鼻内窥镜术上颌窦自然开口的处理

目的探讨内窥镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法配对研究５６例双侧鼻窦炎、鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分别为９２．９％和８０．４％（随访６个月时）。回顾性观察５１例施ＣａｌｄｗｅｌＬｕｃ术的患者，下鼻道造口的术后开放率仅为４０．６％。分析３８张单侧鼻窦炎或鼻息肉的鼻窦ＣＴ片，测量对照侧与病变侧的上颌窦口膜样部的上下径和前后径，差异无显著性。病变侧上颌窦口周围的中鼻甲气化、增生及钩突偏曲、筛泡骨性增生等解剖结构异常的发生率明显高于对照侧（Ｐ＜０．０５）。结论鼻内窥镜下处理上颌窦自然开口的关键是窦口周围的解剖异常因素。     

鼻内窥镜下上颌窦自然孔的处理体会

目的 探讨更为完善的上颌窦自然孔开窗术。方法 对慢性鼻窦炎患者分为前期手术组的后期手术组。其中,资料完整,符合统计要求的１３５例,前期组７９例（１５８例）采用常规上颌窦开放法,开窗孔在１．０（上下径）～１．５（前后径）ｃｍ范围以内。后期组５６例（１１２例）采用改进后的上颌窦开放法,开窗孔上下径〉１．０ｃｍ,前后径〉１．５ｃｍ。观察２组术后窦口开放情况。结果 前期组上颌窦口Ⅰ期开放率７８．５％（１２     

鼻内窥镜下经上颌窦自然开口冲洗注药治疗小儿鼻窦炎

对120例（212侧）慢性化脓性上颌窦炎患儿，在鼻内窥镜下置入中号肾分泌造影管，经上颌窦自然开口反复冲洗窦腔，排除上颌窦内脓液，同时注入抗生素。经观察，90％的患儿经治疗后，鼻塞及流脓涕症状消失，10％的患儿症状减轻。表明该法是治疗小儿鼻窦炎的较好方法。     

鼻内窥镜下上颌窦自然孔的处理体会

目的　探讨更为完善的上颌窦自然孔开窗术。方法　对慢性鼻窦炎患者分为前期手术组和后期手术组。其中 ,资料完整 ,符合统计要求的 135例 ,前期组 79例 (15 8侧 )采用常规上颌窦开放法 ,开窗孔在 1 0 (上下径 )～ 1 5 (前后径 )cm范围以内。后期组 5 6例 (112侧 )采用改进后的上颌窦开放法 ,开窗孔上下径 >1 0cm ,前后径 >1 5cm。观察 2组术后窦口开放情况。结果　前期组上颌窦口I期开放率 78 5 % (12 4/15 8) ,开放良好率 43 0 % (6 8/15 8) ,Ⅰ、Ⅱ期合计开放率 85 4% (135 /15 8) ,开放良好率 45 0 % (71/15 8) ;后期组上颌窦口I期开放率 92 9% (10 4/112 ) ,Ⅰ、Ⅱ期合计开放率94 6 % (10 6 /112 ) ,开放良好率均为 79 5 % (89/112 )。两组Ⅰ期、Ⅱ期上颌窦口开放良好率和开放率经统计学分析 χ2 检验P <0 0 5 ,差异有显著性。结论　完善手术操作并尽量扩大上颌窦开窗可提高上颌窦口开放率及开放良好率     

鼻内窥镜下中鼻道上颌窦开窗术

内窥镜鼻窦手术中经中鼻道行上颌窦开窗术可重建上颌窦通气和引流，为符合鼻窦生理的功能性手术方法。对７５例接受内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患各行中鼻道上颌窦开窗术９４侧，下鼻道上颌窦开窗术６４侧，开窗孔开放情况经３～１５个月随访观察，术后６个月时窗口开放者为８６．７％，闭合者为１３．３％，下鼻道开窗孔开放者为５４．７％，闭合者占４５．３％，两者比较Ｐ＜０．０１，差异有显著性，表明中鼻道上颌窦开窗术优于下鼻道上颌窦开窗术。并从解剖、生理方面讨论中鼻道上颌窦开窗术的临床应用价值。     

鼻内窥镜下中鼻道下颌窦开窗术

内窥镜鼻窥手术中经中鼻道行上颌窦开窗术可重建上颌窦通气和引流，为符合鼻窦生理的功能性手术方法，对７５例接受内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患者中鼻道上颌窦开窗术９４例，下鼻道下颌窦开术６４例，开窗孔开放情况经３－１５个月随访观察，术后６个月时窗口开放者为８６．７％，闭合者为１３．３％，下鼻道下窗孔开放者为５４．７％，团合者占４５．３％，两者比较Ｐ＜０．０１差异有显著性，表明中鼻道下颌窦开窗术优于     

