Timperley Daniel, Sacks Raymond, Parkinson Richard J, Harvey Richard J
Rhinology and Skull Base, Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, 354 Victoria Street, Sydney, NSW 2010, Australia.
Otolaryngol Clin North Am. 2010 Aug;43(4):699-730. doi: 10.1016/j.otc.2010.04.002.
There are many approaches to obtaining a workable endoscopic surgical field in sinus surgery. With extended sinus and transdural endoscopic surgery, a more rigid approach must be taken. There are 3 main factors that invariably lead to poor surgical outcomes in endoscopic sinus and skull base surgery: bleeding, inadequate access, and unidentified anatomic anomalies. Bleeding is arguably the most common reason for incomplete resection. An understanding of microvascular and macrovascular bleeding allows a more structured approach to improve the surgical field in extended endoscopic surgery. The endoscopic surgeon should always be comfortable in performing the same procedure as an open operation. However, converting or abandoning an endoscopic procedure should rarely occur because much of this decision making should take place preoperatively. Along with poor hemostasis, inadequate access is an important cause of poor outcome. Evaluation of the anatomy involved by pathology but also the anatomy that must be removed to allow adequate exposure is important. This article reviews the current techniques used to ensure optimal surgical conditions and outcomes.
在鼻窦手术中，有多种方法可获得可行的内镜手术视野。对于扩大鼻窦手术和经硬膜内镜手术，必须采取更为严格的方法。在内镜鼻窦和颅底手术中，有3个主要因素总是导致手术效果不佳：出血、入路不足和未识别的解剖异常。出血可以说是不完全切除的最常见原因。了解微血管和大血管出血有助于在扩大内镜手术中采用更有条理的方法来改善手术视野。内镜外科医生在进行与开放手术相同的操作时应始终得心应手。然而，很少应转换或放弃内镜手术，因为大部分此类决策应在术前做出。除了止血不佳外，入路不足也是导致手术效果不佳的重要原因。评估病变涉及的解剖结构以及为充分暴露而必须切除的解剖结构很重要。本文综述了用于确保最佳手术条件和效果的当前技术。
