內視鏡內側上頷竇切除術於鼻及鼻竇疾病之應用

Endoscopic Medial Maxillectomy for Sinonasal Diseases

陳泓廷(Hung-Ting Chen) ； 邱贊仁(Tsan-Jen Chiu) ； 陳培榕(Peir-Rong Chen) ； 黃同村(Tung-Tsun Huang)

《台灣耳鼻喉頭頸外科雜誌》 48卷3期 (2013/09) Pp. 240-246

https://doi.org/10.6286/2013.48.3.240

摘要

背景：針對上頷竇及鄰近構造病變，近年來經鼻內視鏡內側上頷竇切除術已逐漸取代開放式手術成為新的選擇，本篇研究主要收集本院接受鼻竇內視鏡內側上頷竇切除術的患者，對於術後結果作一分析。方法：回溯性收集2005年7月至2013年1月，在本院因上頷竇及鄰近構造病變接受內視鏡內側上頷竇切除術的病患，分析其臨床資料、腫瘤位置與根源、是否接受淚囊鼻腔造口手術、手術併發症與追蹤結果。結果：共17名病患納入本研究，平均追蹤20.9個月。12名為倒生性乳突瘤患者（2名合併有惡性腫瘤），2名是上頷竇黏液囊腫，1名是上頷竇神經鞘瘤，1名瘤性許奈德氏乳突瘤，1名是乳癌轉移至上頷竇患者。6名病患同時合併使用犬齒窩穿刺法以清除腫瘤，另外有5名同時接受淚囊鼻腔造口手術。術後有4名病患產生復發，2名接受再次手術，之後無任何復發跡象。手術後無主要併發症產生，但有1名病患有持續鼻部結痂情況，時間達7個月，所有病患對術後鼻部呼吸通暢度感到滿意。結論：經鼻內視鏡內側上頷竇切除術為安全且有效的手術方法，詳細的術前評估，能判斷腫瘤根源並予以根除，與手術後鼻竇內視鏡的定期追蹤，是此手術能成功的重要關鍵。

關鍵字

鼻及鼻竇疾病 ； 上頷竇 ； 內視鏡內側上頷竇切除術

並列摘要

OBJECTIVES: Recently, transnasal endoscopic medial maxillectomy (EMM) has been described as an alternative technique to open maxillectomy for sinonasal diseases. In this article, we present a series of patients who underwent EMM for various diseases of the maxillary sinus and adjacent structures.METHODS: Retrospective chart review was conducted on patients undergoing EMM for diseases of the maxillary sinus and adjacent structures from July 2005 to January 2013. The demographic data, operative technique, pathologic report, follow-up times and complications were collected.RESULTS: Seventeen patients were enrolled in this study. The average follow-up peroid was 20.9 months. Twelve patients had sinonasal inverted papilloma (2 patients with malignant component), 2 had maxillary sinus mucoceles, one had maxillary sinus Schwannoma, one had oncocytic Schneiderian papillomas and the other one had maxillary sinus metastasis of breast cancer. Six patients received canine fossa puncture concurrently to extirpate the extensive disease. Dacryocystorhinostomy was performed in 5 patients. The diseases recurred in 4 patients and 2 of them accepted second surgery. No more disease recurrence was observed after surgery in both of them. There were no major complications. Prolonged nasal crusting was observed in one patient and persisted for 7 months. Nasal breathing was satisfying in all patients.CONCLUSIONS: EMM is a safe and effective treatment for diseases of the maxillary sinus and adjacent structures. Proper preoperative evaluations, determination of disease origin and close postoperative endoscopic follow up are the keys for success.

並列關鍵字

sinonasal disease ； maxillary sinus ； endoscopic medial maxillectomy