本文關(guān)鍵詞：鼻內(nèi)鏡技術(shù)在鼻眼相關(guān)外科及鼻顱底外科中的應(yīng)用　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：我國(guó)鼻內(nèi)鏡外科創(chuàng)立于上世紀(jì)80年代,起初主要應(yīng)用于鼻部疾病的診斷工作。經(jīng)過(guò)探索、快速發(fā)展和持續(xù)發(fā)展三個(gè)階段的不斷發(fā)展,鼻內(nèi)鏡技術(shù)越來(lái)越為廣大耳鼻咽喉頭頸外科醫(yī)師所掌握。隨著基礎(chǔ)研究和臨床研究的不斷深入,手術(shù)技術(shù)的不斷改進(jìn),影像學(xué)技術(shù)的不斷發(fā)展,鼻內(nèi)鏡技術(shù)的應(yīng)用范圍不斷拓展,不再局限于耳鼻咽喉頭頸外科,并逐漸涉及眼科和顱底外科的各個(gè)領(lǐng)域。本研究擬對(duì)瀘州醫(yī)學(xué)院附屬醫(yī)院耳鼻咽喉頭頸外科鼻內(nèi)鏡技術(shù)的拓展應(yīng)用情況進(jìn)行回顧性分析,旨在探討鼻內(nèi)鏡技術(shù)在鼻眼相關(guān)外科和鼻顱底外科中的延伸應(yīng)用,總結(jié)我科鼻內(nèi)鏡技術(shù)延伸應(yīng)用的經(jīng)驗(yàn)與不足。方法：收集我科2000年1月-2013年12月病歷資料完整的77例經(jīng)鼻內(nèi)鏡行鼻眼相關(guān)外科及鼻顱底外科手術(shù)患者的病歷資料,包括性別、年齡、診斷、手術(shù)日期、手術(shù)方式、手術(shù)時(shí)間、手術(shù)并發(fā)癥、術(shù)中失血及預(yù)后等,并進(jìn)行總結(jié)分析。術(shù)前依據(jù)鼻內(nèi)鏡檢查、病理組織活檢及影像檢查資料等確定診斷和手術(shù)方式,術(shù)中采用“單人單手”和(或)“雙人雙手”操作技術(shù),出院時(shí)由主刀醫(yī)師交待術(shù)后隨訪事宜,定期門診復(fù)查鼻內(nèi)鏡檢查、眼科檢查、影像學(xué)檢查及實(shí)驗(yàn)指標(biāo)等,同時(shí)通過(guò)電話及信訪等形式進(jìn)行隨訪,了解術(shù)后主要癥狀、體征改善及并發(fā)癥等情況。此外,腫瘤患者隨訪還包括復(fù)發(fā)、轉(zhuǎn)移及生存情況等。結(jié)果：(1)77例患者中,鼻眼相關(guān)外科患者60例,鼻顱底外科患者17例；(2)鼻內(nèi)鏡技術(shù)在鼻眼相關(guān)外科拓展應(yīng)用疾病種類包括鼻-鼻竇源性眶并發(fā)癥,慢性淚囊炎、鼻淚管阻塞,球后占位,球后異物,外傷性視神經(jīng)病(Traumatic optic neuropathy, TON),復(fù)雜眶壁骨折；鼻內(nèi)鏡技術(shù)在鼻顱底外科拓展應(yīng)用疾病種類包括垂體瘤,腦脊液(cerebrospinal fluid, CSF)鼻漏,前顱底及累及前顱底病變,脊索瘤,顱鼻溝通性腫瘤,顱咽管瘤。(3)12例患者發(fā)生手術(shù)并發(fā)癥,其中鼻眼相關(guān)疾病9例,鼻顱底疾病3例,具體包括術(shù)中出血500ml(輸血治療)6例,眶周腫脹5例(術(shù)后2-6天消退),眶內(nèi)出血1例,術(shù)后高熱可疑顱內(nèi)感染1例,并發(fā)癥發(fā)生率15.58%(12/77)。(4)術(shù)后隨訪4月-10年,鼻竇囊腫致眶并發(fā)癥26例經(jīng)鼻內(nèi)鏡囊腫造口術(shù)治愈；慢性淚囊炎及鼻淚管阻塞11例(13眼),行經(jīng)鼻內(nèi)鏡淚囊鼻腔吻合術(shù)(endonasal endoscopic dacryocystorhinostomy, EN-EDCR),治愈9例(11眼),好轉(zhuǎn)1例(1眼),無(wú)效1例(1眼)；鼻腔、鼻竇良性腫瘤10例,治愈8例,復(fù)發(fā)2例；鼻腔、鼻竇惡性腫瘤5例,腫瘤均全部切除,復(fù)發(fā)3例,死亡1例,復(fù)發(fā)與死亡患者術(shù)后均拒絕接受放化療；炎癥性病變3例,其中包括慢性鼻竇炎2例,真菌性上頜竇炎1例,均行功能性內(nèi)鏡鼻竇手術(shù)(function endoscopic sinus surgery, FESS)治愈；球后占位2例,治愈1例,復(fù)發(fā)1例；球后異物1例,異物完整取出；外傷性視神經(jīng)病1例,經(jīng)鼻內(nèi)鏡視神經(jīng)減壓(endoscopic optic nerve decompression, EOND)后好轉(zhuǎn)；復(fù)雜眶壁骨折1例,治愈；垂體瘤4例行鼻內(nèi)鏡經(jīng)蝶竇垂體瘤切除術(shù)后治愈；CSF鼻漏5例,治愈；前顱底及累及前顱底病變4例,治愈；脊索瘤2例,治愈1例,復(fù)發(fā)1例；鼻顱溝通性腫瘤1例,術(shù)后1年腫瘤復(fù)發(fā)死亡；顱咽管瘤1例治愈。