医学论文-鼻内镜术上颌窦自然开口的处理.docVIP

医学论文-鼻内镜术上颌窦自然开口的处理 【摘要】? 目的 探讨内镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法 配对研究56例双侧鼻窦炎、鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果 窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分别为92.9%和80.4%（随访6个月时）。回顾性观察51例施Caldwell-Luc术的患者，下鼻道造口的术后开放率仅为40.6%。分析38张单侧鼻窦炎或鼻息肉的鼻窦CT片，测量对照侧与病变侧的上颌窦口膜样部的上下径和前后径，差异无显著性。病变侧上颌窦口周围的中鼻甲气化、增生及钩突偏曲、筛泡骨性增生等解剖结构异常的发生率明显高于对照侧（P＜0.05)。结论 鼻内镜下处理上颌窦自然开口的关键是窦口周围的解剖异常因素 【关键词】? 鼻窦炎；鼻息肉；内镜术；上颌窦 　　Ostium of maxillary sinus in endoscopic sinus surgery ??? 　　XIE Zhi-gou,CHEN Yan-lin. 　　Department of the ENT,Head and Neck Surgery,The First People’s Hospital of Xiaogan City,Hubei 432000,China??????? 　　【Abstract】? Objective? To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps.??? Methods? Fifty-six patients(112 sides)undergone endoscopic sinus surgery were studied.??? Results? The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively.Fifty-one patients(64 sides) undergone Caldwell- Luc operations were retrospectively studied.The patency rate of inferior antrostomy was 40.6%.CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed.The scale values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group.Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. Conclusion? The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.??? 　　【Key words】? sinusitis;nasal polyps;endoscopy;maxillary sinus 　　临床观察发现鼻窦开口的粘连、狭窄或闭锁是慢性鼻窦炎、鼻息肉患者术后症状未控制或复发的原因之一，其中上颌窦开口狭窄相对较多。回顾性比较内镜下中鼻道开窗与下鼻道开窗的窦口开放率。通过配对研究扩大或不扩大窦口术后上颌窦开口的狭窄和闭合情况，比较病变侧与对照侧的上颌窦口膜样部的大小及窦口周围的解剖异常情况，探讨鼻内镜术上颌窦开口的处理方法。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 　　选择双侧病变接近的慢性鼻窦炎、鼻息肉患者56例，男35例，女21例，年龄14～65岁，平均36.8岁。其中慢性鼻窦炎37例，鼻息肉19例。参照Rice的手术方法［1］，每个患者一侧常规扩大上颌