The nose department tumor surgical operation

Nose, paranasal sinus of good, the malignant tumor Be much more clinical to see.Because the nose, paranasal sinus and front Lu nest, eye socket, tears machine and nose swallows, the wing Mao parts, such as nest and mouth cavity...etc. dissect a relation closely, nose and paranasal sinus tumor often can invade and these part;The part comes from an ex- Lu nest, nose to swallow, the tumor of the eye socket etc. part also usually involve in a nose department;The original hair is at the nose one Lu, nose one mouthful and nose one Kuang etc. hand over the tumor of boundary part can the double cause nasal cavity and paranasal sinus complications to the development.Along with the microsurgery technique, mirror technique inside the paranasal sinus and the image diagnosis technical development, to the understanding, diagnosis level of nose department tumor raise further, opened widely a nose department thus surgical operation orientation certificate category, all had a substantial progress in the aspects of choosing that the surgical operation handles after entering the road, the assurance the surgical operation excision the scope and Shu and complications prevention etc..The developing of new technique that combine realms, such as laser, radio frequency and microwave...etc., and tiny principle for creating surgery, improved the understanding to round the surgical operation period to traditional nose, paranasal sinus tumor, pay attention to to hand over the boundary part tumor diagnosis and Shu type of quest, valued a nose and the paranasal sinus normal physiology function of keep intact with instauration, make the nose department tumor surgical operation just in the all-directions development, and become day by day the ear nose throat a head of neck surgery learns of an important realm.
A, the surgical operation adapt to certificate and pathological changes excision principle
(A)the surgical operation adapt to a certificate 1.Nasal cavity, paranasal sinus benign tumor.
2.The malignant tumor that limits at nasal cavity, paranasal sinus has no dirty machine in distance to transfer.
3.The nose, paranasal sinus malignant tumor infringes upon surrounding bone substance or Lu bottom bone substance and infringe upon hard meninges or brain substantial, the scope limits fore Lu nest have no distance organ to transfer.
(Two)the pathological changes cut off a principle
1.As far as possible at orthoptic sex integrity will cut off a lump body next time.The physical volume smaller benign tumor can make use of inside the mirror and the technique excisions, such as laser, radio frequency and microwave...etc..
2.The surgical operation presses to have no germ first, behind have germ order of sequence to carry on.Such as invasion nose, paranasal sinus tumor in the Lu is first proper inside the Lu, empress the Lu outside carry on surgical operation.
3.The close by organ, organization implicates, together with implicate part all cut off, then go a repair surgical operation.Break Lu bottom such as the nose, paranasal sinus cancer bone substance, infringe upon hard meninges inside the Lu or brain substantial damaged may also along together cut off.
Two, prepare before the Shu
1.Earnest check-up, understands pathological changes scope and whole body condition, bear to be subjected to surgical operation ability.
2.The analyzing of necessity room check understands the function appearance of each important dirty machine.If the electrocardiogram check, liver and kidney the function check, Ning blood the function check etc..
3.The image learns a check
(1)X line, CT or MRI check:With understand pathological changes scope, definitely and around the bone substance break degree.Like Shai plank, Shai Dou, the last Han Dou, Die Dou, Die bone, rock bone, and wing Tu...etc. have already had no break and break degree and close by cleft infringe upon circumstance.CT and MRI can know the entire content that understands tumor and it relationship with surroundings structure, cut off scope and draft a Shu type to contain important value to the valuation surgical operation.
(2)the number reduces shadow blood vessel to build a shadow(DSA):The blood vessel builds a shadow to understand the blood of tumor to provide a circumstance and mainly provide blood of blood vessel and vein reflux condition and it with Lu inside blood vessel of relation.Can carry on bolting to fill to mainly providing blood artery to bleed in the decrease Shu.
(3)malignant tumor's needing definitely have already had no distance to transfer.Shoot a slice of understanding to have matchless lung and Zong to separate to transfer such as the chest X line, the bone X line shot a slice of understanding to have no bone to transfer, the liver and kidney B was super to expel liver, .The kidney transfers etc..
