孤立性蝶窦炎性疾病的诊治

目的 :提高对孤立性蝶窦炎性疾病症状、体征的认识和首诊准确率。方法 :分析 4 9例孤立性蝶窦炎性疾病的临床表现 ,比较非内窥镜手术 10例和内窥镜手术 39例的手术效果。结果 :未经鼻窦内窥镜手术者 ,1例行蝶窦灌洗后头痛立即缓解 ,4例症状在 1周内缓解 ,5例 2～ 4个月后症状复发 ,窦口瘢痕狭窄阻塞 ,需手术切开引流。经鼻窦内窥镜蝶窦开放术者 ,治愈 31例 ,其中 10例手术后症状立即消失 ,2 1例术后 3～ 5d症状缓解 ;好转 8例 ,其中 5例仅感轻微头痛和嗅觉失灵 ,鼻内窥镜见窦口粘膜肿胀 ,CT、MRI复查未见窦腔病变 ;3例术后2个月视力恢复。术后 1个月复诊窦口开放率为 87.2 %。随访 6～ 4 8个月无病变及症状复发 ,未再次手术。结论 :孤立性蝶窦炎经CT或MRI等高清晰度的影像学检查加之以鼻窦内窥镜检查均可明确诊断 ,且经鼻窦内窥镜手术对其治愈有显著的优越性

The diagnosis and treatment of isolated sphenoid sinus disease

OBJECTIVE: To detail the underlying symptoms and signs of patients with isolated sphenoid sinus inflammatory disease and enhance the initial diagnostic accuracy. METHOD: 49 patients with isolated sphenoid sinus inflammatory disease were reviewed, and the outcomes of the endoscopic surgery were compared with the non-endoscopic surgery. RESULT: In patients who underwent endoscopic sphenoidotomy, 31 were virtually free from symptoms and 5 still experienced mild headache and hyposmia but their radiographic finding had become normalized. None of them need re-operation within 6-48 months follow-up. However, in patients with non-endoscopic sinus irrigation, only one was free from the symptoms and 5 patients underwent re-operation because of recurrence. CONCLUSION: Nasal endoscopy and CT/MRI scan could provide a precise diagnosis for isolated sphenoid sinus disease and endoscopic surgery is valuable in its treatment.