小钻孔鼻内双入路内镜下额窦开放术的临床价值研究

目的：探索小钻孔、鼻内双入路内镜下额窦开放术的临床价值。方法：根据术前鼻内镜及CT检查结果进行评估，挑选术中可能出现引流通道识别困难的26例慢性额窦炎患者进行研究。双入路组11例（13侧），采用小钻孔、鼻内双入路内镜下额窦开放术，首先在额窦前壁钻直径4～5mm骨孔，通过注水冲洗、光照、顺行法放入导管等方法显示额窦引流通道位置，经鼻内、鼻外双入路行额窦开放术；鼻内镜组15例（18侧），常规行鼻内镜下额窦开放术，采用Friedman的“钩突径路”术式。术后定期随访处理。结果：双入路组均顺利找到额窦开口，完成额窦开放，无手术并发症；鼻内镜组出现眶纸板损伤2例，筛前动脉损伤1例。随访10～24个月，双人路组额窦口通畅11侧（85％），狭窄2侧；鼻内镜组通畅15侧（83％），狭窄3侧；两组均无完全堵塞者。结论：前壁小钻孔、鼻内双入路内镜下额窦开放术治疗慢性额窦炎安全性高，疗效好，可提高术者对额窦引流通道解剖认知水平及额窦手术技能，值得在基层医院推广。

Endoscopic minitrephination combined with endoscopic frontal sinusotomy for management of chronic frontal sinusitis

Objective：To evaluate the efficacy of endoscopic minitrephination combined with endoscopic frontal sinusotomy in the management of complex chronic frontal sinusitis. Method： Twenty-six patients suffering from chronic frontal sinusitis with complex frontal drainage approach were analyzed. Eleven patients （13 sides） received endoscopic minitrephination combined with endoscopic frontal sinusotomy, while the other 15 patients （18 sides） received endoscopic frontal sinusotorny only. Postoperatively all cases were followed up to evaluate the efficacy. Result：The ostia of frontal sinus were successfully opened in the group of patients received endoscopic minitrephi- nation combined with endoscopic frontal sinusotomy without any complications. In the endoscopic frontal sinusoto- my only group, three cases of complications were observed, one with the injury of anterior ethmoidal artery and the other two with the injury of papyraceous lamina. After 10 to 24 months of follow up postoperatively, the symptoms were relieved in all cases without recurrence. The combined surgery group with endoscopic minitrephi- nation showed an endoscopic frontal sinus patency rate of 85 %, and the endoscopic frontal sinusotomy only group exhibited an endoscopic frontal sinus patency rate of 83 %. Conclusion： Endoscopic minitrephination combined with endoscopic frontal sinusotomy is a simple, convenient, safe and effective method for management of complex chronic frontal sinusitis.