本文關(guān)鍵詞： 鼻內(nèi)鏡 淚前隱窩入路 上頜竇 良性病變　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：1研究背景在鼻竇疾病中以上頜竇病變多見。其中內(nèi)翻性乳頭狀瘤、上頜竇息肉、上頜骨囊腫、出血壞死性鼻息肉、上頜竇囊腫、上頜竇后鼻孔息肉等屬于良性病變;鱗狀細胞癌、腺癌、腺樣囊性癌、惡性黑色素瘤等屬于惡性病變。由于這些病變的復(fù)發(fā)性以及難治性,怎樣徹底清除病變,提高預(yù)后成為越來越多耳鼻喉科大夫研究的方面。2007年周兵等提出的鼻腔外側(cè)壁切開(現(xiàn)稱為淚前隱窩入路PLRA)為清除復(fù)雜上頜竇病變提供可靠而又簡便的手術(shù)方法,值得我們學(xué)習(xí)研究。2目的通過研究分析經(jīng)鼻內(nèi)鏡下淚前隱窩入路(PLRA)切除上頜竇良性疾病的案例,探討其應(yīng)用及注意事項,為以后的臨床工作提供更好的指導(dǎo)作用。3方法采用回顧性分析法進行研究,收集84例行鼻內(nèi)鏡下淚前隱窩入路(PLRA)進行手術(shù)治療的患者,病變性質(zhì)為良性。其中包括內(nèi)翻性乳頭狀瘤(Inverted papilloma,IP)患者 44 例,上頜竇息肉(Maxillary polyps)11 例,上頜竇囊腫6例,上頜骨囊腫6例,含牙囊腫2例,出血壞死性鼻息肉4例,上頜竇后鼻孔息肉3例,翼腭窩神經(jīng)鞘瘤2例,上竇壁及眶底骨折2例,牙源性角化囊腫1例,膽脂瘤1例,腦脊液鼻漏1例,口腔上頜竇瘺1例。病例來自于2010年8月-2016年12月期間就診我院并行該術(shù)式人群。采用靜吸復(fù)合麻醉的方法下行本研究術(shù)式,評估手術(shù)時間以及住院時間長短、術(shù)中情況及術(shù)后規(guī)律行鼻內(nèi)鏡檢查觀察恢復(fù)情況,總結(jié)手術(shù)經(jīng)驗及療效。4結(jié)果該樣本各患者手術(shù)時間從50分鐘至225分鐘不等,住院時間從3天至28天不等,平均手術(shù)、住院時間分別為90分鐘、7.6天。其中有4例IP患者復(fù)發(fā),經(jīng)再次手術(shù)后,隨訪時間段內(nèi)無復(fù)發(fā)。術(shù)后觀察未見明顯并發(fā)癥。5結(jié)論對于上頜竇復(fù)雜病變,采取PLRA能夠?qū)⑸项M竇自然入口及經(jīng)下鼻道開窗無法清除的病變徹底清除,通過適當(dāng)擴大PLR入路開窗能夠充分暴露病變,徹底清除病變黏膜及下方一定范圍的骨質(zhì)是手術(shù)成功的關(guān)鍵。手術(shù)時間以及住院時間較合理,無明顯并發(fā)癥發(fā)生。
[Abstract]:Background: maxillary sinus lesions are common in sinus diseases, including inverted papilloma, maxillary sinus polyp, maxillary cyst, hemorrhagic necrotic nasal polyp, maxillary sinus cyst. The posterior nostril polyp of maxillary sinus is a benign lesion. Squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma and malignant melanoma are malignant lesions. In 2007 Zhou Bing et al proposed the lateral wall incision of the nasal cavity (now called the anterior lacrimal recess approach PLRAA). To provide a reliable and simple surgical method for the removal of complex maxillary sinus lesions. Objective to analyze the cases of benign maxillary sinus diseases by transnasal endoscopic approach of anterior lacrimal recess (PLRAA) and discuss its application and attention. Methods A retrospective analysis was used to study 84 cases of patients undergoing surgery by endoscopic approach of anterior lacrimal recess (PLRAA). The lesions were benign in nature, including 44 patients with inverted papilloma papillomafida (IPP). Maxillary polyps)11 was found in maxillary sinus polyp, maxillary sinus cyst in 6 cases, maxillary cyst in 6 cases, dental cyst in 2 cases and hemorrhagic necrotic nasal polyp in 4 cases. There were 3 cases of posterior maxillary sinus polyp, 2 cases of pterygopalatine fossa neurilemmoma, 2 cases of upper sinus wall and orbital floor fractures, 1 case of odontogenic keratocyst, 1 case of cholesteatoma and 1 case of cerebrospinal fluid rhinorrhea. One case of oral maxillary sinus fistula was treated with this method from August 2010 to December 2016 in our hospital. The duration of operation, length of stay in hospital, intraoperative and postoperative regular endoscopic examination were evaluated to observe the recovery. Results the operation time ranged from 50 minutes to 225 minutes, and the hospitalization time ranged from 3 days to 28 days. The average operation time was 90 minutes. 7. 6 days. Among them, 4 patients with IP recurred, and no recurrence occurred during the follow-up period after reoperation. Conclusion there is no obvious complication of 5. 5 in the maxillary sinus. PLRA can completely remove the lesions which can not be cleared by opening the natural entrance of maxillary sinus and through the inferior nasal canal. The lesions can be fully exposed by properly expanding the PLR approach. The key to the success of the operation is to thoroughly clear the diseased mucous membrane and a certain range of bone below. The operation time and the hospital stay are reasonable and there are no obvious complications.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R765.9

