非侵袭性上颌窦曲菌病43例临床分析

目的：探讨非侵袭性上颌窦曲菌病的临床特点及经鼻内镜治疗的价值。方法：总结1993－1999年在我院行鼻内镜鼻窦手术（Endoscopic Sinus Surgery,ESS)治疗的非侵袭性上颌窦曲菌病43例,分析该疾病的诊断,治疗及影响疗效和转归的因素。结果：所有病例都在其霉菌团块中找到曲霉菌菌丝或孢子;双径路（经尖牙窝或下鼻道加上颌窦自然窦口）术式的术后愈合期为4．9周,而单径路（经上颌窦自然窦口）术式的术后愈合期为10．2周,2组差异有显著性（P＜0．01）,使用抗真菌剂冲洗术腔组的术后愈合期为6．6周,未使用抗真菌剂组的术后愈合期为7．3周,但其差异无显著性（P＞0．05）。结论：霉菌团块标本对非侵袭性鼻窦真菌病的诊断具有重要意义;ESS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,是否使用抗真菌剂冲洗术腔对疗效无明显影响。     

功能性鼻内镜手术治疗非侵袭性上颌窦霉菌病57例

目的 探讨非侵袭性上颌窦霉菌病的临床特点、功能性鼻内镜手术治疗的价值及影响疗效的因素.方法 总结2004年3月～2007年12月在我院行功能性鼻内镜鼻窦手术(Functional Endoscopic Sinus Surgery,FESS)治疗的非侵袭性上颌窦霉菌病57例,分析该疾病的诊断、治疗及影像、疗效和转归的因素.结果 双径路(经上颌窦自然窦口加下鼻道开窗)术式的术后愈合期为5.2周,而单径路(经上颌窦自然开口)术式的术后愈合期为8.4周,两组差异有统计学意义(P＜0.01);单径路术式中术后使用抗真菌药物组的术后愈合期为8.2周,未使用抗真菌剂组的术后愈合期为8.5周,其差异无统计学意义(P＞0.05).结论 功能性鼻内镜手术(FESS)可以有效治疗非侵袭性上颌窦霉菌病,由于彻底清除病变,充分通气引流,双径路术式疗效优于单径路,术后是否使用抗真菌药物对疗效无明显影响.     

儿童功能性鼻窦内窥镜术后再次内窥镜复查的意义

自１９８９年报道功能性鼻窦内窥镜手术（ＦＥＳＳ）可安全应用于儿童以来,对长期药物治疗无效的儿童慢性鼻窦炎ＦＥＳＳ已成为常用治疗手段,其术后处理通常包括在第一次内窥镜术后２周内于全麻下再次内窥镜检（ｓｅｃｏｎｄ－ｌｏｏｋｎａｓａｌｅｎｄｏｓｃｏｐｙ,ＳＬＥ）。第二次镜检的目的是清除可能存在的粘连、血凝块或肉芽组织,或者取出第一次手术旋转的扩张管、清理窦腔和上颌窦开口的大块肉芽。理论上说,ＳＬＥ可改善手术效果,因此大量文献报道ＳＬＥ已作为常规采用,但对ＳＬＥ的必要性尚缺乏研究。该文的目的是确定ＳＬＥ…     

鼻内窥镜下中、下鼻道上颌窦开窗术比较

鼻内窥镜下上颌窦开窗术是治疗慢性上颌窦炎的有效方法,传统的上颌窦根治术是在下鼻道开窗引流,当今鼻内窥镜手术多提倡扩大上颌窦自然开口,经中鼻道上颌窦开窗术。为观察不同手术径路对治疗上颌窦炎的疗效影响,增加临床实践经验,我科于１９９７年４月～１９９８年８月选择慢性上颌窦炎３７例,分别行鼻内窥镜下中、下鼻道上颌窦开窗术,并观察治疗效果。结果：３７例随访均在６个月以上,其中,中鼻道开窗１９例,治愈１２例,好转６例,无效１例,有效率９４．７％。下鼻道开窗１８例,治愈１３例,好转４例,无效１例,有效率９４．…     

鼻内镜下上颌窦良性病变的手术治疗

目的:探讨鼻内镜下上颌窦良性病变的手术切除方法.方法:41例上颌窦息肉、囊肿、曲菌病、内翻性乳头状瘤等良性病变,分别采用3种不同的手术方式清除病灶,其中30例经扩大的上颌窭自然开121径路;4例经鼻内中、下鼻道双径路;7例经扩大的上颌窦自然开口及鼻腔外侧壁切除双径路.结果:术后随访6个月以上,治愈39例,2例复发,治愈率95.1%.结论:鼻内镜下经鼻腔采用3种不同的手术径路切除上颌窦良性病变,疗效肯定,创伤小,值得临床推广.     

