Wormald P J, McDonogh M
Department of Otolaryngology, Chinese University of Hong Kong.
J Laryngol Otol. 1998 Jun;112(6):547-51. doi: 10.1017/s0022215100141052.
Uncinectomy is an important step in endoscopic sinus surgery. The traditional method of performing uncinectomy has the risk of penetration of the lamina papyracea with orbital fat exposure. If the orbital penetration is not recognized, major complications may follow. In this study the authors used historical consecutive controls to compare the incidence of orbital penetration, identification of the natural ostium and lacrimal apparatus injury by the traditional surgical technique and a new technique of uncinectomy. Six hundred and thirty-six uncinectomies have been performed using the 'swing-door' technique. The 636 uncinectomies performed prior to changing techniques were used as historical controls. The incidence of orbital penetration (six compared to 0; p < 0.05) and ostium non-identification (42 not identified as compared to 0; p < 0.001) was significantly less with the new technique. One lacrimal injury occurred with the 'swing-door' technique compared to zero with the standard technique (p > 0.05). The techniques are described and the complications discussed. The authors recommend this technique as it is easy to learn, allows removal of the uncinate flush with the lateral nasal wall and allows easy identification of the natural ostium of the maxillary sinus.
筛窦切除术是鼻内镜鼻窦手术中的重要步骤。传统的筛窦切除方法存在穿透纸样板并暴露眶脂肪的风险。如果未识别出眶部穿透，可能会引发严重并发症。在本研究中，作者采用历史连续对照的方法，比较传统手术技术与一种新的筛窦切除技术在眶部穿透发生率、自然开口识别以及泪器损伤方面的差异。已使用“摇门”技术进行了636例筛窦切除术。在改变技术之前进行的636例筛窦切除术用作历史对照。新技术的眶部穿透发生率（6例对比0例；p < 0.05）和开口未识别率（42例未识别对比0例；p < 0.001）显著更低。“摇门”技术发生了1例泪器损伤，而标准技术为0例（p > 0.05）。文中描述了这些技术并讨论了并发症。作者推荐该技术，因为它易于学习，能使筛骨钩突与鼻外侧壁齐平切除，并便于识别上颌窦的自然开口。
