CAJ | 학술논문

目的分析和讨论经鼻内镜下泪前隐窝入路,经上颌窦后外侧壁切除累及翼腭窝及颢下窝神经鞘瘤手术结果,探讨手术方法及适应证.方法病例资料来自2004年至2011年住院接受经鼻内镜下泪前隐窝入路翼腭窝和颞下窝神经鞘瘤切除手术患者6例,其中男性和女性各3例,年龄29 ～ 59岁.手术前主要接受鼻窦CT扫描和MRI检查.采用全身麻醉下经鼻内镜下泪前隐窝入路进入翼腭窝和颞下窝.手术后组织病理学确认为神经鞘瘤.术后定期CT或MRI检查随访观察.结果 6例患者实现手术完整切除.平均随访19.3个月无复发,有3例在术后第1～2周出现面部上颌神经分布区域较明显麻木感,随后逐渐减轻,仅1例随访终期遗留术侧口角轻度麻木.结论内镜下经鼻开放泪前隐窝入路切除翼腭窝和颞下窝神经鞘瘤,完整保留鼻腔外侧壁,损伤小,并发症少,为经鼻进入翼腭窝和颞下窝的创新微创入路.
목적 분석화토론경비내경하루전은와입로,경상합두후외측벽절제루급익악와급호하와신경초류수술결과,탐토수술방법급괄응증.방법 병례자료래자2004년지2011년주원접수경비내경하루전은와입로익악와화섭하와신경초류절제수술환자6례,기중남성화녀성각3례,년령29 ～ 59세.수술전주요접수비두CT소묘화MRI검사.채용전신마취하경비내경하루전은와입로진입익악와화섭하와.수술후조직병이학학인위신경초류.술후정기CT혹MRI검사수방관찰.결과 6례환자실현수술완정절제.평균수방19.3개월무복발,유3례재술후제1～2주출현면부상합신경분포구역교명현마목감,수후축점감경,부1례수방종기유류술측구각경도마목.결론 내경하경비개방루전은와입로절제익악와화섭하와신경초류,완정보류비강외측벽,손상소,병발증소,위경비진입익악와화섭하와적창신미창입로.
Objective To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemperal fossa (PPF and ITF) through postero-lateral wall via prelacrimal recess approach (PLRA).The surgical technique and indications were presented and discussed.Methods Six patients aged from 29-59 year-old with Schwannoma in the PPF and ITF,who received the tumor resection via PLRA under endoscope,were enrolled in this paper.Three were female and 3 were male.All of them received preoperative CT and MRI.The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia.Schwannoma was histopathologically confirmed after surgery.The postoperative periodical CT and MRI follow up was conducted.Results The tumors were removed completely in these 6 patients.No recurrence was found during 19.3 months follow up on the average.Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards.Only 1 patient had mild altercation numbness at the end of follow up.Conclusions Schwannoma involved PPF and ITF can be removed endoscopically via PLRA.The lateral wall of nasal cavity might be kept intact.It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.