結(jié)論：(1)鼻內(nèi)鏡技術(shù)的發(fā)展為鼻眼相關(guān)外科及鼻顱底外科疾病提供了一種安全、有效、微創(chuàng)的治療方式；(2)鼻內(nèi)鏡技術(shù)在鼻眼相關(guān)外科及鼻顱底外科領(lǐng)域的應(yīng)用應(yīng)嚴(yán)格掌握適應(yīng)癥,對(duì)并發(fā)癥的防治不容忽視；(3)鼻內(nèi)鏡技術(shù)在鼻眼相關(guān)外科及鼻顱底外科領(lǐng)域的拓展及推廣應(yīng)用需各相關(guān)科室(如眼科、神經(jīng)外科、神經(jīng)內(nèi)科及影像學(xué)科等)的團(tuán)隊(duì)協(xié)作；(4)鼻內(nèi)鏡技術(shù)拓展應(yīng)用病例數(shù)相對(duì)較少,需加強(qiáng)鼻內(nèi)鏡技術(shù)推廣和人員培訓(xùn),促進(jìn)學(xué)科的交流與合作。
[Abstract]:Objective : To study the application of nasal endoscopic technique in the surgical and nasal skull base surgery , including sex , age , diagnosis , operation date , operation mode , operation time , surgical complication , intraoperative blood loss , prognosis and so on . ( 3 ) Surgical complications occurred in 12 patients , including 6 cases of nose - eye related diseases and 3 cases of nasal skull base , including 6 cases of nose - eye related diseases , 5 cases of orbital swelling ( 2 - 6 days after operation ) , 1 case of intraorbital hemorrhage , 1 case of high - heat suspicious intracranial infection , and complication rate 15.58 % ( 12 / 77 ) . ( 4 ) Follow - up for 4 months to 10 years , 26 cases of orbital complications of nasal sinus cyst were cured by endoscopic sinus surgery ( 13 eyes ) , 9 cases ( 11 eyes ) were cured , 1 case was cured ( 1 eye ) , 1 case was cured , 1 case was cured , 1 case was cured , 1 case was cured , 1 case was complicated orbital wall fracture , 1 case was cured , 4 cases of pituitary adenoma were cured by nasal endoscope , 5 cases were cured , 1 case was cured , 4 cases of anterior skull base and anterior skull base lesion were cured . Conclusion : ( 1 ) The development of nasal endoscopic technique has provided a safe , effective and minimally invasive treatment modality for nasal - eye related surgery and nasal skull base surgery .

【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R765.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 韓德民;微創(chuàng)技術(shù)與鼻眼相關(guān)外科[J];眼科;2003年05期

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本文編號(hào)：1415005