目的:探讨经鼻内窥镜下手术治疗管内段视神经损伤的围手术期护理。方法:对收治的11例视神经损伤住院患者的资料及围手术期护理过程进行分析总结。结果:行视神经减压术的11例患者中1例失访,7例有效,其中4例视力有较明显的提高。结论:经鼻内镜视神经减压术损伤小,并发症少,手术时间短,疗效满意,其中围手术期的护理是提高手术疗效的一个重要环节。
目的 观察鼻内镜下三种不同微创手术治疗非侵袭型真菌性上颌窦炎的疗效及氟康唑冲洗术腔的临床意义。 方法 回顾性分析我科2006年1月－2010年12月收治的284例非侵袭型真菌性上颌窦炎住院患者资料。患者分别采用单纯鼻内镜下上颌窦窦口开放术（术式1）、鼻内镜下上颌窦窦口开放联合经唇龈沟上颌窦前壁开窗（术式2）、以及鼻内镜下上颌窦窦口开放联合下鼻道开窗（术式3）进行治疗；术式3治疗的患者术后定期换药时，分别使用生理盐水或氟康唑反复冲洗鼻腔和上颌窦。所有患者门诊随访至少半年。 结果 在本组接受术式1、术式2和术式3治疗的患者分别有51例、45例和188例。上述三种术式治疗的患者中，分别有15例，9例和6例患者出现复发，复发率分别为29.6%、20.0%和3.2%；其中术式3治疗的患者复发率显著性低于术式1或术式2治疗的患者（P＜0.05）。在术式3治疗的患者中，生理盐水和氟康唑冲洗的伤口愈合时间分别为3.8周和 3.7周，两种冲洗方式对伤口的愈合影响差异无统计学意义（P＞0.05）。 结论 鼻内镜下上颌窦窦口开放联合下鼻道开窗是治疗非侵袭型霉菌性上颌窦炎的最佳方式，且伤口愈合时间与冲洗液种类无关。
Objective To compare endoscopic sinius surgery plus middle meatus fenestration with endoscopic sinius surgery plus middle and inferior meatus fenestration for fungus ball maxillary sinusitis. Methods Applying a prospective randomized controlled trial, 80 patients with fungal ball maxillary sinusitis from January, 2010 to March, 2011 were collected and then divided into two groups, including experiment (40 cases) and control groups (40 cases). The trial group received endoscopic sinius surgery plus middle and inferior meatus fenestration, which the control group received endoscopic sinius surgery plus middle meatus fenestration. Then a follow-up was conducted from the end of surgery to February 28th, 2013. All patients took subjective and objective assessment before and after the surgery, including VAS, SNOT-20, Lund-Mackay CT system scores and Lund-Kennedy endoscopic mucosal score. Results with the trial group was superior to the control group in VAS score, SNOT rating and Lund-Kennedy mucosa score 6 months, 1 year, and 2 years after surgery (Plt;0.01). Lund-Mackay CT score of the control group was significantly higher than the trial group after 1 year of surgery (Plt;0.01). According to the Haikou standard to assess the efficacy of surgery, we found that the total effectiveness rate of the trial group (100.0%; recovery: 36 cases; improved: 4 cases) was higher than that of the control group (87.5%; recovery: 28 cases; improved: 4 cases), with a significant difference (P=0.021). Conclusion Endoscopic sinius surgery plus middle and inferior meatus fenestration with a lower reoccurrence rate is superior to endoscopic sinius surgery plus middle meatus fenestration for fungus ball maxillary sinusitis in clinical efficacy.
ObjectiveTo observe the clinical effect of retrograde lacrimal intubation under endoscope in the treatment of chronic dacryocystitis. MethodsWe retrospectively analyzed the clinical data of 83 patients (103 eyes) with chronic dacryocystitis treated in our department from March 2011 to January 2013. They underwent retrograde lacrimal intubation under endoscope. The postoperative follow-up continued 9 months and the curative effect was observed. ResultsEighty-eight eyes were cured, accounting for 85.44%; improvement occurred in 10 eyes, accounting for 9.71%; five eyes were not cured, accounting for 4.85%. As a result, the total effective rate was 95.15%. ConclusionRetrograde lacrimal intubation under endoscope is a safe and effective surgical method for the treatment of chronic dacryocystitis.
ObjectiveTo evaluate the safety and effect of balloon sinuplasty for the treatment of chronic sphenoid sinusitis. MethodsFrom November 2011 to March 2013, 17 patients received balloon catheter dilation of sinus ostia. All the patients were followed up for 12 months postoperatively and the therapeutic effect was evaluated. ResultsAt the end of the following-up, the clinical symptoms of all the patients got relieved. Through nasal endoscopic examination, we found that apertura sphenoidalis developed well in 15 cases, sinus mucosa edema in one case, sinus stenosis in one case, and no postoperative complications occurred. The mean visual analogue scale (VAS) scores were 5.21±1.51 preoperatively and 3.23±1.34, 3.35±1.41, 3.58±1.46 at 3, 6 and 12 months postoperatively. The mean sino-nasal outcome test-20 scores were 12.50±1.96 preoperatively and 7.30±1.79, 7.64±1.93, 7.77±2.02 at 3, 6, 12 months postoperatively. The mean Lund-Kennedy endoscopic mucosal morphology scores were 3.51±1.47 preoperatively and 1.77±1.11, 1.88±1.01, 2.00±0.97 at 3, 6, 12 months postoperatively. The mean CT scores were 1.57±1.06 preoperatively and 0.85±0.62 at 12 months postoperatively. Compared with the preoperative scores, the postoperative scores were significantly different. ConclusionBalloon sinuplasty is worthy of clinical application for its advantages of good clinical effect and safety.
目的：探讨鼻内镜手术治疗鼻内翻性乳头状瘤(NIP)的疗效。方法：回顾性分析用鼻内镜手术治疗的36例经病理确诊的NIP患者的临床资料，随访1～6年。结果:”一次性治愈31例(86.1%)；5例复发(13.9%)，3例在门诊内窥镜下分次摘除并结合YAG激光治愈，2例再次于鼻内镜结合Caidwell-Luc手术治疗，无恶变病例，结论：根据病变范围选择适当的手术方式，经鼻内镜手术切除鼻腔鼻窦内翻性乳头状瘤效果良好。
To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.