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目的讨慢性鼻-鼻窦炎鼻息肉内镜手术严重并发症的分类、发生率及其影响因素,以期从中获得启示。方法对随访资料完整的1102例(1769侧)慢性鼻-鼻窦炎鼻息肉患者内镜手术发生21例次严重并发症的情况进行总结、分析。结果21例次严重并发症包括:眶内血肿3例次、眼内直肌损伤2例次、视力丧失1例次、颅内血肿1例次、脑脊液鼻漏3例次、鼻泪管阻塞3例次、鼻中隔穿孔2例次、大出血2例次、下肢血栓形成2例次、术后哮喘发作2例次。严重并发症的发生率为1.91%(21/1102),其中眼部并发症(0.54%)和颅内并发症(0.36%)发生率较高。患者的病变范围、前期手术史和术者的手术经验及技巧是影响严重并发症发生率的重要因素。结论导致鼻内镜手术严重并发症的因素众多,然而主观因素比客观因素起更大的影响作用,其中以术者的手术经验尤为重要。
Objective To discuss the classification, incidence and influencing factors of severe complications of endoscopic sinus surgery for chronic rhinosinusitis and nasal polyps, in order to gain enlightenment. Methods A total of 21 cases of secondary serious complications of endoscopic surgery in 1102 cases (1769 sides) with chronic sinusitis and nasal polyps with complete follow-up data were summarized and analyzed. Results 21 cases of severe complications included 3 cases of orbital hematoma, 2 cases of intraocular rectus injury, 1 case of visual loss, 1 case of intracranial hematoma, 3 cases of cerebrospinal fluid rhinorrhea and 3 cases of nasolacrimal duct obstruction Cases, nasal septum perforation 2 cases, 2 cases of bleeding, lower extremity thrombosis in 2 cases, 2 cases of postoperative asthma attacks. The incidence of serious complications was 1.91% (21/1102), with a higher incidence of ocular complications (0.54%) and intracranial complications (0.36%). The extent of the patient’s lesion, the history of previous surgery and surgeon’s surgical experience and skills are important factors affecting the incidence of serious complications. Conclusion There are many factors leading to serious complications of endoscopic sinus surgery. However, the subjective factors play a more significant role than the objective factors, and the surgical experience of the surgeons is particularly important.