复发性鼻息肉的鼻内窥镜修正术

目的：探讨鼻内窥镜修正术治疗复发性鼻息肉的疗效和手术体会。方法：回顾分析１９９７年７月－１９９８年１０月间２１例因鼻息肉复发在我院行鼻内窥镜修正术的患者,２１例均双侧同时手术,根据ＣＴ所见及术中情况,采用筛窦全切或次全切,上颌窦自然窦口扩大,尖牙窝径路上颌窦病变组织清除等手术方式。结果：随访６－１２个月评定疗效,治愈７傅,好转８例,无效６例,总有效率７１．４％,无一例出现严重并发症。结论：鼻内窥镜     

鼻内窥镜加柯-陆手术联合进路治疗慢性鼻窦炎

目的：探讨提高慢性鼻窦炎疗效的方法。方法：对１０４例伴有上颌窦病变的慢性鼻窦炎患者行鼻内窥镜和柯－陆手术联合进路鼻窦手术,彻底清除病变。结果：术后随访６～１２个月（平均９个月）,治愈８５例（８１．７％）,好转１５例（１４．４％）,无效４例（３．８％）,总有效率９６．１％。结论：该方法可彻底清除上颌窦病变,恢复上颌窦的生理性引流通道,防止复发,弥补了经鼻内窥镜鼻窦手术在处理上颌窦病变时的局限性。     

内窥镜鼻窦手术治疗鼻窦霉菌病的体会

目的：为探讨鼻窦霉菌病的合理手术方法。方法：对所遇８例鼻窦霉菌病分别采用不同术式进行了治疗。结果：其中７例为非侵袭型上颌窦曲霉菌病，１例采用上颌窦根治术，６例采用内窥镜鼻窦手术，均获治愈，另１例为侵袭型鼻脑曲霉菌病，采用鼻侧切开术，术后２月死亡。结论：分析认为：１）窦口鼻道复合体在鼻窦霉菌病的发病、转归中起重要作用，也是须手术处理的关键部位。２）治疗非侵袭型鼻窦霉菌病，宜采用内窥镜鼻窦手术。３）取     

鼻窦炎口服液在鼻内窥镜手术后的应用观察

为探讨加速鼻内窥镜鼻窦手术后创面愈合的方法、加快术后术腔粘膜炎症和水肿的消退，避免应用激素发生的副作用，１９９８年８月～１９９９年１０月，应用鼻窦炎四眼液（太极集团·重庆桐群阁药厂生产），用于鼻内窥镜手术后的病人，取得满意效果，现报告如下。１对象与方法 ＦＥＳＳ手术１５０例，随机分为治疗组（鼻窦炎口服液组）和对照组（口服强的松组）。治疗组７５例，男４５例，女３０例；年龄１２～５０岁，平均年龄４１．５岁。全鼻窦炎８例，筛窦、上颌窦炎５０例，额、筛、上颌窦炎１７例，术后均口眼鼻窦炎口服液。对照组７５…     

鼻内窥镜手术治疗非侵袭性鼻窦真菌病

目的 :探讨鼻内窥镜手术代替传统柯 陆手术治疗非侵袭性鼻窦真菌病的疗效。方法 :采用Storz30°鼻内窥镜行病侧钩突切除 ,扩大上颌窦开口 ,行下鼻道开窗 ,双进路清除病灶。术后用 1%H2 O2 及生理盐水冲洗 ,不用抗真菌药。结果 :2 9例随访 6个月～ 3年 ,原有症状消失 ,未见复发。结论 :采用鼻内窥镜手术治疗非侵袭性鼻窦真菌病 ,较之柯 陆手术创伤小、照明好、清除病灶准确 ;不损害鼻腔正常生理功能 ;保证鼻窦通气引流 ,减少复发 ,治愈率高     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