功能性鼻内窥镜手术治疗上颌窦曲菌病

目的：探讨鼻内窥镜下非侵袭性上颌窦曲菌病的治疗及影响疗效的因素。方法：分析我院行功能性鼻内窥镜手术（Ｆｕｎｃｔｉｏｎａｌ ＥｎｄｏｓｃｏｐｉｃＳｉｎｕｓ Ｓｕｒ ｇｅｒｙ,ＦＥＳＳ）治疗的非侵袭性上颌窦曲菌病４１例的手术径路及抗真菌剂的使用对疗效及转归的影响。结果：双径路（经尖牙窝加下颌窦自然开口）术式的术后愈合期为４．７周,而单径路（经上颌窦自然开口）术式的术后愈合期为９．３周,两组差异有显著性意义（Ｐ〈０．０１）,使用抗真菌剂冲洗术腔组的术后愈合期为６．４周,未使用抗真菌剂的术后愈合期为６．７周,但其差异无统计学意义（Ｐ〉０．０５）,结论：ＦＥＳＳ是治疗非侵袭性上颌窦曲菌病的有效方法,双径路疗效优于单径路,是否用抗真菌剂冲术腔对疗效无明显影响。     

鼻内窥镜手术治疗上颌窦后鼻孔息肉

以往手术治疗上颌窦后鼻孔息肉(ACP)多行单纯息肉摘除术或柯-陆手术.我们应用鼻内窥镜经中鼻道进路或中鼻道和犬齿窝穿刺联合进路治疗ACP12例,效果满意.报道如下.     

鼻内窥镜双径路治疗上颌窦病变

为扩大鼻内窥镜治疗上颌窦病变的适应范围，我院1992年以来应用易内窥镜双径路，治愈．－‘些依传统需行上颌窦根治术的病例，收到了较好的效果，现报告如下。1资料与方法1．1临床资料37例中男19例，女18例；年龄17～68岁。慢性筛窦，上颌窦炎伴多发性鼻息肉12例（其中8例同时有上颌窦后鼻孔息肉，有手术史的10例）；全具窦炎伴多发性息肉者11例，其中10例有手术史。以上病例术前均经临床及鼻窦CT诊断并经上颌窦镇检查证实，L颌窦粘膜病变广泛，粘膜呈重度息肉样变的范围均在全b颌窦粘膜的SO％以上，上述23例中双侧病变着20例，属！型三期…     

经上颌窦前壁钻孔行鼻窦内窥镜术30例报告

报告经上颌窦前壁钻孔行鼻窦内窥镜手术３０例，疗效较好。与鼻腔、鼻窦内窥镜手术比较，该术式具有观察方便，出血少，反应轻，操作方便，并发症少，术后复发率低等优点。     

鼻内镜手术中扩大上颌窦自然口的意义

目的：探讨鼻内镜手术中扩大上颌窦自然口对上颌窦炎转归的影响。方法：将慢性上颌窦炎218例随机均分为两组,A组的手术范围是切除钩突、筛泡,开放前、中、后组筛窦,扩大上颌窦自然开口,切除部分肥厚明显的中鼻甲;B组手术范围是切除钩突、筛泡,开放前、中组筛窦,不处理上颌窦自然开口,尽量保留中鼻甲,特别肥厚者也行部分切除。结果：218例均随访1年以上。按海口1997年疗效评定标准,A组治愈100例,治愈率92%,B组治愈99例,治愈率91%;A组好转9例,好转率8%,B组好转10例,好转率9%。结论：鼻内镜手术范围的关键是切除窦口鼻道复合体的解剖变异,是否扩大上颌窦口并不十分重要。     

鼻内镜手术中上颌窦口的识别与处理

鼻内镜鼻窦手术的关键是处理窦口鼻道复合体，建立与恢复以窦口鼻道复合体为中心的各组鼻窦通气引流通道。要提高手术成功率，上颌窦口需要保持长期通畅。由于上颌窦口位置变异较多，特别是严重炎症、息肉增生等，有时寻找上颌窦口并非易事。现将我们识别与处理上颌窦口的经验报告如下。     

鼻内镜下上颌窦口处理方法的探讨

目的：探讨内窥镜鼻窦手术中上颌窦自然开口处理方法与预后的关系。方法：对慢性鼻窦炎、鼻息肉患者682例采用不同途径寻找上颌窦开口并根据窦口的形态和上颌窦本身的病变情况,决定开口方式与处理方法。结果：随访6个月,发现窦口开发率为84.22%(574/682例),闭锁率为16.88%（106/682）。结论：上颌窦口的处理方法是鼻内窥镜手术重要步骤,也是影响疗效与预后的关键因素之一。     

影像导航下的鼻内镜手术

OBJECTIVE: To evaluate the advantages and disadvantages of different type of image-guidance system in endoscopic sinus surgery. METHODS: Fifty-three endoscopic sinus surgery were performed under different type of image-guidance system, there were 24 chronic sinusitis with or without nasal polyp, 4 juvenile nasopharyngeal angiofibroma, 8 pituitary adenoma, 9 ethmoid ossifying fibroma, 2 nasopharyngeal mixed tumor, 1 nasal leiomyoma, 3 fungal sinusitis, and 2 inverting papilloma. RESULTS: In all cases, the preoperative time was 15-30 minutes, the registration rate were 1.3-2.0, the localization accuracy was within 1 mm. Compared with the traditional endoscopic sinus surgery, the operating time was similar, without obvious difference. No complication occurred. CONCLUSION: All types of image-guidance system could work well with endoscopic system, each of them had its own shortages. Every type of image-guidance system could identify the borders and critical anatomical structures in the corresponding CT data, especially in cases in which anatomical landmarks were no longer present, with anatomical variation, intranasal and anterior skull base tumor. Combined with endoscopic surgery, the image-guided endoscopic surgery provided accurate tumor resection while preserving normal tissue, increased surgical effectiveness, decreased overall surgical complications. It is believed that the image-guidance system is a useful tool for endoscopic sinus surgery.     