【參考文獻】

相關(guān)期刊論文 前10條

1 鄭力維;周浩;;鼻內(nèi)鏡聯(lián)合下鼻道開窗雙徑路治療上頜竇難治性病變的效果[J];中國醫(yī)藥導(dǎo)報;2016年06期

2 高麗;黃新生;;鼻內(nèi)鏡手術(shù)相關(guān)的上頜竇后外側(cè)壁解剖學(xué)研究進展[J];臨床耳鼻咽喉頭頸外科雜志;2015年24期

3 劉英;李連偉;;完整刮治術(shù)及開窗引流術(shù)治療中老年頜骨囊腫的臨床療效及預(yù)后分析[J];中國老年學(xué)雜志;2015年08期

4 廖建春;;上頜竇內(nèi)鏡手術(shù)的解剖與臨床[J];中華解剖與臨床雜志;2014年06期

5 馬有祥;;上頜竇不同手術(shù)入路選擇的利與弊[J];中華耳鼻咽喉頭頸外科雜志;2014年09期

6 張立強;李學(xué)忠;史麗;蔡曉嵐;葉萍;馮昕;潘新良;;上頜竇內(nèi)翻性乳頭狀瘤的鼻內(nèi)鏡外科治療[J];中華耳鼻咽喉頭頸外科雜志;2014年09期

7 閆素英;李希平;房居高;魏永祥;;3種鼻內(nèi)鏡手術(shù)治療上頜竇內(nèi)翻性乳頭狀瘤的療效比較[J];中國微創(chuàng)外科雜志;2014年06期

8 梁敏志;楊東輝;夏廣生;譚向杲;;復(fù)發(fā)性上頜竇內(nèi)翻性乳頭狀瘤二次手術(shù)探討[J];中國中西醫(yī)結(jié)合耳鼻咽喉科雜志;2014年02期

9 劉婷婷;董振輝;張念凱;李晶玉;;與鼻內(nèi)鏡上頜竇手術(shù)視野相關(guān)的上頜竇形態(tài)特征[J];臨床耳鼻咽喉頭頸外科雜志;2013年23期

10 周兵;黃謙;崔順九;王成碩;李云川;于振坤;陳曉紅;葉婷;;內(nèi)鏡下經(jīng)鼻淚前隱窩入路切除翼腭窩及顳下窩神經(jīng)鞘瘤[J];中華耳鼻咽喉頭頸外科雜志;2013年10期

，

本文編號：1477432