慢性鼻窦炎鼻息肉再次内镜鼻窦手术

目的 探讨需行再次内镜鼻窦手术的原因，评价再次内镜鼻窦手术的疗效。方法 对114例（161侧）需行再次内镜鼻窦手术的患者术前行鼻内镜和鼻窦CT扫描检查，术后随访2例以上。结果 114例（161侧）中复发性鼻窦炎98例（129侧），复发性鼻息肉16例（32侧）。额隐窝狭窄2例（3例），前组筛窦炎18例（24侧），前组筛窦炎和上颌窦自然开口堵塞31例（46侧），中鼻甲粘连6例（7侧），后组筛窦炎18例（24侧），后组筛窦和蝶窦炎36例（54侧），蝶窦炎3例（3侧）。伴有鼻中隔偏曲者15例。经2年以上随访，复发性鼻窦炎者88例（111侧）痊愈，10例（18侧）症状缓解，16例（32侧）复发性鼻息肉患者11例（22例）痊愈，5例（10例）症状缓解。结论 行再次内镜鼻窦手术的原因主要是前次手术未彻底清除病变（首先与术者经验不足有关）；其次为鼻息肉病。再次内镜鼻窦手术效果满意，无严重并发症。

Revision endoscopic sinus surgery for chronic sinusitis and polyps]

OBJECTIVE: To investigate common reasons for revision endoscopic sinus surgery (RESS) and evaluate the effect of RESS. METHODS: Before the revision surgery 114 patients were examined by CT scans and nasal endoscopy, after surgery all the patients were followed up for more than 2 years. RESULTS: There were 16 cases of recurrence of polyps, 98 cases of recurrence of sinusitis. Among 114 cases there were 18 cases of anterior ethmoid sinus disease, 2 frontal recess stenosis, 31 anterior ethmoid sinuse disease with maxillary ostium obstruction, 6 middle turbinate adhesion, 18 posterior ethmoid sinus disease, 36 posterior ethmoid sinus disease with sphenoid sinus disease, 3 isolated sphenoid sinusitis. There were 15 cases with septal deviation. 99 cases were successful and 15 unsatisfied. CONCLUSION: Sinus disease that was not completely resected during the original surgical procedure due to the surgeon's less experience was the most common reason for the RESS, another reason was recurrent polyposis. The results were very rewarding except nasal polyposis.