鼻窦球囊导管扩张术的远期疗效分析

目的 评估鼻窦球囊导管扩张术的安全性和有效性.方法 应用鼻窦球囊导管扩张术治疗48例(94侧)慢性鼻窦炎伴或不伴鼻息肉以及霉菌性鼻窦炎和鼻窦囊肿患者,随访1年、2年,分析手术前后鼻内镜检查、冠状位鼻窦CT检查结果,用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评分观察手术效果,以SNOT-20调查表评价预后.结果 患者主观症状均有不同程度改善,SNOT-20评分表中各项与术前比较差异有统计学意义(P＜0.01).鼻内镜检查见窦口通畅,与术前比较差异有统计学意义(P＜0.01),7例(8侧)窦口肿胀、狭窄可在术后随访过程重新扩大处理.1例出现眶周淤斑,无颅底和眼眶等严重并发症.结论 鼻窦球囊导管扩张术操作简便,能有效解除窦口阻塞,同时能够保留鼻腔鼻窦的正常结构,手术微创,出血少,安全有效.鼻内镜检查和鼻窦CT客观上反映了手术的良好转归.对合适的伴或不伴鼻息肉的鼻窦炎病例,可单独应用鼻窦球囊导管扩张术或联合标准的鼻内镜鼻窦手术.

Long-term efficacy of balloon catheter sinusotomy.

Objective To evaluate the safety and efficacy of the balloon catheter sinusotomy. Methods 48 patients （ 94 sides） with chronic sinusitis accompanied nasal polyps or not, fugal sinusitis and cyst of nasal sinus received bal- loon catheter dilation, and they were post-operatively followed up in 1 or 2 years. Endoscopic examination and coro- nal CT scanning were pre-operatively and post-operatively carried out. Lund-Kennedy endoscope and Lund-Mackay nasal sinus CT scoring system were adopted to score and evaluate surgical effect, in addition, SNOT-20 questionnaire was introduced to evaluate prognosis. Results All subjective symptoms were improved to different degrees. Post- operative score of each item on the questionnaire SNOT-20 was different from that of the pre-operative questionnaire （ P 〈 0. 001 ）. Ostial patency rate under endoscopic examination was highly increased （ P 〈 0.01 ）, and swelling and limited ostium of 7 cases （8 sides） was enlarged in the follow-up period. Lund-Mackay nasal sinus CT scoring sys- tem showed that there was a significant difference between the pre-operative and post-operative scores. Peri-orbital ecchymosis occurred in 1 case, however no severe complications such as skull base and orbit injuries occurred. Con- clusion The minimally invasive surgery, nasal sinus balloon catheter dilation is safe and easy to operate, which can effectively relieve blocking sinus and maintain normal structure of the nasal cavity and the sinus. The evidently im- proved subjective symptoms and outcomes reflect on endoscopic and CT scans. Nasal sinus balloon catheter dilation combined with or without standard endoscopic sinus surgery can be adopted for suitable patients with chronic sinusitis accompanied with nasal polyps or not.