摘要
目的根据病变累及部位将颅鼻眶部划分不同区域,并讨论手术入路的选择及手术技巧。方法自1998年1月至2004年8月收治74例颅鼻眶部骨性病变患者,按手术所需将颅鼻眶部划分成四部三区。根据不同部位的病变,选择不同的手术入路,在术中结合使用影像导航及鼻内镜技术。结果21例骨纤维结构不良患者,除早期1例失明外,术前视力高于0.1的术后视力恢复较好,术前视力低于0.1的术后视力稍有改善或基本维持术前状态。53例占位性病变其中病灶全切45例,约占84.9%,大部切除8例。术后无眼球内陷者。鼻塞均有好转。位于眶尖部的病灶切除后症状基本消失且无视神经损伤。结论选择避免面部切口的经颅入路可更好地显露手术野,使用术中影像导航及鼻内镜技术能提高全切率,减少血管神经的损伤。
OBJECTIVE To define subregions within the cranio-nasal-orbital region based on regions of pathological changes, and to discuss the operative approaches and techniques in the treatment of diseases in this region. METHODS The cases of 74 patients admitted into our department from January 1998 to August 2004 were reviewed retrospectively. All had bone diseases in the cranio-naso-orbit region. The clinical features and the imaging characteristics of diseases in various regions were summarized, and the cranio-naso-orbit region was divided into 4 parts and 3 areas based on this information. Operative approaches were chosen on this basis. Navigation and endoscopic techniques were combined in the operations. RESULTS In the 21 patients with fibrous dysplasia, with the single exception of a patient blinded due to operational injury to the optic nerve, the eyesights of patients with pre- operative eyesights of 〉0.1 improved significantly, while the eyesights of the other patients improved slightly or not at all. In the 53 cases of mass diseases, 45 cases （84.9 %） required complete removal whereas 8 cases required bulk removal. No cases of sunken eyeball was found. Snuffle was improved in all cases. Most symptoms disappeared and no optic nerve injury resulted after the tumors in the orbital apex were removed. CONCLUSION Selecting the proper operative approach is important to the uncovering of the operative area. The use of navigation systems and endoscope could increase the rate of complete removals, result in fewer injuries of vessels and nerves, and avoid facial incision.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2006年第4期261-264,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
颅底
眶肿瘤
鼻窦
内窥镜检查
Skull Base
Orbital Neoplasms
Paranasal Sinuses
Endoscopy
