CT扫描对前筛窦及其吡邻结构的研究

将４０具完整成人尸头进行冠状位及横断位ＣＴ扫描，其中部分尸头还运用横断位ＣＴ扫描重建矢状位ＣＴ扫描，对前筛窦及其嘴邻结构进行观察。结果示；根据ＣＴ扫描，可将前筛窦气房分为４组：即漏斗前筛房，漏斗外气房，漏斗后气房，筛泡筛房；同时又可将前筛窦分为筛内型和筛外型。表明ＣＴ扫描能充分显示前筛窦气房的气化变异及其邻近结构的影像学特征     

筛窦及其邻近结构CT影像学研究

为内窥镜鼻窦手术提供影像学资料，观察了筛窥及其邻近结构的关系，对９名健康人筛窦进行了横断民支面连续ＣＴ扫描，对２０名观察人进行了横断加冠状层面扫描，每人平均扫描２２次，发现个体间筛窦及其与邻近组织的解剖结构存在着很大的变异，横断扫描可清晰地显示出后级筛窦或蝶窦与视神经管的解剖关系和颈内动脉与蝶窦的解剖关系。冠状扫描可详细地观察到窦口鼻道复合体的筛窦与眼眶，前颅底的解剖关系，鼻窦ＣＴ扫描对鼻窦炎病因     

鼻内窥镜手术治疗后组筛窦结石1例

患者 ,男 ,58岁。因右鼻塞流脓涕 1 0余年、右耳听力下降半个月入院。自发病以来右侧鼻塞 ,流脓涕 ,多次治疗无效。半个月前出现右耳闭塞感 ,听力下降 ,曾 2次行鼓膜置管术 ,疗效不佳。专科检查 :右侧中鼻甲肥大 ,中鼻道可见脓性分泌物。右耳鼓膜内陷 ,呈琥珀色 ,内有液平面。鼻咽部粘膜光滑 ,未见新生物。CT示右侧后组筛窦高密度影。在局麻下行鼻腔内窥镜手术 ,于右侧后组筛窦取出 2个结石 ,大小为 1 .0 cm× 0 .8cm× 0 .1 cm,0 .5cm× 0 .3cm× 0 .2 cm,吸尽粘脓性分泌物 ,开放筛窦。 1周后鼻塞和听力下降改善出院。病理报告为钙化物。1…     

鼻内窥镜下筛窦CT影像学分型手术疗效分析

慢性鼻窦炎鼻息肉是耳鼻咽喉科常见病,常规鼻窦手术虽能将病灶清除干净,但术中损伤大。鼻内窥镜手术的运用,提高了疗效,减少了手术并发症的发生。现将我科3年来开展的鼻内窥镜筛窦CT影像学分型手术总结如下。     

鼻内窥镜下切除筛窦胆脂瘤1例

鼻窦胆脂瘤临床少见 ,位于筛窦者更少。我院2 0 0 0年 3月收治 1例 ,在鼻内窥镜下切除后痊愈出院 ,经 7个月随访无复发。报告如下。患者 ,男 ,45岁。因左鼻腔阻塞 ,涕多而臭收治入院。鼻镜检查见左中鼻道明显膨隆 ,中鼻甲轻度息肉样变。 CT检查 :左侧筛窦、上颌窦及额窦窦腔混浊 ,尤以筛窦区为甚 ,无明显骨质破坏征象。报告 :左侧鼻窦炎。术前 4d按功能性内窥镜鼻窦手术给予消炎、抗感染、预防出血等准备。术前半小时肌注度冷丁5 0 mg,皮下注射阿托品 0 .5 mg。手术时先用 1 %地卡因 1 5 ml加 0 .1 %肾上腺素 2 ml混匀后浸湿棉片 ,分 2次行…     

鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎

目的：探讨提高变应性鼻炎疗效的方法,方法：应用鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎１０６例,结果随访１年,显效８９例（８４．０％）有效１２例（１１．３％）,无效５例（４．７％）,总有效率达９５．３％。结论：鼻内窥镜下微波热凝筛前神经治疗变应性鼻炎,具有视野清楚,操作简便,疗效好等优点,值得临床应用。     

筛窦及其邻近结构CT影像学研究

为内窥镜鼻窦手术提供影像学资料，观察了筛窦及其邻近结构的关系。对９名健康人筛窦进行了横断层面连续ＣＴ扫描，对２０名健康人进行了横断加冠状层面扫描，每人平均扫描２２次，发现个体间筛窦及其与邻近组织的解剖结构存在着很大的变异。横断扫描可清晰地显示出后组筛窦或蝶窦与视神经管的解剖关系和颈内动脉与蝶窦的解剖关系。冠状扫描可详细地观察到窦口鼻道复合体和筛窦与眼眶、前颅底的解剖关系。鼻窦ＣＴ扫描对鼻窦炎病因学分析、鼻内窥镜手术设计和术中防止并发症的发生均具有重要意义。     

Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis

Objective

Endoscopic sinus surgery (ESS) is a worldwide standard surgical procedure for chronic rhinosinusitis (CRS). Residual ethmoid cells (RECs), which result from failure to completely remove them, have been thought to be a cause of recurrence of CRS. Our objective was to investigate the relationship between the REC score and post ESS recurrence of CRS.

Methods

From January 2002 through December 2003, a total of 138 consecutive CRS patients (86 men and 52 women; mean age: 44 years) underwent ESS at the Department of Otorhinolaryngology, Ota General Hospital. CT was performed at 6 or more months post ESS for all patients. The left and right ethmoid sinuses were each divided into superior-anterior, inferior-anterior and posterior parts. The extent of RECs in each part was assessed using a 3-grade scoring system. The outcome of CRS was classified into a satisfactory outcome group and a poor outcome group based on the improvement rate determined from the pre ESS and post ESS CT image findings. The two groups were then compared for the age, gender, presence/absence of nasal polyps, presence/absence of allergic rhinitis, presence/absence of asthma, the peripheral eosinophil count (%) and the total REC score. In addition, the individual correlations between the above variables and the poor outcome group were analyzed by logistic regression analysis.

