内镜辅助下经泪前隐窝入路治疗真菌性上颌窦炎的体会

Treatment of Fungal Maxillary Sinusitis through Anterior Lacrimal Recess Approach under Nasal Endoscope

摘要: 目的：探讨经泪前隐窝径路鼻内镜下清除上颌窦真菌性鼻窦炎的临床效果。方法：选取2008年1月~2018年1月三家医院耳鼻咽喉头颈外科收治的真菌性上颌窦炎患者192例中上颌窦气化发育有明显齿槽隐窝及泪前隐窝的28例患者采用内镜辅助下经泪前隐窝入路治疗。结果：28例病例术后病理学检查均可见大量真菌菌丝，全部为曲霉菌感染，真菌球性鼻–鼻窦炎14例，变态反应性真菌性鼻–鼻窦炎13例，慢性侵袭性真菌性鼻–鼻窦炎1例。所有患者术后定期随访半年以上未见复发。结论：鼻内镜下泪前隐窝入路能够充分显露上颌窦腔，彻底切除上颌窦内的病变，手术操作方便，能够有效治疗上颌窦真菌性鼻窦炎，可作为上颌窦真菌性鼻窦炎的首选手术入路。

Abstract: Objective: This paper is to investigate the clinical effect of treatment of fungal maxillary sinusitis through anterior lacrimal recess approach under nasal endoscope. Methods: From January 2008 to January 2018, 192 patients with fungal maxillary sinusitis admitted to the department of oto-laryngology, head and neck surgery in three hospitals; 28 patients with obvious alveolar recess in the development of maxillary sinus gasification and anterior lacrimal fossae were treated with anterior lacrimal recess approach under nasal endoscope. Results: Postoperative pathological examination revealed a large number of fungal mycelia in all 28 cases, all of which were aspergillus infection. There were 14 cases of fungal ball sinusitis, 13 cases of allergic fungal sinusitis, and 1 case of chronic invasive fungal sinusitis. All patients had no recurrence for more than half a year after regular postoperative follow-up. Conclusion: The anterior lacrimal recess approach under nasal endoscopy can fully expose the maxillary sinus cavity and completely remove the lesions in the maxillary sinus, which is convenient for surgical operation and can effectively treat fungal sinusitis of the maxillary sinus, and can be the preferred surgical approach for fungal sinusitis of the maxillary sinus.