Sethi D S
Department of Otolaryngology, Singapore General Hospital, Republic of Singapore.
Otolaryngol Head Neck Surg. 1999 May;120(5):730-6. doi: 10.1053/hn.1999.v120.a89436.
Isolated sphenoid lesions are rare. It is likely that isolated sphenoid sinus disease is underreported for a number of reasons. First, the presenting symptoms are often nonspecific; second, the inaccessibility of the sinus precludes optimal physical examination; and third, before the advent of CT and MRI scanning, radiologic examination of the sinus was inadequate. Endoscopic evaluation and current imaging techniques with CT or MRI have contributed to an increase in diagnosis of these lesions. Twenty-one patients with isolated sphenoid lesions that I treated in a 4-year period are presented. The pathology was unilateral sphenoid sinusitis (8), sphenoid mucoceles (4), inflammatory sphenochoanal polyp (3), inverting papilloma (2), invasive pituitary adenoma (1), carcinoma (1), aspergilloma (1), and fibrous dysplasia (1). Endoscopic biopsy was carried out in 7 patients (33.3%). A precise diagnosis after endoscopy, biopsy, and imaging studies was established in all patients. Definitive treatment included an endoscopic sphenoidotomy in 15 (71.4%). Five patients (23.8%) were treated with other therapeutic modalities. One patient did not require any definitive treatment. The combined use of imaging techniques and diagnostic nasal endoscopy allows for an accurate diagnosis and enables minimally invasive techniques to be tailored to the patient's disease.
孤立性蝶窦病变较为罕见。孤立性蝶窦疾病可能因多种原因而报告不足。首先，其临床表现往往不具特异性；其次，蝶窦位置深在，难以进行全面的体格检查；第三，在CT和MRI扫描出现之前，蝶窦的放射学检查不够完善。内镜评估以及当前的CT或MRI成像技术有助于提高这些病变的诊断率。本文报告了我在4年期间治疗的21例孤立性蝶窦病变患者。病理类型包括单侧蝶窦炎（8例）、蝶窦黏液囊肿（4例）、炎性蝶筛窦息肉（3例）、内翻性乳头状瘤（2例）、侵袭性垂体腺瘤（1例）、癌（1例）、曲霉菌病（1例）和骨纤维异常增殖症（1例）。7例患者（33.3%）接受了内镜活检。所有患者均通过内镜检查、活检及影像学检查明确了诊断。确定性治疗包括15例（71.4%）患者接受了内镜下蝶窦切开术。5例患者（23.8%）接受了其他治疗方式。1例患者无需任何确定性治疗。影像学技术与诊断性鼻内镜的联合应用可实现准确诊断，并能根据患者病情采用微创技术。
