An Alternative Method of Endoscopic Intrasphenoidal Vidian Neurectomy.
An Alternative Method of Endoscopic Intrasphenoidal Vidian Neurectomy.
复制标题
内窥镜蝶内维迪恩神经切除术的另一种方法
DOI：
10.1177/2473974x18764862
复制
发表时间：
2018-01
期刊：
影响因子：
1.5
通讯作者：
Yang P
中科院分区：
文献类型：
--
作者：
Zhao C;Ji Y;An Y;Xue J;Li Q;Suo L;Hou R;Zhang Y;Geng Z;Shen H;Ren J;Yang P
目的探讨一种简便的手术入路，以利于临床治疗.研究设计设计了一种新颖的经鼻内窥镜三步手术方法进行翼管神经切除术，并在91例常规药物治疗难治的轻度至重度过敏性和非过敏性鼻炎患者中进行了尝试。内镜下翼管神经切除术需要翼管的精确定位。然而，由于其位置较深且翼腭窝的解剖结构复杂，在手术中不易定位。受试者与方法经鼻内镜下蝶窦前壁穿孔术为第一步，切除前壁直至暴露蝶窦前壁与蝶窦底交界处的翼管为第二步。最后一步是翼管神经的精确切除和烧灼。在某些病例中，蝶窦发育良好，外侧间隙较大，包括扩大后筛窦切除术，以充分暴露翼管。结果经组织学检查和Schirmer试验证实，该技术成功切除翼管神经，具有翼管定位容易、翼腭窝神经血管束损伤小等优点。结论：这种新颖的三步法内镜下翼管神经切除术加一个扩展手术保证了翼管的良好暴露，从而保证了准确的翼管神经切除术。
Objective To develop an easy surgical approach to facilitate clinical management. Study Design A novel transnasal endoscopic 3-step surgical method for vidian neurectomy was designed and tried in 91 cases with a mild-to-severe degree of allergic and nonallergic rhinitis refractory to routine medical therapy. Setting Endoscopic vidian neurectomy requires accurate localization of the vidian canal. However, it is not easy to localize during surgery because of its deep location and the complex anatomy of the pterygopalatine fossa. Subjects and Methods This technique consists of 3 steps, including transnasal endoscopic perforation of the anterior wall of the sphenoidal sinus as the first step and removal of the anterior wall until the exposure of the vidian canal in the junction between the anterior wall and the floor of the sphenoid sinus as the second step. The last step is the accurate resection and cauterization of the vidian nerve. In some cases in which the sphenoid sinus developed well with a big lateral space, an extended procedure of posterior ethmoidectomy was included to allow good exposure of the vidian canal. Results Using this technique, successful endoscopic vidian neurectomy in this series of patients was confirmed by both histology and Schirmer test, showing its distinct advantages of easy localization of the vidian canal and less risk of injury to the nerve and vessel bundles within the pterygopalatine fossa. Conclusion Taken together, this novel 3-step procedure of endoscopic vidian neurectomy plus an extended procedure guarantees good exposure of the vidian canal and therefore accurate vidian neurectomy.