何引+吴家森+殷海+刘柏松

【摘要】目的探讨经鼻内镜泪前隐窝入路治疗上颌窦良性病变的适应证及临床效果。方法回顾性分析2011年1月到2015年1月收治的上颌窦良性病变患者80例，随机分成研究组与对照组，每组40例。研究组采用鼻内镜下泪前隐窝进路，对照组采用中鼻道及下鼻道开窗联合进路，比较分析两组手术时间、术中出血量、住院时间，观察患者的术后并发症及术后疗效。结果研究组手术时间、术中出血量及住院时间均低于对照组（P<0.001）；研究组术后并发症发生率为5.0%，术后复发率为2.5%，均低于对照组的15.0%，但组间比较差异无统计学意义（P>0.05）。结论经鼻内镜泪前隐窝入路手术时间短、出血量少、住院时间短、术后复发率低，可作为处理上颌窦良性病变的术式之一。

【关键词】鼻内镜手术；泪前隐窝；上颌窦；良性病变

中图分类号：R765.4文献标识码：ADOI：10.3969/j.issn.10031383.2016.05.011

【Abstract】ObjectiveTo explore the indication and clinical effects of treatment of benign lesion of maxillary sinus through anterior lacrimal recess.MethodsA retrospective analysis was carried out on 80 cases of benign maxillary sinus diseases admitted to hospital from January，2011 to January，2015.All patients were randomly divided into study group and control group with 40 cases in each group.The study group were adopted anterior lacrimal recess under nasal endoscope，and the control group were adopted windowing of middle nasal meatus combined with inferior nasal meatus. And then，operation time，amount of bleeding during operation，hospital stay of the two groups were compared and analyzed.In addition，postoperative complications and postoperative curative effects were observed.ResultsOperation time，amount of bleeding during operation and hospital stay of the study group were less than those of the control group（P<0.001）.The incidence of postoperative complications and postoperative recurrence rate in the study group was 5.0% and 2.5%，respectively，significantly lower than those of the control group （both 15.0%），but difference was not statistically significant（P>0.05）.ConclusionEndoscopic anterior lacrimal recess approach has some advantages like short operation time，less bleeding，short hospital stay and low postoperative recurrence rate，it can be regarded as first choice in the treatment of benign maxillary sinus diseases.

【Key words】nasal endoscopy；anterior lacrimal recess；maxillary sinus；benign lesions

隨着鼻内窥镜手术的发展，近年来处理上颌窦良性病变的手术方式不断改进，过去主要利用中鼻道进路，或者中鼻道进路联合下鼻道开窗以及传统的柯陆氏进路的手术方式，然而上颌窦的解剖特点决定了这些进路都无法全方位暴露上颌窦，特别对于上颌窦的前壁、前内侧部位，以及泪前隐窝和齿槽隐窝部位存在手术盲区和死角。本研究将80例上颌窦良性病变患者，采用鼻内镜下泪前隐窝入路及中鼻道联合下鼻道开窗进路手术并进行比较分析，从而为上颌窦良性病变的手术治疗提供科学依据。

1资料与方法1.1一般资料回顾性分析2011年1月到2015年1月我院收治的上颌窦良性病变的80例患者，男性46例，女性34例；……