鼻内镜下3种手术路径治疗上颌窦后鼻孔息肉比较

目的:比较鼻内镜下3种手术路径治疗上颌窦后鼻孔息肉（antrochoanal polyp，ACP）的临床疗效。方法:51例ACP病人，随机分成3组，分别采用3种不同的手术路径结合鼻动力系统清除病变，A组21例经中鼻道上颌窦自然开口路径，B组15例经下鼻道开窗路径，C组15例经犬齿窝处开窗路径。结果:3组病人手术时间、术中出血量差异有统计学意义（P<0.01），A、B组手术时间及术中出血量明显均高于C组（P<0.01），随访12~48个月，3组间病情完全控制和病情部分控制率比较差异无统计学意义（P>0.05），但A组病情未控制率均高于B组和C组（P<0.01和P<0.05）。术后A组2例出现鼻腔粘连，B、C组均无并发症出现，3组间并发症发生率差异无统计学意义（P>0.05）。A组复发4例，B组复发1例，C组无复发，3组复发率比较差异无统计学意义（P>0.05）。结论:鼻内镜手术具有较好的安全性，可有效控制ACP复发率，下鼻道开窗及犬齿窝路径可使ACP病人病情得到有效控制，犬齿窝处开窗路径手术时间短、出血少，可获得较好的视野。

Effect comparison of three nasal endoscopic approaches in the treatment of antrochoanal polyp

Objective:To compare the clinical efficacy between three nasal endoscopic approaches in the treatment of antrochoanal polyp(ACP).Methods:Fifty-one patients with ACP were randomly divided into the group A(21 cases),group B(15 cases)and group C(15 cases).The group A,group B and group C were operated from maxillary sinus ostium through middle meatus,inferior meatus and canine fossa,respectively.Results: The differences of the operation time and intraoperative bleeding between three groups were statistically significant(P<0.01),and the operation time and intraoperative bleeding in group A and group B were significantly more than those in group C(P<0.01).During the following up for 12 to 48 months,there were no statistical significance in the total and partial control rate between three groups(P>0.05),and the uncontrol rate in group A was significantly higher than that in group B and group C(P<0.01 and P<0.05).Two cases with nasal adhesion in group A,and no complication in group B and group C were found,and there was no statistical significance in the incidence rate of postoperative complication between three groups(P>0.05).Four cases in group A recurred,1 case in group B recurred,no case in group C recurred,and the difference of the recurrence rate between three groups was not statistically significant(P>0.05).Conclusions:Nasal endoscopy in the treatment of ACP is safe,which can effectively control the recurrence rate.The surgical approaches through inferior meatus and canine fossa can effectively control the patients'condition.The surgery through canine fossa has the advantages of short time,little bleeding and good view.