鼻丘在鼻内镜下额窦开放术中的作用

目的总结鼻内镜下采用鼻丘径路开放额窦的疗效,并与以钩突为主要参考标志的鼻内镜下额窦开放术的疗效进行比较,探讨鼻丘在鼻内镜下额窦开放术中的作用。方法47例(85侧)患者接受鼻内镜下额窦开放术,其中鼻内镜下鼻丘径路额窦开放术26例(49侧),开放鼻丘前壁,经鼻丘后内上方开放额窦。以钩突为主要参考标志的鼻内镜下额窦开放术21例(36侧),通过判定钩突上端与鼻腔外侧壁附着点的位置开放额窦。结果①两组患者均平均随访9个月(6～12个月),术后所有患者主观症状均有不同程度的缓解,鼻内镜下评价两组患者的治愈率分别为84%和81%,差异无统计学意义(χ2=0.139,P>0.05);②近半数鼻丘径路手术可在0°鼻内镜下完成(46%),使用30°或70°鼻内镜相对较少;而钩突标志组手术全部需要使用30°鼻内镜,多数病例(71%)需要70°鼻内镜。结论鼻丘和钩突同为鼻内镜下额窦开放术的重要参考标志,根据患者病情正确选择手术方式,可获得满意疗效。

Endoscopic frontal sinus surgery through agger nasi cell approach

Objective To evaluate the access to the frontal recess by identifying the agger nasi cell and uncinate process. Methods Fourty-seven patients (85 sides) who underwent endoscopic frontal sinus surgery in our department constituted the study population. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal ostium was identified by using agger nasi cell approach or identifying the uncinate process. Results The frontal sinus ostium was identified in 100% of patients (85 sides). After an average follow-up of 9 months, 41 sides of 49 sides (84%) had endoscopically healed sinuses by using agger nasi cell approach. And 21 sides of 36 sides (81%) had endoscopically healed sinuses by identifying the uncinate process. Conclusions The agger nasi cell approach to the frontal recess gives an access and allows identification of the frontal ostium. In addition, it provides direct visualization with a 0 degree endoscope into the frontal recess.