摘要：

目的 回顾分析经鼻内镜颅底手术后蝶窦炎的致病原因，总结其诊断与治疗特点并评价预后。方法 纳入 2005 年 6 月至 2017 年 12 月行经鼻内镜颅底手术后继发蝶窦炎的患者共 24 例，采用扩大内镜经鼻入路手术开放蝶窦并清除病灶；通过鼻窦 CT、MRI、鼻内镜检查，以及视觉模拟评分（VAS）和 Lund-Kennedy 评分评价患者预后。结果 临床表现以头痛（21 例，87.50%）、鼻塞（11 例，45.83%）、流涕（9 例，37.50%）为主要症状。术前鼻窦影像学检查可见广泛性蝶窦壁骨质增厚和（或）蝶鞍骨质不连续，蝶窦壁黏膜呈中等强化征象；术中鼻内镜下可见后组筛窦和蝶窦区黏膜水肿、息肉、瘢痕形成。手术前后 VAS 评分之头痛（F = 118.961，P = 0.000）、鼻塞（F = 3.519，P = 0.035）、流涕（F = 30.563，P = 0.000）和Lund-Kennedy 评分（F = 26.064，P = 0.000）差异具有统计学意义，其中术后 3 和 12 个月 VAS 评分之头痛（均 P = 0.000）、流涕（均 P = 0.000）和 Lund-Kennedy 评分（均 P = 0.000）均低于术前。结论 经鼻内镜颅底手术视野不充分，不恰当应用人工材料可导致蝶窦炎症反应，引起较严重的头痛、鼻塞和流涕症状；以内镜下扩大开放蝶窦，清理窦内病变组织和修复材料为首选治疗方法，从而改善症状和使黏膜上皮化。

关键词: 颅底肿瘤, 内窥镜, 蝶窦炎, 外科手术, 再手术, 手术后并发症

Abstract:

Objective To retrospectively analyze the etiology of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery, summarize the characteristics of diagnosis and treatment, and evaluate the prognosis. Methods Clinical data of 24 cases of sphenoid sinusitis secondary to endoscopic transnasal skull base surgery from June 2005 to December 2017 were collected. Endoscpic extended sphenoidectomy was performed to remove the lesion. Nasal CT, MRI, nasal endoscope, Visual Analogue Scale (VAS) and Lund-Kennedy score were used to evaluate the prognosis of patients. Results Clinical symptoms of those patients included headache (21 cases, 87.50%), nasal obstruction (11 cases, 45.83%) and runny nose (9 cases, 37.50% ). Preoperative nasal sinus imaging examinations showed extensive hyperosteogenesis of sphenoid sinus walls and/or discontinuous bone substance of sella turcica, and moderate enhancement of mucosa of sphenoid sinus walls. Intraoperative endoscopic display showed edema, polyp and scar formation of mucosa in posterior ethmoidal sinus and sphenoid sinus. There were significant differences between preoperative and postoperative VAS scores, such as headache (F = 118.961, P = 0.000), nasal obstruction (F = 3.519, P = 0.035) and runny nose (F = 30.563, P = 0.000), and Lund-Kennedy score (F = 26.064, P = 0.000). VAS scores in headache (P = 0.000, for all) and runny nose (P = 0.000, for all) and Lund-Kennedy score (P = 0.000, for all) 3 months and one year after surgery decreased significantly in comparison with before surgery. Conclusions Insufficient surgical field for endoscopic transnasal skull base surgery, inappropriate and unreasonable use of artificial materials can lead to severe sphenoid sinus inflammation and more severe symptoms such as headache, nasal obstruction and runny nose. An extended sphenoidectomy should be adopted under endoscope and the lesions and artificial repair materials must be cleaned, so as to improve the symptoms and achieve mucosal epithelization.

Key words: Skull base neoplasms, Endoscopes, Sphenoid sinusitis, Surgical procedures, operative, Reoperation, Postoperative complications