摘要
目的探讨鼻内镜在鼻颅底外伤处理中的临床运用价值。方法对35例鼻颅底外伤的患者应用鼻内镜技术进行诊治,回顾性分析手术前后的临床资料。结果35例鼻颅底外伤患者中15例合并有鼻大出血,急诊经鼻内镜处理后出血停止。单纯鼻骨骨折3例行鼻内镜手术,术后鼻外观及鼻通气良好。5例鼻骨骨折合并鼻中隔骨折或脱位,4例鼻内镜下行鼻中隔矫正复位术,术后鼻外观及鼻通气良好;1例术后左鼻塞,检查见鼻中隔左偏,1个月后行中隔矫正后鼻塞消失。2例合并鼻泪管断裂,鼻内镜辅助下手术治愈。处理上颌窦(前、上壁)骨折4例、筛窦骨折2例、额筛窦骨折4例(2例伴脑脊液鼻漏)、上颌窦筛窦骨折合并眶纸板骨折4例(2例伴复视)、蝶筛窦骨折6例(1例伴脑脊液鼻漏)。鼻内镜手术后均对位生长愈合良好,无复视及视力障碍,眼球运动正常,外形尚好,窦口引流通畅,鼻腔鼻窦上皮化好。伴脑脊液鼻漏者已愈合。35例中1例鼻腔大出血,虽鼻出血停止但因合并严重脑挫裂伤死亡。结论在处理鼻颅底复杂性外伤中配合应用鼻内镜可以获得较满意疗效。
Objective To explore the clinical value of nasal endoscope in management of nasal skull base trauma. Methods Nasal-skull-base trauma were diagnosed and treated with nasal endoscope in 35 patients,their clinical data was analysed retrospectively. Results Of all the 35 cases,15 cases with severe nasal bleeding got cured after emergency endoscopic treatment;3 cases with simple nasal bone fracture got normal nasal appearance and ventilation;5 cases of nasal bone fracture combined with septal fracture or dislocation,4 got normal nasal appearance and ventilation after surgical correction of nasal septum,one remained nasal obstruction owing to septal deflection and got cured with revision correction of nasal septum one month later. 2 cases of nasolacrimal duct rupture got cured with endoscope-assisted surgery. Later endoscopic treatment was applied to patients with fracture of maxillary sinus（4 cases） ,fracture of ethmoid sinus（2 cases） ,fracture of frontal sinus and ethmoid sinus（4 cases,2 with cerebrospinal fluid leakage） ,combined fracture of maxillary sinus with papyraceous lamina（4 cases,2 with diplopia） ,fracture of sphenoid sinus（6 cases,1 with cerebrospinal fluid rhinorrhea） . Of all the complicated patients,one died of severe brain trauma,and the others were cured with extinguishment of diplopia and visual impairment,normal eye movement and nasal appearance,patent ostium drainage and epithelization of nasal and sinusal cavities. Conclusion Complicated nasal skull base trauma can be treated endoscopically with satisfactory effect .
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2009年第6期436-439,共4页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
鼻内镜
外伤
手术
Endoscope, nasal
Trauma
Surgery
