摘要
Abstract
Objective To explore the surgical techniques and clinical effects of the transnasal methyl plate approach,aiming to systematically evaluate an open sphenoid sinus approach that combines a good surgical field of view and minimally invasive nature.Methods A retrospective analysis was conducted on the clinical data of 35 patients with isolated sphenoid sinus lesions or unilateral sphenoid sinus with adjacent ethmoid sinus from September 2019 to September 2023.All patients had their sphenoid sinuses opened through a four-step programmed operation via the middle nasal methyl plate approach.Observe the relevant conditions of the surgery and the occurrence of complications;The visual analogue scale(VAS)was used for scoring to evaluate the improvement of symptoms such as headache and runny nose.The modified Lunder-Kennedy(MLK)score was used to evaluate the recovery status of the surgical cavity.Results All patients retained the uncinate process,middle turbinate and ethmoid vesicles during the operation,and 26 cases(74.3%)retained the superior turbinate.All patients met the clinical cure criteria,manifested as unobstructed drainage in the surgical cavity,complete epithelialization of the mucosa,and good opening of the sphenoid sinus.Postoperative pathology revealed sphenoid sinus mycosis in 19 cases(54.3%),sphenoid sinus polyps in 7 cases(20.0%),and chronic inflammation of the sphenoid sinus mucosa in 9 cases(25.7%).No severe complications occurred.Only one patient case(2.9%)experienced oozing from the middle turbinate wound on postoperative day 12,which was successfully managed with electrocautery.The VAS score of headache decreased from(4.71±1.66)points before the operation to(0.83±0.39)points after the operation.There was a statistically significant difference before and after the operation(t=13.71,P<0.01).The VAS score for runny nose decreased from 4.00(0.00,6.00)points before the operation to 0.00(0.00,1.00)points after the operation.A comparison before and after the operation showed a statistically significant difference(Z=-4.47,P<0.01).There was no significant difference in the olfactory dysfunction VAS score before and after surgery(P>0.05).The MLK score decreased from 4.50(2.00,4.00)points before the operation to 1.00(0.00,1.00)points.There was a statistically significant difference before and after the operation(Z=-5.20,P<0.00).Conclusion The method of the inner nasal turbinate is strictly followed by the anatomical level of the sinus dissection,which can be exposed to the ideal of the field in the basis of the maximum limit of the physiological structure of the nasal cavity.This method has definite clinical effect on the lesions limited to the sinus and posterior group.It's worth applying to the clinic.关键词
蝶窦/后组筛窦/中鼻甲基板/微创手术/鼻内镜Key words
sphenoid sinus/posterior ethmoid sinus/middle turbinate basal lamella/minimally invasive surgery/nasal endoscope分类
医药卫生
