慢性鼻窦炎鼻内镜手术中额筛区骨瘤的处理
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倪鑫,Email:nixin@bch.org.cn.

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北京市科技新星项目经费资助(2006B31)


Surgical strategy for osteoma during endoscopic sinus surgery for chronic rhinosinusitis
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    摘要:

    目的了解因慢性鼻-鼻窦炎伴/不伴鼻息肉(chronic rhinosinusitis with or without nasal polyps, CRSwNP/CRSsNP)接受ESS的患者中骨瘤的发病情况、分布特点,讨论其术中处理原则。方法 回顾分析2006年11月~2010年1月因CRSwNP/CRSsNP接受ESS的520例患者中26例患者合并骨瘤的发病情况、术中处理及术后并发症。结果额筛区骨瘤发病率5%(26/520),其中位于额窦和前组筛窦23例;位于后组筛窦3例。骨瘤同时累及颅底7例,累及眶内壁4例。术中经鼻内镜下完整切除骨瘤20例,经鼻内镜下部分切除2例,未处理7例。均未出现眶部、颅内并发症。结论因CRSwNP/CRSsNP接受ESS的患者中骨瘤并不少见。以单个骨瘤为主、症状不典型且不易与鼻窦炎区分,常在CT检查时发现;额窦和前组筛窦远远多于后组筛窦。大多数骨瘤可以经鼻内镜下完整切除,在保证充分引流前提下可采用经鼻内镜下部分切除或暂不处理。

    Abstract:

    ObjectiveTo realize the characteristics of occurrence and distribution of osteoma found in patients undergoing endoscopic sinus surgery (ESS) due to chronic rhinosinusitis with or without nasal polyps (CRSwNP/CRSsNP), and to discuss the surgical strategy for this tumor.MethodsClinical data of 520 adult patients undergoing ESS due to CRSwNP/CRSsNP from Nov. 2006 to Jan. 2010 was analyzed retrospectively. The clinical data included the occurrence and location of osteoma, involvement of lamina papyracea/anterior skull base, surgical strategy for the tumor, surgical complications and so on.ResultsOsteoma was found in 26 of the 520 cases. The occurrence rate was 5% (26/520 cases), with the size of 0.4 cm×0.4 cm×0.4 cm to 1.5 cm×1.5 cm×3.0 cm. Most of them were isolated (23/26) and located in frontal sinus (13 cases) or anterior ethmoid sinus (11 cases). Involvement of anterior skull base and orbital wall was respctively found in 7 and 4 cases. Of all the 26 patients, 20 cases were treated with complete endoscopic resection, 2 with partial endoscopic resection, and 7 without any intervention. All patients had neither immediate nor longterm postoperative orbit/skull base complications.ConclusionsOsteoma is not uncommon in CRSwNP/CRSsNP patients undergoing ESS. This tumor is usually isolated without apparent symptoms and occasionally found in sinus CT. Anterior ethmoid sinus and frontal sinus are most frequently involved. Complete endoscopic resection of the tumor can be achieved in most cases. Under the premise of ensuring sufficient drainage, partial endoscopic resection or nonintervention of the tumor is also acceptable.

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葛文彤 李云川 倪鑫.慢性鼻窦炎鼻内镜手术中额筛区骨瘤的处理[J].中国耳鼻咽喉颅底外科杂志,2013,19(3):217-220

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  • 在线发布日期: 2013-06-30
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