[Draf IIb额窦切开术及其改良术式的临床应用]

Zhou Bing, Wang Cheng-shuo, Huang Qian, Cui Shun-Jiu, Li Yun-chuan, Wang Gui-sheng, Zhang Li-Li, Huang Zhen-xiao, Sun Yan

Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Affiliated to Capital Medical University, Beijing 100730, China.

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 May;47(5):358-62.

OBJECTIVE

To summarize the follow-up outcomes of Draf IIb frontal sinusotomy and it's modified procedures, and to discuss the surgical indications and prognostic factors.

METHODS

Thirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma (IP), 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography (CT) scans. Patients with tumor accepted magnetic resonance imaging (MRI). The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea received magnetic resonance cisternography (MRC). The Draf IIb frontal sinusotomy and it's modified Draf IIb-1-3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope.

RESULTS

Among 19 cases of Draf IIb, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf IIb-1, 2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf IIb-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf IIb-3 were mucocele. The follow-up ranged from 8 to 73 months. Twenty-two cases of the frontal nepostium were widely opened, 7 were stenosis and 3 were closed. Revision surgery was seen in 2 cases with IP. All of them had no complications.

CONCLUSIONS

The Draf IIb frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.

目的

总结Draf IIb式额窦切开术及其改良术式的随访结果，探讨手术适应证及预后因素。

方法

选取2004年至2010年期间接受治疗的32例患者纳入本研究。其中复发性额窦内翻性乳头状瘤（IP）15例，黏液囊肿6例，复发性鼻窦炎4例，骨瘤3例，伴脑脊液鼻漏的脑膜脑膨出2例，单纯脑膜脑膨出1例，急性额窦炎1例。所有患者术前行鼻窦计算机断层扫描（CT）。肿瘤患者接受磁共振成像（MRI）检查。脑膜脑膨出及脑脊液鼻漏患者接受磁共振脑池造影（MRC）检查。Draf IIb式额窦切开术及其改良的Draf IIb - 1 - 3术式主要在全身麻醉下通过高速磨钻和动力系统在内镜下施行。术后1周行CT扫描作为随访基线。术后在内镜下进行随访。

结果

19例行Draf IIb式手术，其中额窦复发性IP 12例，黏液囊肿4例，复发性鼻窦炎2例，骨瘤1例。5例行Draf IIb - 1术式，额窦复发性IP、复发性鼻窦炎各2例，骨瘤1例。6例行Draf IIb - 2术式，脑膜脑膨出3例，IP、急性额窦炎、骨瘤各1例。2例行Draf IIb - 3术式，均为黏液囊肿。随访时间为8至73个月。额窦开口广泛开放22例，狭窄7例，封闭3例。2例IP患者行二次手术。所有患者均无并发症发生。