Maniglia A J
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, University Hospitals of Cleveland, OH 44106.
Laryngoscope. 1991 Apr;101(4 Pt 1):349-54. doi: 10.1002/lary.1991.101.4.349.
Endoscopic sinus surgery has become an acceptable technique for the treatment of chronic sinus disease. This report analyzes five complications which came to my attention. Two cases were orbital:1 bilateral blindness due to damage of the optic nerves, and 1 damage of medial rectus muscle. The other 3 cases were intracranial:two cribriform plate damage with frontal lobe injury and hematoma, and 1 damage of the anterior cerebral artery, resulting in death. This rather novel technique, especially when used by less-experienced surgeons, has major complications similar to what has been reported with the traditional intranasal sphenoethmoidectomy. Knowledge of anatomy, good training, and meticulous surgical technique are very important. Endoscopic sinus surgery in patients with extensive pathology should be used with caution, especially if general anesthesia is selected or if excessive bleeding occurs. It would be beneficial to otolaryngologists to have previous experience in the traditional technique before adopting endoscopic sinus surgery to their armamentarium. Even then, major complications may occur in the hands of very experienced surgeons. Early recognition and proper management of these complications are of utmost importance in order to minimize disability or prevent death.
内镜鼻窦手术已成为治疗慢性鼻窦疾病的一种可接受的技术。本报告分析了引起我注意的五种并发症。其中两例涉及眼眶：1例因视神经损伤导致双侧失明，1例内侧直肌损伤。另外3例为颅内并发症：两例筛板损伤伴额叶损伤和血肿，1例大脑前动脉损伤，导致死亡。这种相当新颖的技术，尤其是在经验不足的外科医生使用时，会出现与传统鼻内蝶筛窦切除术所报告的类似的严重并发症。了解解剖结构、接受良好的培训以及采用细致的手术技术非常重要。对于病变广泛的患者，内镜鼻窦手术应谨慎使用，尤其是在选择全身麻醉或出现大量出血的情况下。耳鼻喉科医生在将内镜鼻窦手术纳入其手术方法之前，若有传统技术的经验将是有益的。即便如此，在经验非常丰富的外科医生手中也可能发生严重并发症。为了将残疾降至最低或预防死亡，尽早识别并妥善处理这些并发症至关重要。