Functional endoscopic sinus surgery]

Eighty-two cases of functional endoscopic sinus surgery were analyzed. It include 62 males and 20 females; the oldest was 72 years of age and the youngest eight years of age. A hard endoscope with a diameter of 4mm and the CCD micro-videorecorder produced by Circon and Olympus Company were used. Operations were done under general anesthesia in all cases. Twenty-three cases (28.1%) recovered in one stage and recovery was delayed in 28 cases (34.2%); late inflammation occurred in 23 cases (28.1%); 8 cases failed (9.8%). The cure rate was 62.2%. Two cases (2.4%) had operative complications namely injury to the lamina papyracea and anterior ethmoidal artery, all recovered uneventfully.     

Histological evaluation of maxillary sinus mucosa after functional endoscopic sinus surgery

BACKGROUND: This study was performed to evaluate the histological changes of the maxillary sinus mucosa of patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS). METHODS: In a cohort study, biopsy specimens were collected from the maxillary sinus of patients submitted for FESS. One year after surgery, patients were clinically reassessed. Patients showing recurrence of disease (group 1) required a revision surgery, through which a second biopsy specimen was collected. Patients showing a favorable clinical response (group 2) were submitted to an outpatient maxillary biopsy through the previous opened middle meatus antrostomy. Biopsy material from four cadavers was used as control. The histological and electron microscope findings were analyzed. RESULTS: At the initial surgery, patients presented many histopathological alterations, such as an inflammatory process infiltrating the submucosa, atypical respiratory epithelium with an important increase in goblet cells, metaplasia, or mixed epithelium. Group 1 patients persisted with the same alterations 1 year later, but ciliary dysmorphy was more accentuated. Group 2 patients presented a predominantly pseudostratified epithelium, but some areas contained an increased number of goblet cells and a reduction in the number of ciliated cells. CONCLUSION: Recovery of the maxillary sinus mucosa of patients with CRS, observed by electron and light microscopy, was incomplete 1 year after endoscopic surgery, even in nonsymptomatic patients; nevertheless, these alterations were more important in symptomatic patients than in asymptomatic patients.     

慢性鼻窦炎内窥镜手术上颌窦粘膜扫描电镜观察

为了对行内窥镜鼻窦手术的慢性鼻窦炎患者上颌窦粘膜的术后超微结构变化进行评价，利用扫描电镜及图像分析技术对１６例（２０侧）术中和术后上颌窦粘膜及自然孔粘膜的纤毛面积进行定量测定。发现术前上颌窦及其自然孔粘膜纤毛细胞明显减少，杯状细胞，微绒毛细胞增多，部分病例有鳞状上皮化生。术后６个月￣１年，大部分病例受损的纤毛细胞明显恢复，纤毛细胞覆盖面积增加，有统计学意义，通过内窥镜手术，改善上颌窦的通气、引流、     

Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery

OBJECTIVES: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis. STUDY DESIGN: METHODS: This study was conducted on 88 maxillary sinuses of 74 patients after ESS. The maxillary sinus fontanel was broadly opened via the middle meatus using an endoscope, and a saccharin granule was adhered to the bottom of the maxillary sinus mucosa The time until the patient recognized the sweet taste was recorded. Before the ST test, the bilateral maxillary sinuses were classified into the following four groups on the basis of the post-ESS severity of mucosal edema and swelling as revealed by endoscopic observation: normal (45 sinuses), mild mucosal edema and swelling (24), moderate mucosal finding (14), and severe mucosal finding or filling of the sinus with a polyp(s) (5). RESULTS: The mean ST values in the normal group and the groups with mild, moderate, and severe mucosal edema and swelling were 35.7, 38.1, 63.6, and 88.0 minutes, respectively. Thus the ST increased with the post-ESS severity of the mucosal lesion. However, for the group with mild mucosal edema and swelling, scanning electron microscopic observation of three maxillary sinuses in which the ST exceeded 120 minutes and four sinuses in which the ST was 40 minutes revealed extensive cilia loss in the former sinuses, but not in the latter. A second post-ESS endoscopic observation was performed in 17 patients, revealing improvement in 11 sinuses, no change in 5 sinuses, and aggravation in 1 sinus (compared with the initial test). The ST test was also repeated, revealing that the ST became shorter in most of the endoscopically improved sinus group. However, a few sinuses showed a discrepancy between the change in the endoscopic findings and the ciliary function (ST). CONCLUSION: Measurement of the maxillary sinus ST is a simple, accurate, and useful technique for assessing the post-ESS mucociliary function in conjunction with endoscopy, and the information gained can help in deciding subsequent therapy.