传统上颌窦根治术后上颌窦骨质增生瘢痕形成临床观察.docVIP

传统上颌窦根治术后上颌窦骨质增生瘢痕形成临床观察 　 作者：乔莉，邱建华，陈福权，黄华，薛涛 【关键词】 上颌窦/外科学；骨质增生；瘢痕 【Abstract】 AIM: To study the pathological changes of maxillary sinus in the patients after conventional maxillary radical treatment, CaldwellLuc operation, and discuss its clinic significance. METHODS: Retrospective analysis was conducted in 136 patients who needed operation again due to recurrence of nasosinusitis and polyp after CaldwellLuc operation. The hyperosteogeny and cavity volume of maxillary sinus were detected by preoperative CT scanning. The local situations of maxillary sinus intracavity and inferior meatal opening were observed during functional endoscopic sinus surgery. RESULTS: The increased intracavity densities and osseous hyperplasia of maxillary sinus were seen in 48 cases of these 136 patients (35%) by CT examination. Large amounts of scar tissues were found in maxillary sinus cavities during the operation in the 48 cases, and 22 cases of which (46%) developed imperforation of inferior meatal openig. Besides, the occurrence of simple imperforation was confirmed during operation in 26 cases of the 88 patients (30%) without positive finding of preoperative CT examination. CONCLUSION: The conventional maxillary radical treatment, CaldwellLuc operation, can lead to hyperosteogeny and scar formation of maxillary sinus. So, it is important to strictly master the indications for decreasing the incidence of complications. 【Keywords】 maxillary sinus/surgery; hyperosteogeny; cicatrix 【摘要】 目的： 研究传统上颌窦根治术后上颌窦局部骨质增生与瘢痕形成的病理改变情况,并讨论其临床意义. 方法： 回顾性分析136例曾行传统上颌窦根治术，后因复发鼻窦炎或鼻息肉来我院就诊且需行手术治疗的患者，术前CT扫描分析上颌窦骨质增生及窦腔容积变化程度以及术中内镜下观察上颌窦腔及下鼻道开窗情况. 结果： 在136例中有48例（35%）术前CT检查发现上颌窦腔密度增高，明显骨质增厚. 手术发现窦腔明显缩小，腔内大量瘢痕. 在48例骨质增生患者中有22例（46%）下鼻道开窗闭锁. 在术前CT显示无上颌窦腔密度增高及骨质增厚的88例病例中，有26例(30%)术中发现有单纯性下鼻道开窗闭锁. 结论： 传统上颌窦根治术可引起上颌窦腔骨质增厚瘢痕形成，降低并发症的重要方法是严格掌握适应症. 【关键词】 上颌窦/外科学；骨质增生；瘢痕 传统上颌窦根治手术是以彻底清除患窦的黏膜组织以及上颌窦低位开窗引流为原则. 因没有充分考虑黏膜纤毛的功能，术后可出现不可逆并发症. 而这种手术方式在一些地方仍然是治疗上颌窦炎的主要方法. 我们回顾性研究2～25 a前因上颌窦炎行传统上颌窦根治术，后因复发鼻窦炎或鼻息肉来我院就诊需