儿童鼻内镜鼻窦手术30例临床分析

目的 探讨儿童开展鼻内镜手术治疗鼻息肉、鼻窦炎的经验、体会。方法 对30例儿童慢性鼻窦炎、鼻息肉病人全麻下行鼻内镜手术，术后随访1年以上。结果 治愈12例(40％)，好转14例(46．7％)，无效4例(13．3％)，总有效率86．7％。术后并发症主要是鼻腔粘连、窦口狭窄和闭锁。结论 鼻内镜鼻窦手术治疗儿童鼻窦炎、鼻息肉具有良好的疗效，但术者应十分熟悉儿童鼻窦的解剖特点，手术以纠正鼻腔、鼻窦的解剖异常、恢复其良好的通气和引流为目的，术后加强随访复查和综合治疗以提高疗效。     

鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿

目的：研究鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿和术后处理方法及长期疗效。方法：对24例侵入眼眶的鼻窦黏液囊肿患者,均采用鼻内镜下造口术;术后按内镜鼻窦手术后的常规处理,重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化。结果：随访1～5年。24例患者术后均无囊肿复发,无眶内并发症,眼球复位。结论：鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿,无复发和并发症,是一种值得推荐的手术方式;术后处理的重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化;长期复查是必要的。     

经鼻内镜鼻窦手术360例临床分析

目的 探讨经鼻内镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的远期疗效。方法 对1996-2000年360例（663侧）完成随访的鼻内镜手术进行临床分析。术后随访6个月-2年。结果 治愈率为73.15%，其中I型治愈率为92.53%，Ⅱ型治愈率为67.92%，Ⅲ型治愈率为44.44%，3型治愈率呈递减趋势。结论 鼻内镜手术是治疗慢性鼻窦炎和鼻息肉的有效方法，手术疗效与其临床分型密切相关。术中恰当处理中鼻甲、鼻中隔偏曲及术后的综合治疗，对鼻内镜鼻窦手术远期疗效具有重要的意义。     

垂体瘤切除术后鼻窦黏液囊肿形成临床分析

目的探讨垂体瘤切除术后鼻窦黏液囊肿形成的原因、好发部位及治疗方法。方法回顾性分析我科1998年1月至2007年8月诊治的7例垂体瘤切除术后鼻窦黏液囊肿患者的临床资料。结果7例中,筛窦黏液囊肿2例、额窦黏液囊肿2例、额窦、筛窦黏液囊肿3例。鼻内镜下鼻内进路或鼻内外联合进路行囊肿切除术,一次手术治愈,随访1-3年无复发。结论垂体瘤切除术后发生鼻窦黏液囊肿多因手术改变了鼻腔结构以及术后复查不及时造成中鼻道狭窄、粘连、鼻窦开口阻塞引起。垂体瘤切除术后鼻窦黏液囊肿好发于筛窦、额窦或额窦和筛窦并发。鼻内镜下鼻内进路或鼻内外联合进路行囊肿切除术是首选的治疗方法。手术中建立鼻窦鼻腔的通畅引流,术后定期检查可有效减少垂体瘤切除术后鼻窦黏液囊肿的形成以及预防囊肿切除术后复发。     

经鼻内镜手术治疗鼻窦黏液囊肿27例

鼻窦黏液囊肿的传统手术多采用鼻外径路、上颌窦根治术径路,且尽可能完整切除囊壁。随着鼻内镜手术的广泛开展,现多采用鼻内镜手术治疗。手术尽可能保证足够开放引流为原则。笔者介绍27例鼻窦黏液囊肿的鼻内镜手术治疗。     

常规照明下利用鼻内镜器械行鼻窦手术的体会

目的：介绍常规照明下利用鼻内镜器械行鼻窦手术的经验。方法：分析227例慢性鼻窦炎、鼻息肉病人在额镜照明下利用鼻内镜器械手术的疗效。结果：随访半年以上，227例病人治愈、好转、无效率分别是53．7％(122／227)、30．4％(69/227)、15．9％(36/227)；并发症14例。结论：额镜照明下利用鼻内镜器械行鼻窦手术治疗慢性鼻窦炎、鼻息肉疗效满意，优于传统鼻窦手术，可在不具备内镜的基层医院开展。     