4.Pathology's checking should go a pathology check before the Shu in principle and definitely diagnose.But can not carry on before the Shu for some parts specially sharing a sexually transmitted disease changing, live an organization check, or before the Shu many diseases of the check can not confirm but clinical height doubt is malignant tumor, should go to quickly keep a slice check in deep freeze in the Shu.
5.Have blood to probably keep on time and anticipate to lose blood circumstance the valuation Shu convenient blood and have blood according to the physical endowment condition, surgical operation of the pathological changes property, surgical operation scope and sufferer.
6.Antibiotic the applied parts of surgical operationses before the Shu should prevent sex from using before the Shu antibiotic.Unite into road surgical operation such as Lu one side, should calm down to note antibiotics for a day before the Shu, should enhance one more in the Shu, the nasal cavity drop is used antibiotics, the nasal cavity secretion is more, go nasal cavity to flush in the meantime.
7.To the companion press to increase Gao Zhe inside the Lu, should use 20% sweet dew Chuns first, the dehydration declines Lu to press, improvement sufferer general circumstance, increment the sufferer be subjected to sex to the bearing of surgical operation.
Three, the surgical operation enter the choice of road and Shu type
The surgical operation enters the choice of road and Shu type mainly to infringe upon part and scope but settle according to the pathological changes property, pathological changes.
(A)the Shu type choose a principle
1.The Shu type can promise Shu at orthoptic under white up but under, goes to from the outside inside, from shallow and deeply and gradually or a time of integrity cut off tumor.
2.As far as possible avoiding hurting hard meninges, the brain brain nerves, such as organization, work, Ⅱ , Ⅲ , Ⅳ , V and Ⅵ ...etc. and artery and vein in the Shu is afferent.If the harm can not avoid, should as far as possible make the harm reduced to lowest limit, the Shu type should as well satisfy wild in same Shu in to the repair of each structure wound.
3.Can availably control Shu to bleed in the artery, vein that may take place.
4.Be advantageous to to the repair and orthopedics of the organization harm.
(Two)main enter road Shu of type
1.Nose side's cutting open Shu is the ideal that cuts off nasal cavity, last seamy side of Han Dou and the tumor of Shai Dou to enter road, after canning also extend to handle set the pathological changes of the Shai Dou, sum Dou and Die Dou, the soft organization extensively implicating to the nasal cavity and the top Han Dou can also do selectivity excision.The advantage of this Shu type is the visual field is generous and is advantageous to the curing for good of tumor sex excision, the weakness is a face to leave behind scar formation.
2.The noodles exact center lifts to turn over a full revelation double of Shu Shu type's ability a side up before the Han wall and nasal cavity structure, the ability is good to approach to separate in the nasal cavity, nose, last Han Dou, the Shai Dou, Die Dou and nose swallow and slope etc. dissect part, after cutting off the area's tumor, the face doesn't leave behind scar formation.
3.The mirror surgical operation in the nose the majority thinks for limit at nasal cavity of or last pathological changes of Han Dou of the nasal cavity Die Dou, the Shai Dou tie limit, can adopt mirror surgical operation inside the nose, more extensive pathological changes should adopt other Shu types or mirror inside the nose to combine together with other Shu types.The advantage of the Shu's type is can accurate assurance tumor part, reserve to glue film and bone structure as usual, avoid face scar formation, the weakness is a disadvantage in stop bleeding, and operate for single hand.
4.Lu one side unites into the road tumor resection Shu's type to be applicable to excision to break ex- Lu bottom bone substance, infringe upon the tumor of hard meninges or invasion brain organization, can inside an excision Lu and the tumor out of the Lu.According to the scope of tumor can in advance the nest sum bone petal opens Lu Shu to cut off tumor to invade before the Lu and of hard meninges and Lu brain organization, again go the nose side of extension to cut open Shu, tumor cut off nasal cavity and paranasal sinus, can repair the hard meninges and Lu bottom defection and damage of cut off or damaged in the meantime.Include three kinds of familiar enter road:The sum goes forward road, the sum plank inside the Dou to enter road and is entered road by Kuang good luck.
