CAJ | 학술논문

目的通过回顾性总结鼻内镜下经鼻改良Lothrop手术(endoscopic modified Lothropprocedure,EMLP)的临床随访结果,分析EMLP的适应证、手术方法和预后因素.方法资料来源于2003-2011年在我院完成EMLP手术的73例额窦病变患者,其中男52例,女21例;年龄14 ～72岁,平均45.6岁.术前行鼻窦CT扫描,肿瘤患者术前行MRI检查.手术后在内镜下随访.结果 73例额窦病变患者中额窦内翻性乳头状瘤21例,鼻窦炎伴鼻息肉合并哮喘16例,额窦炎12例,慢性鼻窦炎伴或不伴鼻息肉9例,骨瘤7例,额窦黏液囊肿4例,变应性真菌性鼻窦炎3例,脑膜脑膨出1例.73例中有前期手术史61例,手术次数1～6次,平均1.8次.术后随访6～ 122个月,平均25.0个月.随访终期额窦开放良好者44例(44/73,60.3％),狭窄25例(25/73,34.2％),闭锁4例(4/73,5.5％),再手术7例(7/73,9.6％).无手术并发症.结论 EMLP对额窦肿瘤是非常有效的手术方式;对于复发慢性鼻窦炎伴或不伴鼻息肉及哮喘,采用EMLP并结合药物治疗,可获得更好的缓解效果;病变性质、黏膜缺失程度、前期手术及解剖因素等,是重要的预后因素.
목적 통과회고성총결비내경하경비개량Lothrop수술(endoscopic modified Lothropprocedure,EMLP)적림상수방결과,분석EMLP적괄응증、수술방법화예후인소.방법 자료래원우2003-2011년재아원완성EMLP수술적73례액두병변환자,기중남52례,녀21례;년령14 ～72세,평균45.6세.술전행비두CT소묘,종류환자술전행MRI검사.수술후재내경하수방.결과 73례액두병변환자중액두내번성유두상류21례,비두염반비식육합병효천16례,액두염12례,만성비두염반혹불반비식육9례,골류7례,액두점액낭종4례,변응성진균성비두염3례,뇌막뇌팽출1례.73례중유전기수술사61례,수술차수1～6차,평균1.8차.술후수방6～ 122개월,평균25.0개월.수방종기액두개방량호자44례(44/73,60.3％),협착25례(25/73,34.2％),폐쇄4례(4/73,5.5％),재수술7례(7/73,9.6％).무수술병발증.결론 EMLP대액두종류시비상유효적수술방식;대우복발만성비두염반혹불반비식육급효천,채용EMLP병결합약물치료,가획득경호적완해효과;병변성질、점막결실정도、전기수술급해부인소등,시중요적예후인소.
Objective To sum up the follow-up outcomes of endoscopic modified Lothrop procedure (EMLP) and retrospectively analyze the indications,methods and prognostic factors of EMLP.Methods The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper.The mean age was 45.6 (ranging from 14 to 72 years).There were 52 males and 21 females.Only patients with follow-up time greater or equal to 6 months were included.Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients.All patients were followed under endoscope.Results There were 21 inverted papilloma in the frontal sinus,16 chronic sinusitis with asthma,12 frontal sinusitis,9 chronic sinusitis with or without polyps,7 osteoma of the frontal sinus,4 frontal mucocele,3 allergic fungal sinusitis and 1 congenital encephalocele.Sixty-one cases had prior surgical history ( 1.8 times on the average).Their mean follow-up was 25.0 months,(ranging from 6 to 122 months).At the end of follow-up,44 cases (60.3％ ) had well opened frontal drainage pathway.Twenty-five (34.2％ ) was re-stenosed and 4 (5.5％)closed.Seven cases (9.6％ ) underwent revision surgeries.There were no surgical complications.Conclusions EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis.Combined with medical treatment,EMLP will have a better results for chronic sinusitis with or without polyps and asthma.The degree of diseases,mucosal loss,anatomic variability and prior surgeries are important prognostic factors.