain the function of nasal lacrimal duct and nasal cavity,and provides the new minimally invasive approach for complete resection of lesions of nasal cavity and the maxillary sinus.