鼻内镜手术中扩大上颌窦自然口的意义

目的：探讨鼻内镜手术中扩大上颌窦自然口对上颌窦炎转归的影响。方法：将慢性上颌窦炎218例随机均分为两组，A组的手术范围是切除钩突、筛泡，开放前、中、后组筛窦，扩大上颌窦自然开口，切除部分肥厚明显的中鼻甲；B组手术范围是切除钩突、筛泡，开放前、中组筛窦，不处理上颌窦自然开口，尽量保留中鼻甲,特别肥厚者也行部分切除。结果：218例均随访1年以上。按海口1997年疗效评定标准，A组治愈100例,治愈率92%，B组治愈99例,治愈率91%；A组好转9例,好转率8%，B组好转10例,好转率9%。结论：鼻内镜手术范围的关键是切除窦口鼻道复合体的解剖变异，是否扩大上颌窦口并不十分重要。

Role of enlarging ostium maxillary in endoscopic sinus surgery

Objective: To explore the role of enlarging ostium maxilare on chronic maxillary sinusitis in endoscopic sinus surgery. Methods: A total of 218 cases suffering from chronic maxillary sinusitis and receiving endoscopic sinus surgery were divided into two groups at random. In group A, both uncinate process and ethmoidal bulla were excised, and anterior and posterior ethmoid cells were opened, ostium frontale was opened, ostium maxilare was enlarged, mostly plump middle turbinate was excised. In group B, uncinate process and ethmoidal bulla were resected, anterior ethmoid cells were opened, and ostium maxilare and middle turbinate were reserved. Results: On the standard of 1997(Haikou), the cure rate was 92% in group A and 91% in group B, and the mend rate was 8% in group A and 9% in group B in a follow up of more than one year. There was no significant difference between the two groups. Conclusion: The key for transnasal endoscopic surgery is resection of the anatomical variation of ostiomeatal complex but not enlargement of the ostium maxillary.