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額竇功能性內視鏡手術

Functional Endoscopic Surgery of the Frontal Sinus

摘要


理想上,能有效清除病灶且具最低侵犯性及致病性的手術法是額竇疾外科療法的最佳選擇。傳統上,額竇手術大致可分為摘除法(ablation),填塞法(obliteration)及額鼻通道重建法(recnstruction of nasofrontal drainage)。手術在全身麻醉下經鼻外施行其侵犯性與致病性較大,以典型的骨成型術(osteoplasty)合併填塞而言,手術經額竇前骨板取道進入行根除性手術,並未強調額鼻引流。額竇功能性內視鏡手術能在局部麻醉下行竇口成型術(ostioplasty),其理念不僅合乎額鼻黏液纖毛傳送生理機能,且旨在恢復額鼻通氣與引流,更是實現經鼻引流額竇的革命性手術法。額竇的引流系狀態似沙漏,大多數的額疾病灶位於或延伸至額隱窩附近,應用不同角度的內視鏡並配合鼻竇電腦斷層掃描,可以直視額隱窩行精細的手術重建額鼻引流,並保存額隱窩良好的架構及正常的黏膜,是具最低侵犯性與致病性的手術選擇。尤其本手術法具備術後內視鏡值視手術域及放射顯影追蹤檢查功能,應用有效評估及確保長期療效。1991年度,本院基隆耳鼻喉科應用本法施行於連續求診或轉診來的多類型額竇疾病病例,獲得令人滿意的初步療效。即使部分病例術後竇口有窄縮的現象,仍能保持正常額鼻引流與通氣。特此提出初步報告。

並列摘要


Selecting the least invasive operation likely to eraidcate an obstructing focus is the ideal surgical management of frontal sinus disease. Frontal sinus surgery has consisted of abkaton, obliteration and reconstruction of ansofrontal drainage, which are performed via external approah under general anasthesia. Although providing excellent frontal exposure, frotal osteoplasty addreddes less about nasofrotal draunage and its morbidity has precluded unform acceptance. Ostioplasty is a procedure to open the frontal sinus ostium or isthmus for frontal deatinage and ventilation. Functional endoscopic sinus surgery offers a minimally invasive approach for frontal ostioplasty and reduced morbidity for procedure performed under local anesthesia. It is a revolutionary procedure which is not only corresponding with the concept of frontl mucociliary clearance function but also fulfilling endonasal approach for froontal siuus drainage. This paper presents our preliminary experience of functional endoscopic frontal sinus surgery with consecutive scaes of frontal sinus diseaes which visitsd this department in 1991. Even thogh some cases post-poeratively show partial ocnstriction of frontal isthms, their drainage and ventilation appar to be patent and the preliminary result is encouraging. We report the operative methods and the cases.

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