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、     

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，可以逐渐恢复粘膜的正常生理功能。     

鼻窦内窥镜手术处理病变中鼻甲的意义

目的：探讨功能性鼻窦内窥镜于术（ＦＥＳＳ）中处理病变中鼻甲的临床意义。方法：按照成人中鼻甲解剖学标准,在３２例鼻窦炎、鼻息肉患者ＦＥＳＳ中,对病变中鼻甲进行适当处理,并于术后对中鼻甲形态恢复、筛窦术腔及上凳窦窦中开放率进行随访观察。结果：术后６个月中鼻甲形态恢复正常２４例（７５％）,发生粘连８例（２５％）,其中术腔闭塞２例（６．３５％）;上颌窦窦口开放良好２５例（７８．１％）,狭窄６例（１８．８％     

Ultrastructural ciliary changes of maxillary sinus mucosa following functional endoscopic sinus surgery: an image analysis quantitative study

This was a study of the effect of functional endoscopic sinus surgery (FESS) on the ciliary regeneration of maxillary sinus mucosa in patients with chronic maxillary sinusitis, using objective quantitative methods. Twenty specimens from the mucosa of both the superolateral wall and the ostium of the maxillary sinus were sampled during FESS and then six to 12 months later. They were light examined first by light microscopy and then by scanning electron microscopy in combination with image analysis software in order to study the cilia under higher magnification and to calculate proportion of the field that was ciliated. Samples were taken and studied at Cairo University hospital. This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration and could return towards normal with the improvement of ventilation and drainage of the maxillary sinus following FESS. There were no significant changes in the degree of glandular hyperplasia, goblet cells or pathological glands after surgery.     

The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels

BACKGROUND: Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of "mini-functional endoscopic sinus surgery" has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. METHODS: Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. RESULTS: This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. CONCLUSIONS: The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.     

功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则

目的　探讨内窥镜鼻窦手术后粘膜的转归过程并对此过程进行阶段划分。方法　对32 8例 (均为双侧 )功能性内窥镜鼻窦手术患者术后粘膜形态学进行连续观察。结果　 90 %以上的术腔在 1～ 2周内清洁 ,80 %以上的术腔在 3～ 10周内有水肿、囊泡、肉芽、息肉生长和纤维结缔组织增生、粘连等去粘膜化反应或再生病变发生 ,并与上皮化呈竞争性生长。 90 %的术腔在经过恰当的处理后可完成上皮化 ,其中接近 60 %的术腔是在术后 11～ 14周完成上皮化。结论　将术后粘膜转归过程划分为 3个阶段 :术腔清洁阶段、粘膜转归竞争阶段和上皮化完成阶段。提出对术后各阶段进行正确的局部处理是保证手术整体疗效的重要组成部分。     

功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则

探讨内窥镜鼻窦手术后粘膜的转归过程并对此过程进行了阶段划分,方法对３２８例功能性内镜鼻窦手术患者术后粘膜形态学进行连续观察。结果９０％以上的术腔在１－２周内清洁,８０％以上的术腔在３－１０周内有水肿,囊泡,肉芽,息肉生长和纤维结缔组织增生,粘连等去粘膜化反应或再生病变发生,并与上皮化呈竞争性生长。     

A rare complication of functional endoscopic sinus surgery: maxillary atelectasis-induced spontaneous enophthalmos

BACKGROUND: The first case report of spontaneous enophthalmos due to maxillary atelectasis as a late complication of FESS is presented. METHODS: Chart review of a 24-year-old male who developed a left progressive enophthalmos within three months post bilateral functional endoscopic sinus surgery. RESULTS: The preoperative computed tomography showed a normal left maxillary sinus. The postoperative computed tomography revealed a left maxillary atelectasis with a descending orbital floor. The subject received revised endoscopic sinus surgery and his enophthalmos was stable without further progression after the operation. CONCLUSIONS: This may have been caused by an ostium occlusion with retention of secretions inducing sinus inflammation, osteolytic activity, and osseous remodeling of the sinus walls. A negative pressure may develop. When the pressure gradient exceeds the sinus wall tension, maxillary atelectasis and enophthalmos occur. Prevention of this complication of FESS should include making a patent naso-antral window, minimizing mucosal trauma, and careful postoperative sinoscopic treatment. A "functional" sinus is the goal.