导航鼻内镜下治疗鼻窦囊肿

目的 探讨应用影像导航系统在鼻内镜下治疗鼻窦囊肿的方法及优势。方法 在导航鼻内镜下对121例鼻窦囊肿施行手术,其中上颌窦黏液囊肿12例,上颌窦黏膜囊肿5例,筛窦黏液囊肿43例,额窦黏液囊肿29例,蝶窦黏液囊肿32例。均采用气管插管全麻,根据手术中的需要标定探针或吸引器作为术中的定位设备,在鼻内镜下使用导航定位设备以判断囊肿的准确位置,根据术中探针的指引通过最短的距离到达囊肿,完整或部分切除囊壁,通畅引流。结果 121例手术均准确定位了囊肿的位置,完成手术, 无术中、术后并发症发生。结论 影像导航系统结合鼻内镜治疗鼻窦囊肿具有定位准确、手术创伤小的优点,可以有效地提高手术疗效和避免并发症的发生。     

传统手术后复发性鼻窦炎鼻息肉的鼻内镜修正术

由于鼻腔鼻窦解剖结构的复杂性和鼻息肉本身具有易复发的特性,使得鼻窦炎鼻息肉术后复发成为困扰鼻科临床医师的难题.Kenndey等(1985)报道用鼻内镜手术治疗慢性鼻窦炎鼻息肉,治愈率可达80%,其复发率仍达20%.而许多基层医院因限于条件还未装备鼻内镜,因此还有大量的基层医院仍在以传统手术治疗鼻窦炎、鼻息肉.这些患者或因手术时限于条件为避免严重并发症的发生导致手术不彻底,或因患者不能按时随访清理而导致复发,复发率远远高于20%.我们从2002年1月～2003年12月开始采用鼻内镜修正术治疗传统手术后复发性鼻窦炎鼻息肉,取得了较好疗效,现选取资料完整、定期随访的75例报告如下.     

经鼻内镜鼻窦手术237例临床分析

目的探讨经鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉的远期疗效及影响疗效的相关因素。方法回顾性分析1999～2003年237例接受经鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉患者资料，术后随访7-24个月。结果本组病例治愈175例（73.8％)，好转41例(17.3％)，无效21例(8．9％)，总有效率91．1％。结论经鼻内镜鼻窦手术具有较好的疗效，其疗效与临床分型、手术前后用药、定期换药等综合因素有关。     

鼻内镜手术96例体会

目的：探讨在基层医院开展鼻内镜手术治疗鼻息肉、鼻窦炎的体会。方法：对96例慢性鼻窦炎鼻息肉病人行鼻内镜手术，术后随访半年以上。结果：治愈69例（71.9％），好转24例（25％），无效3例（3.1％），总有效率96.9％。术后并发症主要是鼻腔粘连、上颌窦口狭窄。结论：鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉具有良好的疗效，尽管在基层医院条件差，落实好围术期每一个环节，仍可取得满意疗效。     

Cholesterol granulomas in antrochoanal polyps: a clinicopathologic study

The purpose of this study was to investigate antrochoanal polyps with cholesterol granuloma (CG), which is a granulomatous reaction to cholesterol crystals that has been precipitated in the tissue. It is usually associated with chronic middle ear disease, common in the mastoid air cells, less common in the orbit and rarely found in the paranasal sinuses. The aim of this study was to analyze the etiology and pathological findings of antrochoanal polyps associated with cholesterol granuloma. This is a retrospective study of five cases of antrochoanal polyp with cholesterol granuloma, (four males and one female between 15 and 77 years of age) who presented with nasal obstruction, rhinorhea and snoring. The cases were clinically and histologically reviewed. Four patients were treated endoscopically and one by intranasal polypectomy without endoscope. There was no recurrence during the follow-up between 24 to 36 months (mean 31.2 months). Five uncommon cases with antrochoanal polyp with cholesterol granuloma are presented. The cholesterol granulomas consist of fibrous granulation tissue containing cholesterol crystals with surrounding foreign body giant cells. The pathogenesis of antrochoanal polyp with cholesterol granuloma is unclear, and further investigations are needed.     

