目的 探讨应用鼻内镜行额窦口周围区域解剖标志的识别及相应手术方式的探讨. 方法 总结70例鼻内镜下额窦手术病例,术中仔细识别额隐窝、鼻丘气房、额窦底、嗅凹、钩突、纸样板等解剖结构. 结果 35例采用钩突头端附着于纸样板的病例采用DrafⅠ手术方式进行,25例钩突头端单附着于中鼻甲根部采用经中鼻甲腋途径额窦窦口开放术,10例钩突颅底中鼻甲联合附着处患者采用DrafⅡA方式进行手术.术中均成功开放额窦窦口,无颅内及眶内并发症发生.术后随访1-3年,无额窦炎复发病例,63例患者术前症状完全改善,7例术前症状明显改善. 结论 以钩突头端的附着方式决定不同的额窦手术入路,以鼻丘气房、嗅凹为核心解剖标志的辨认确定额窦入口对于保证手术的成功、预防并发症的发生有重要的意义.%Objective To confirm the frontal sinus peripheral region anatomical token during nasal endoscopy operation and its corresponding surgical ways.Methods The clinical data of 70 cases undergoing frontal sinus operation through nasal endoscopy were summarized.The anatomical tokens were carefully differentiated,including the frontal recess,agger nasi cell,frontal sinus bottom,olfactory concave,uncinate process,lamina papyracea.Results Of 70 cases,35 cases of frontal sinusitis with the uncinate process appending to the lamina papyracea underwent the operation through the Draf Ⅰ style,25 cases of the uncinate process appending to the middle nasal turbinate underwent operation through the middle turbinate armpit,and 10 cases of the uncinate process appending both the skull base and the nasal turbinate underwent the operation of the Draf Ⅱ A style.All the patients were successfully operated,and no intra-cranial and intra-orbital complications occurred.After follow-up for 1-3 years,no cases recurred,symptoms of sinusitis in 63 cases were fully improved and 7 cases were obviously improved.Conclusion To decide the frontal sinus operating style through the different uncinate process head terminal appending style and to confirm the frontal sinus ostium through the differentiation of the vital anatomical tokens as agger nasi,olfactory concave during the operation are of high significance to guarantee the success of the operation and prevent the complications.
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