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目的:探讨蝶窦及鞍区更直接的手术径路,结合影像学资料对超越蝶窦范围的相关疾病进行适当处理,防止严重并发症的发生。方法:在鼻内镜下,分别采用经前筛-后筛-蝶窦、经上鼻道-后筛-蝶窦、经鼻中隔-蝶窦以及直接以后鼻孔上缘为标志经蝶窦前壁自然口进入蝶窦等途径,对46例蝶窦占位并蝶窦骨壁破坏的病变进行处理。结果:蝶窦囊肿及脓囊肿21例,经上鼻道径路处理后痊愈;蝶窦内血肿机化1例,经上鼻道径路清除;蝶窦内血肿并颈内动脉假性动脉瘤3例,1例术中探查发生致命性大出血,后经血管内介入治疗后痊愈,其余2例仅作鼻内镜检查,经DSA证实并行血管内介入治疗后治愈;蝶窦乳头状瘤4例,均行蝶窦自然开口径路,3例治愈,1例因广泛侵犯蝶窦外侧壁仅部分切除;蝶窦胆脂瘤2例,经上鼻道入路完整切除;蝶窦内脑膜脑膨出1例,经蝶窦前壁自然口打开蝶窦,经穿刺抽出脑脊液,手术停止并加固修补暴露脑膜;蝶窦真菌病1例,经上鼻道径路清除蝶窦内病变并联合抗真菌治疗后痊愈;蝶窦恶性肿瘤3例,经前后筛径路切除蝶窦内大部分肿瘤,后辅以放化疗;鼻咽癌侵入蝶窦5例,病理检查证实后行放化疗;垂体瘤术后蝶窦脑脊液鼻漏并肉芽增生5例,经上鼻道或鼻中隔径路均一次修补成功。结论:鼻内镜下处理蝶窦及蝶窦相关疾病径路多样,适当选择径路可达到直接、安全、微创等目的。术前蝶鞍CT薄层扫描、三维重建以及DSA是防止超越蝶窦范围病变手术并发症发生的有效手段之一。
Objective: To explore the more direct surgical approach to the sphenoid sinus and the sellar region, and to deal with the related diseases beyond the scope of the sphenoid sinus in combination with imaging data to prevent the occurrence of serious complications. Methods: Under nasal endoscopy, the anteroposteriorly-posterior screening-sphenoid sinus, the superior nasal passages-posterior screening-sphenoid sinus, transnasal septum-sphenoid sinus, Into the sphenoid sinus and other ways, 46 cases of sphenoid sinus space-occupying and destruction of the sphenoid sinus wall lesions were processed. Results: 21 cases of sphenoid sinus cyst and pus cyst were recovered after the treatment of the upper nasal pathology. One case of sphenoid sinus hematoma was established and cleared by the path of the upper nasal tract. Three cases of sphenoid sinus hematoma with internal carotid artery pseudoaneurysm , One case of intraoperative exploration of fatal bleeding, after treatment by endovascular heal, the remaining two cases only for endoscopic examination, confirmed by DSA and endovascular interventional treatment after treatment; 4 cases of sphenoid papilloma, both The sphenoid sinus natural open path, 3 cases of cure, 1 case due to extensive invasion of the sphenoid sinus lateral wall only partial resection; 2 cases of cholesteatoma cholesteatoma, complete removal of the superior nasal passages; For example, the sphenoid sinus was opened through the natural orifice of the anterior wall of the sphenoid sinus and the cerebrospinal fluid was extracted by puncture. The operation was stopped and the meningitis was repaired and repaired. One case of sphenoid sinus fungal disease was cleared by the path of the upper nasal passages and combined with antifungal therapy ; Sphenoid sinus cancer in 3 cases, the majority of tumors in the sphenoid sinus were excised by the anterior and posterior sieve pathways followed by radiotherapy and chemotherapy; nasopharyngeal carcinoma invaded the sphenoid sinus in 5 cases, confirmed by pathology after radiotherapy and chemotherapy; pituitary adenoma Rhinorrhea and granulation hyperplasia in 5 cases, the upper nasal septum or nasal septum pathways are a successful repair. CONCLUSIONS: Nasal endoscopic treatment of sphenoid sinus and sphenoid sinus-related diseases are diverse, and proper path selection can achieve direct, safe and minimally invasive purposes. Preoperative sellar CT thin layer scan, three-dimensional reconstruction and DSA is to prevent one of the effective means of surgical complications beyond the scope of the sphenoid sinus.