霉菌性鼻窦炎临床诊治分析

目的探讨霉菌性鼻窦炎的诊断分型和治疗方法。方法回顾性分析21例霉菌性鼻窦炎病人临床资料，全组病例均行手术治疗，其中功能性鼻窦内镜手术(FESS)13例、柯陆氏5例、鼻内镜下单纯蝶窦开放术1例、FESS加蝶窦开放术2例。结果21例病人均治愈，且均经术后病理证实。结论霉菌性鼻窦炎以上颌窦多发，蝶窦、筛窦次之、额窦最少，分型以非侵袭性霉菌性鼻窦炎最常见，CT检查是早期诊断的有效途径。疗效预后关键在于鼻窦开放程度、引流通畅与否。     

Cholesterol granuloma and aspergilloma of the maxillary sinus

Cholesterol granuloma (CG) of the paranasal sinuses is rare. The proposed mechanisms of initiation are haemorrhage, impaired drainage and obstruction of ventilation. To the best of our knowledge, association of CG with a specific infection has not been described before. We have recently observed CG and aspergilloma of Aspergillus flavus type from the left maxillary sinus of a 58-year-old male patient presenting with nasal obstruction, headache and postnasal discharge. Any causative relationship between the two findings is obscure. The suspected mechanisms underlying aspergilloma and CG of the paranasal sinuses seems similar, since there is obstruction of ventilation and drainage. The cholesterol accumulation cannot be attributed to cellular components or breakdown products of the aspergillus as the major sterol of the plasma membranes of fungi is ergosterol, not cholesterol. Received: 15 February 2000 / Accepted: 31 October 2000     

中耳胆固醇肉芽肿

目的 探讨中耳胆固醇肉芽肿的病因、发病机制以及治疗方法。方法 回顾性总结分析我院1988年3月～2003年3月经手术和病理证实的70例(耳)中耳胆固醇肉芽肿病人的临床资料。70例(耳)中，术前诊断为胆脂瘤型中耳炎37例，骨疡型中耳炎13例，此二者之中考虑胆固醇肉芽肿者13例；中耳乳突术后感染5例，分泌性中耳炎7例，特发性血鼓室8例，其中考虑可能为胆固醇肉芽肿者2例。所有病人均有不同程度听力下降、耳闭塞感或伴耳鸣，亦可有耳溢液、头痛、头昏及其他症状。70例(耳)均接受手术治疗，依照术前检查，根据病变程度不同而选择不同术式。结果 65例(耳)干耳，随访1年以上无复发。3例(耳)行改良乳突根治加鼓室成形术，术后半年流脓，后改行乳突根治术，术后均干耳；2例(耳)行鼓室探查加鼓窦开放术，术后半年及1年又流脓伴听力下降，后改行改良乳突根治加鼓室成形术，术后干耳。结论 中耳胆固醇肉芽肿的病因主要有：含气腔通气受阻、引流障碍及含气腔出血。中耳胆固醇肉芽肿与特发性血鼓室、分泌性中耳炎及胆脂瘤关系密切。术式的选择应根据病变范围和程度来决定，其原则是彻底清除病变，保持通畅引流。     

Primary and secondary fungal infections of the paranasal sinuses: clinical features and treatment outcomes

CONCLUSION: In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended. OBJECTIVE: The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses. MATERIALS AND METHODS: Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection. RESULTS: The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.     

Cholesterol granuloma of the maxillary and frontal sinuses

5 cases of cholesterol granuloma are described, 3 within the maxillary sinuses and 2 within the frontal sinuses. The lesions arise from the mucosa and can be recognized on plain films and tomograms of the sinus as opacity, sometimes resembling a mucocele. Radical operation seems to give absolute cure without any recurrence. The pathogenesis is hemorrhage and/or filtration. The closed cavities of the paranasal sinuses provide favorable conditions for cholesterol to become dissociated from the lipoprotein complex and to precipitate and to give rise to a granulomatous reaction.     

Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child

Cholesterol granulomas of the petrous apex are well-described lesions that originate from chronic obstruction of the air cells in the petrous pyramid. Intracranial surgery, associated with multiple potential complications, has been the salutary action to treat this entity with only two reports of endoscopic drainage of a cholesterol granuloma of the paranasal sinuses. We present the first pediatric patient to be treated by not only endoscopic drainage, but also by the incorporation of computer-assisted image-guided surgery to minimize risk of injury to structures adjacent to the posterior wall of the sphenoid sinus.     

