70°鼻内镜在泪前隐窝入路上颌窦内翻性乳头状瘤切除术中的应用

The application of 70° endoscope in the resection of inverted papilloma of the maxillary sinus via the prelacrimal recess approach

摘要

目的 探讨70°鼻内镜在泪前隐窝入路(prelacrimal recess approach, PLRA)切除上颌窦内翻性乳头状瘤的作用。方法 回顾性分析15例鼻内镜下泪前隐窝入路切除上颌窦内翻性乳头状瘤的患者临床资料，术前均行鼻内镜、CT、增强MRI检查，明确病变范围。根据同仁分期，其中2期3例、3期12例。0°鼻内镜下常规扩大开放上颌窦口，70°鼻内镜下看到上颌窦下壁、前壁、后外侧壁有肿瘤，不能全部切除。行泪前隐窝切口，使用70°鼻内镜观察上颌窦各壁，手术彻底切除肿瘤。术后定期随访，观察肿瘤复发及临床症状改善情况。结果 15例患者均完成手术，随访3~36个月，平均12个月。15例患者术后未见肿瘤复发，鼻阻改善，无鼻出血、头痛、复视、溢泪等临床症状发生，无面部疼痛及异常麻木。结论 鼻内镜下泪前隐窝入路是切除根基部位于上颌窦前壁、下壁、内侧壁前段内翻性乳头状瘤的首选方式，使用70°鼻内镜可观察到上颌窦各壁，视野宽广，有利于彻底切除肿瘤，减少肿瘤复发，改善临床症状。

Abstract

Objective To investigate the efficacy of a 70° endoscope in the resection of maxillary sinus inverted papillomas via the prelacrimal recess approach (PLRA). Methods This retrospective analysis reviewed the clinical data of 15 cases of endoscopic resection of maxillary sinus inverted papillomas via the PLRA. All patients underwent preoperative endoscopic, CT, and contrast-enhanced MRI examinations to determine the extent of the lesions. According to the Tongren staging system, 3 cases were classified as Stage 2 and 12 as Stage 3. Under a 0° endoscope, the maxillary sinus ostium was routinely enlarged and opened; under a 70° endoscope, tumors were observed on the inferior, anterior, and posterolateral wall of the maxillary sinus, and complete resection was not possible. A prelacrimal fossa incision was made, and a 70° endoscope was used to visualize the walls of the maxillary sinus, followed by complete surgical resection of the tumor. Postoperative follow-up was conducted regularly to monitor for tumor recurrence and assess improvement in clinical symptoms. Results All 15 patients underwent the procedure. They were followed up for 3 to 36 months, with a mean follow-up of 12 months. None of the 15 patients experienced tumor recurrence postoperatively; nasal obstruction improved, and no clinical symptoms such as epistaxis, headache, diplopia, or epiphora occurred. There were no reports of facial pain and abnormal numbness. Conclusion The PLRA is the preferred method for resecting inverted papillomas whose base is located on the anterior, inferior, or anterior segment of the medial wall of the maxillary sinus. The use of a 70° endoscope allows for visualization of all walls of the maxillary sinus, providing a wide field of view that facilitates complete tumor resection, reduces the risk of recurrence, and improves clinical symptoms.

关键词

内翻性乳头状瘤 / 上颌窦 / 泪前隐窝 / 鼻内镜

Key words

Inverted papilloma / Maxillary sinus / Prelacrimal recess / Nasal endoscopy

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基金资助

昆明医科大学教育教学研究课题(2023-JY-Y-031)