A Transnasal Microscopic Approach for Nasolabial Cyst Extirpation

顯微鏡下經鼻道鼻唇囊腫之切除

邱昱勳(Yu-Hsun Chiu) ； 劉嘉銘(Chia-Ming Liu) ； 李飛鵬(Fei-Peng Lee) ； 陳瀚聰(Hann-Tsong Chen) ； 黃弘孟(Hung-Meng Huang)

《慈濟醫學雜誌》 14卷6期 (2002/12) Pp. 359-363

https://doi.org/10.6440/TZUCMJ.200212.0359

摘要

目的：鼻唇囊腫為一非齒源性良性腫瘤，診斷之平均年齡為四十至五十歲。過去對於鼻唇囊腫的切除方法，已知的有唇下進行切除(sublabial approach)及鼻側切開術(lateral rhinotomy)，但術中及術後出血正常組織無謂的損傷及傷口腫痛感染等併發症亦伴隨發生，因此我們採行顧顯微鏡下經鼻道進行鼻唇囊腫的切除。在十一名病患身上獲致良好的結果，並提供其作為手術切除之選擇參考。病人與方法：由1995年至1999年，我們共經歷了十一名病患於顯微鏡下經鼻道切除鼻唇囊腫。在施予局部麻醉後，於病灶與皮膚及黏膜交界處作弧狀切開，沿此切縫而貼著囊腫表面進行剝離向上可完整分開囊腫與覆蓋之黏膜，向下可分開囊腫與周圍軟組織，至上頜骨處則呵用黏膜剝離匙將病灶剝離；直到整個囊腫完整取下後，再將黏膜覆蓋回去，手術部位則以凡士林紗布加以填塞止血。結果：接受手術之十一名患者皆成功地移除病灶。術後有九名病患抱怨手術側鼻塞，乃因術後痂皮形成所致。在一至二週的持續治，症狀得以完全解除。術後四至六週以鼻竇內視鏡追蹤檢查，可見手術部位已為正常上皮覆蓋，六個月後以電腦斷層掃描檢查，並無復發跡象。結論：於顯微鏡下經鼻道行鼻唇囊腫切除，因顯微鏡的放大效果可得到更清楚的手術視野；相較於以往的手術方法，較少破壞周圍正常的組織，出血量可控制得宜，且囊腫的完整切除可避免復發之可能。而經由鼻道行手術切除亦較無傷口腫痛及疤痕殘留的問題，可謂較不具侵襲性而有效的手術方法。

關鍵字

鼻唇囊腫 ； 摘除 ； 顯微鏡 ； 經鼻

並列摘要

Objectives:sublabial approach and lateral rhinotomy have been widely used in the past for nasolabial cysts, but are accompanied by various complications. For this reason, we designed a less invasive, safer and more effective procedure for thorough transnasal extirpation of cystic lesions under microsope. Between 1995 and 1999, 11 patients were treated with the new method. Patients and Methods: All procedures were performed using local anesthesia. Under microscope, the operative field was clear and the cyst could be easily separated from surrounding tissue by bimanual manipulation. The cyst was removed as a whole in all 11 patients. Results: There were none of the cosmetic prblems associated with trditional approaches and tissue damage was minimal. Nasoendoscopy showed normal epithelialization without pus accumulation at the operative site four to six weeks after surgery. Conclusion: We feel that the transnasal microscopic method described is a useful alternative to traditional approaches.

並列關鍵字

nasolabial cyst ； extirpation ； microscopic ； transnasal