(1)the sum upper part unite resection into road Lu one side:Adopt nasal cavity, paranasal sinus surgical operation to add a sum into the road top hair border inside slice.Open Lu in the Shu, the creation sum bone petal, orthoptic next expose ex- Lu bottom, and make sure the invasion scope of pathological changes inside the Lu, at safe boundary is the whole piece of excision tumor and reduce a pathological changes to remain and blood vessel inside the Lu, nerve of harm.Nose and the Han noodles area tumor should cut off district according to the scope assurance of the partial pathological changes, hard meninges can also cut off to implicate when it's necessary, and carry on a period repair.Lu bottom bone substance defection and damage more big, may also a period repair.The surgical operation leads long to pull to the brain organization, the interference is more big, Shu behind should press the surgical operation request inside the Lu, notice Lu to press variety, prevent°from brain dropsy, give in time dehydration;
Before the Shu, Shu in, the Shu apply amount of foot behind antibiotics.
(2)the sum plank inside the Dou unite resection into road Lu one side:The normal regulations nose side cuts open the slicing of Shu a people's top end to up postpone to deliver through the sum department person border, do to suffer from the side sum organization petal, open the sum plank inside the Dou, orthoptic next expose ex- Lu bottom, the whole piece of excision pathological changes, surgical operation to brain organization the interference is lighter.But the Lu bottom is invaded the scope wide case and sum Dou to develop bad or have never developed should not apply this Shu type.
(3)Kuang the last good luck unite resection into road Lu one side:Make the sum department skin petal inside the sum department hair border, the good luck that the skin petal is forward anti- to fold to Kuang, separate Kuang periosteum into Kuang, make sum bone and Kuang coping two pieces of bone petals respectively, enter before the person Lu bottom.This enters a road advantage BE:Expose Lu bottom the pathological changes is better, the brain organization leads little, expose after the Shai Dou, Die Dou, last Han Dou and Kuang to the upper part the best, because the bone petal includes the good luck and the parts of Kuang crest of Kuang, don't need to make a nose side again to cut open, the hairdressing is effective.But the Kuang last nerve and artery may be damaged for the place of its shortage.
Four, the Shu handle behind and main complications
(A)the Shu handle behind
1.Protect especially after the Shu should special attention, state of mind, breath, blood pressure, pulse and electrolyte balance.
2.Applied amount of foot can through the blood brain shield of antibiotics.
3.Lu one side unites into road surgical operation should notice to press a circumstance inside the Lu and give when it's necessary dehydration.
4.Keep hard chamber outside the meninges and skin bottom leads to flow to take care of lucid, the 7~1 O d draws out nasal cavity to stop up a thing after the Shu, if have already transplanted a thing attention the perturbation is not.If the nasal cavity coping has knot Jia, cans treat it to shed off by oneself.
(Two)main complications
1.Bleed after the Shu many stop halfway blood ill success with Shu, the Shu chamber stops up more loose relevant.The surgical operation operates proper agile, stop bleeding proper much can avoid thoroughly.
2.Be infected inside Shu chamber or Lu and inside the Kuang each link of surgical operation keep while having no germ appearance, with decrease opportunity to be infected, surgical operation operation should first inside the Lu, after Lu outside.The hard meninges breaks into abuse to want to cautiously repair and ensure tight close, prevent°from brain ridge of the liquid nose leaks of be infected inside occurrence and Lu.
3.The brain ridge liquid nose's leaking is much repaired by the hard meninges damaged area rickety cause.The past hard meninges should use again after using and visiting to leave a Jin film a repair bigger take Di Jin of film overlay, and notice to sew up fix and oppress, much can avoid.Even if the earlier period has a light degree to leak a liquid after the Shu, much can from more.
4.The Lu bone defection and damage area after the hair brain Peng to Lu bone to compare with the big, the bone substance defection and damage should go to repair inside the Lu, can adopt bone plank inside the sum bone, the rib cartilage, bone cement or artificial living creature material carry on.
5.The sense of smell obstacle this complications that makes it lively for to avoid, and can not recover.Therefore should explain to the sufferer before the Shu.