Application Of Intranasal Endoscopic Surgery In Rhino-obital And Rhino-basicranial

Objective:In the 1980s, nasal endoscopic surgery was set up in china. Initially, it was mainly used in diagnosis of nasal disease. Its development undergoes exploration, flourishing and sustained development stages. After the three stages, the technique is mastered by more and more physicians in the department of Otolaryngology Head and neck surgery. With the development of basic research and clinical research unceasingly, the improvement of operation technique, the new progress of the imageology studies, the application of endonasal endoscopy is expanding gradually. It is no longer confined to the otolaryngology head and neck surgery, and gradually involved in various fields of ophthalmology and skull base surgery. In this study, the clinical data of the extended application of endonasal endoscopy were retrospectively analyzed in the Department of Otolaryngology Head and Neck Surgery, the Affiliated Hospital of Luzhou Medical College in order to explore the application of the endonasal endoscopic surgical technique in the rhino-obital diseases and rhino-basicranial diseases, and summarize the surgical experience in our hospital. Methods:A total of 77 patients with rhino-obital diseases and rhino-basicranial diseases accepted the endonasal endoscopic surgery in our department from January 2000 to December 2013. Their medical data, including gender, age, diagnosis, date of surgery, surgical procedures, operation time, complications, operative blood loss, prognostic and so on, were collected and analyzed. The diagnosis and surgical procedure selection was based on preoperative nasal endoscopy, biopsy and imaging examination. The one-handed and/or four-handed technique was used during operation. The postoperative follow-up matters were discharged by surgeons. The patients were regular follow-up with endoscopy, ophthalmology examination, imaging examination and pituitary hormone examination. Follow-up data was obtained through correspondence, telephone and outpatient department visits, observing the improvement of symptoms, sings and the variety of the laboratory indexing. Moreover, the data of the patients with tumor include recurrence, metastasis and survival was also collected. Results:(1)Among these 77 patients, there were 60 cases of rhino-obital diseases,17 cases with rhino-basicranial diseases. (2)The rhino-obital diseases underwent the endonasal endoscopic surgical technique included rhinosinusogenic orbital complications, chronic dacryocystitis and obstruction of the nasolacrimal duct, postocular mass, foreign body in orbit, traumatic optic neuropathy, complex orbital fracture. The rhino-basicranial diseases applied the endonasal endoscopic surgical technique included pituitary adenoma, cerebrospinal fluid(CSF) rhinorrhea, the anterior skull base lesions, chordoma, cranionasal tumors, craniopharyngioma. (3)There were 12 cases with complications, including 9 cases of rhino-obital diseases,3 cases of rhino-basicranial diseases. The complications included intraoperative blood loss over 500ml in 6 cases (treated by blood transfusion), periorbital swelling in 5 cases (resolution of 2-6 days after surgery), orbital hemorrhage in 1 case, postoperative fever in 1 cases(suspected intracranial infection). The ratio of complications was 15.58% (12/77). (4)With 4 months to 10 years follow-up,26 cases suffering sinus cyst with orbital complications were cured after incision ostomy,9 out of 11 cases with chronic dacryocystitis and obstruction of the nasolacrimal duct were cured,1 case improved, invalid in 1 case, after endonasal endoscopic dacryocystorhinostomy (EN-EDCR).10 cases of nasal benign tumors,8 cases were cured,2 cases relapsed.5 cases of nasal malignant tumor, the tumor were totally removed,3 cases recrudesced,1 case was death, recurrence and death patients refused actinotherapy and chemotherapy. Inflammatory lesions in 3 cases, including chronic rhino-sinusitis in 2 cases and 1 case of fungal rhino-sinusitis, were cured by function endoscopic sinus surgery (FESS). Postocular mass in 2 cases,1 case was cured, the other was recurred. The case of foreign body was successfully taken out. Traumatic optic neuropathy (TON) improved after endoscopic optic nerve decompression (EOND). Complicated orbital fracture of 1 case was improved.4 cases of pituitary tumor were cured by endoscopic transsphenoidal removal. CSF rhinorrhea in 5 cases were cured. The anterior skull base lesions in 4 cases were cured. The two cases of chordoma,1 case was cured, and the other case recidivatied.The case of cranial-nasal communicating tumor relapsed and dead in 1 year after operation. The case of craniopharyngioma was cured. Conclusions:(1) Endonasal endoscopic surgery provides a safe, effective, minimally invasive surgical procedures for rhino-obital and rhino-basicranial diseases. (2) The indications of the endonasal endoscopic surgical technique in the rhino-obital diseases and rhino-basicranial diseases should be strictly mastered, meanwhile, complications shouldn’t be ignored. (3) The application and development of the endonasal endoscopic surgical technique are closely linked with relevant departments, such as the department of Ophthalmology, the department of Neurosurgery, the deepartment of Neurology and the department of Imaging. (4) Because of the small amounts cases underwent the application of the endonasal endoscopic surgical technique, it is needed to strengthen the application of the endoscopic surgical technique, promote the personal training, encourage the communication and cooperation among different departments.