- 期刊
微形吸絞器在慢性副鼻竇炎手術之角色
The Role of the Microdebrider in Chronic Paranasal Sinusitis Surgery
摘要
副鼻竇帶及鼻息肉的手術治療方法，在近20年來不斷有創新和進步。近來更因為微形吸絞器（microdebrider）在鼻竇手術上的應用，而有了更進一步的發展。本篇文章乃針對以微形吸絞器輔助進行的鼻竇內視鏡手術，介紹此器械的特點，使用方法，手術的經驗，及優缺點的探討。 微型吸絞器的鼻竇內視鏡手術的應用日漸增加。由於鼻竇手術的特點是，鼻竇四周與重要解剖構造相鄰，須在狹小侷限的空間中進行移除病變軟組織和鑽磨骨頭的動作，因此手術必須著重考量其安全性和精確性。微型吸絞器中的軟組織切削器（soft tissue shaver）具有往復模式切削刀的內管（inner oscillating cutting blade）可精確切割，及時抽吸切割下的組織及血液。骨頭切割鑽磨器（bone cutting burs）的骨幹（shaft ）被外套（sheath）所保護，不會傷害到鑽磨對側的組織。抽吸器（suction）附在外套內，可及時抽吸骨屑，提供一個清晰的手術視野。因此在熟練的操作下，微形吸絞器由於切割精準、及時抽吸（real-time suction）的特性，提供較為清晰的手術視野，可減少對正常黏膜的傷害，進而降低術後沾連及鼻竇開口的疤痕性狹窄。在術中可減少傷害重要的結構，因而降低術後的併發症。因此，微形吸絞器實為內視鏡手術器械中，安全、有效、值得推薦的另一選擇。
並列摘要
Operative techniques for paranasal sinusitis have improved significantly in recent years, especially since the introduction of the microdebrider. This article introduces the instrument, its use, surgical experiences with it, as well as its advantages and disadvantages in endoscopic sinus surgery. The use of powered instrumentation in endonasal endoscopic surgery is increasing. The exacting requirements of soft tissue and bone removal in a confined anatomical area with important anatomical structures nearby makes anatomical contouring with such instruments attractive. Soft tissue shaving cannulas and new bone-cutting drills are potentially less traumatic and also more precise tools for soft tissue extraction and bone removal. The microdebrider can reduce operative damage to normal mucosa, post-operative adhesions, and stenosis of the sinus orifice while also minimizing the possibility of trauma to important anatomical structures, thank to its precise cutting and real-time suction. The microdebrider is a safe, effective, and eminently recommendable instrument for endoscopic surgery.