The medical and surgical treatment of nasal polyps

The work of Kern and Schenck introduced the concept that the nasal polyp was allergic in origin. The ethmoid sinus mucosa is the most common target organ for this allergic reaction leading to the formation of polyps with subsequent nasal obstruction. Patients with nasal polyposis complain of nasal obstruction and may have hyperplastic sinusitis associated with this. This purulent infection compounds the problem of management in these cases. A thorough history and physical examination is necessary to make this diagnosis. X-ray examinations of the nose and paranasal sinuses are essential to formulate a rational plan of management. Therapy should include an allergic evaluation and a plan of allergic management. Surgical management in the past has included nasal polypectomy as the chief mode of therapy in providing temporary relief of the nasal obstruction. Radical, destructive intranasal and paranasal sinus surgery has led to unnecessary and quite severe complications and mortality, and is to be condemned. Ethmoidectomy, and when indicated, a Caldwell-Luc procedure will provide drainage of infection, removal of necrotic tissue and necrotic bone when hyperplastic sinusitis complicates the picture. Intrapolyp injection of corticosteroids has proven of great benefit for less severe cases of nasal polyposis without infection. This treatment may need to be repeated in order to achieve the desired relief from nasal obstruction but is only active locally and does not produce systemic side effects. This mode of therapy may be supplemented by oral corticosteroids and by the use of systemic antibiotics. Intranasal mechanical obstruction other than nasal polyps should be corrected by rational surgery to the nasal septum and turbinates. A thorough workup and evaluation is necessary for a plan of management and any therapy, whether medical or surgical, must be based on this type of thorough evaluation of the patient's problem.     

Nitric oxide: a new concept in chronic sinusitis pathogenesis

PURPOSE: Exhaled NO is produced mainly in paranasal sinuses and nasal mucosa. Nasal NO has been suggested to have a variety of effects in nasal cavity. Decreased exhaled NO is found in chronic sinusitis, and NO metabolite levels are increased in animal models of chronic sinusitis, suggesting a role for them in sinusitis pathogenesis. There was no data available on human NO metabolite level. MATERIALS AND METHODS: We lavaged maxillary sinuses in a control and 2 patient groups. The control group was patients who underwent functional endoscopic sinus surgery (FESS) due to any other reason than chronic sinusitis. The patient groups had chronic rhinosinusitis with and without polyposis who underwent FESS. Maxillary sinuses were lavaged during FESS, and NO metabolites (nitrate and nitrite) were lavaged in the lavage fluid. RESULTS: Nitric oxide metabolite levels (mean +/- SEM) were 8.085 +/- 1.43 mumol/L in healthy maxillary sinus lavage fluid and 18.04 +/- 3.51 and 16.78 +/- 2.91 mumol/L in chronic rhinosinusitis with and without polyposis, respectively. Lavage fluid of sinuses with chronic sinusitis had elevated levels of NO metabolites, which were significantly higher than the control group. The difference between the chronic sinusitis with and without polyposis groups was not significant. CONCLUSIONS: Nitric oxide metabolites were significantly higher in maxillary sinuses of patients with chronic sinusitis. Elevated levels of NO and NO metabolites in sinusitis might damage healthy sinus epithelium. NO metabolites may have an important role in sinusitis pathogenesis.     

Microscope and endoscope-assisted surgery of inflammatory diseases of the paranasal sinuses. Value of the Messerklinger infundibulotomy

Insights into the importance of the infundibulum of the anterior ethmoid bone in the etiology and pathogenesis of chronic paranasal sinusitis, based above all on the studies of Messerklinger, have resulted in a fundamental change in our concept of therapy: the main objective of any treatment must be the restoration of ventilation and drainage of the paranasal sinuses in the region of the semilunar hiatus. Its function in the healing of paranasal sinus diseases parallels the significance of the Eustachian tube for the healing of inflammatory lesions of the middle ear. In many cases, the objective is attained by infundibulotomy, using Messerklinger's technique. Our technique differs from that described by Messerklinger and Wigand: we use the surgical microscope and a self-retaining nasal speculum. It is thus possible to operate with both hands, as in microsurgery of the ear and the larynx. Moreover, the operations can be taught and learned via an observation tube. Since the introduction of this technique which can be extended at any time to complete endonasal surgery of the maxillary, ethmoid and sphenoid sinuses, extranasal operations on the paranasal sinuses have become exceedingly rare. The results have been checked in a newly established paranasal sinus clinic.