Results

The total REC score was 0 in only 35 (25.4%) of the total patients. The most common total REC scores were 1–6 in 85 (61.6%) patients. The superior-anterior part had the largest number of patients with an REC score of 1 or more. The satisfactory outcome group comprised 97 patients (70.3%), while the poor outcome group comprised 41 patients (29.7%). Comparison of these two groups found that the peripheral eosinophil count, the prevalence rate of asthma and the total REC score were each significantly higher in the poor outcome group than in the satisfactory outcome group. Logistic regression analysis identified a peripheral eosinophil count of ≥9.5%, the presence of asthma and a total REC score of ≥4 as factors that correlated significantly with a poor outcome.

Conclusion

The findings of this study indicate that RECs are involved in the recurrence of CRS following ESS. It can be thought that how to achieve full opening of the superior-anterior part of the ethmoid sinus, which includes the frontal recess, will be an issue in the future.     

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     

鼻内镜鼻窦手术前筛窦颅底高度的CT评估价值

目的 探讨内镜鼻窦手术前应用CT评估筛窦颅底高度的价值。 方法 选取就诊于我院的100例共200侧的鼻窦冠状CT扫描图像,测量筛前动脉水平的筛顶中点至眶水平中线的距离,根据测量数据进行分型,同时进行Keros分型,用皮尔森相关系数来确定两者之间是否存在相关性。 结果 筛前动脉管水平的筛顶中点至眶水平中线的距离作为筛窦颅底高度。根据筛窦颅底的高度进行分型,其中Ⅰ型即筛窦颅底高度>7 mm(高位颅底)占44%(88/200),Ⅱ型即筛窦颅底高度介于4~7 mm(中位颅底)占41%(82/200),Ⅲ型即筛窦颅底高度<4 mm(低位颅底)占15%(30/200)。按Keros方法进行测量并分型,Ⅰ型占37%(74/200),Ⅱ型占52%(104/200),Ⅲ型占11%(22/200);Keros分型与筛窦颅底高度之间的皮尔森相关系数为0.384(P<0.001),Keros分型与筛窦颅底高度呈弱相关性。 结论 筛窦颅底高度存在明显差异,术前进行CT影像评估,可有效识别低颅底变异,有助于避免颅底损伤,进而减少内镜手术并发症。     

Post-operative evaluation of functional endoscopic sinus surgery with computed tomography

Fifty consecutive patients underwent functional endoscopic sinus surgery (FES) for bilateral rhinosinusitis. Pre- and post-operative computerized tomographic scans were evaluated. Of 50 patients, 45 (90%) experienced improvement in symptoms. Post-operative scans gave less encouraging results, with a slightly improved score for the combined group of sinuses and for the ethmoidal and maxillary sinuses separately. The difference between the pre- and post-operative CT score for the ethmoidal sinuses was statistically significant. The frontal sinus showed similar pre- and postoperative radiological findings. For the inexperienced surgeon we recommend computer tomographic examination 4–6 months after surgery. This could prove helpful if recurrence of symptoms occurs. For the experienced surgeon, clinical and endoscopic follow-up for at least 3 years is appropriate.     

鼻内镜治疗额、筛窦囊肿的临床分析

目的比较鼻内镜手术和鼻内镜与鼻外联合进路手术治疗额、筛窦黏液囊肿的疗效。方法37例鼻内镜手术和鼻内镜与鼻外联合进路治疗额、筛窦黏液囊肿患者及随访14个月～3年，比较两种术式的治疗效果。结果26例采用鼻内镜手术，11例采用鼻内镜与鼻外联合进路，均能够较好暴露术野，术后囊腔得到充分引流；34例获得满意疗效，无严重并发症发生。结论鼻内镜手术是治疗额、筛窦黏液囊肿安全的有效方法。     

筛窦基板层次气化分析及其在鼻内镜鼻窦手术中的应用

目的探讨应用筛窦基板层次性分析方法,指导内镜下筛窦层次性开放的可行性。方法通过鼻窦CT扫描的薄层DICOM数据,层厚层距均为0.65 mm,ImageViewer软件三维重建分析筛窦的基板（III V）层次及其气化情况。结果获得100例（200侧）患者鼻窦CT原始薄层数据,通过三维重建分析发现筛骨结构包含5个基板（I V）：①基板V的出现率为60.0%,相邻基板间存在潜在的层次间隙;②Haller气房出现率为28.0%,与中鼻甲、上鼻甲基板结构气化相关者分别占19.5%、8.5%;③上鼻甲及基板气化发生率为91.5%,其中19.1%气化为Onodi气房。最上鼻甲及基板出现率60.0%,气化发生率为76.7%,其中15.8%气化为Onodi气房。Onodi气房出现率为33.0%,来源于上鼻甲基板、最上鼻甲基板的分别占17.5%,9.5%,来源于二者共同气化的占6.0%。各基板及其气化结构组成相对独立的通气引流系统,可单独出现引流障碍。手术中筛窦的开放（III V基板）过程,以上鼻甲、最上鼻甲为标志结构,结合CT提示的气化变异,可在其前方分别充分地开放III基板、IV基板气化结构构成的筛窦迷路（包括变异气房,如Haller气房）,而根据CT提示V基板的气化状况和方向,可进一步实现V基板及其气化结构（包括Onodi气房）的开放。结论通过分析筛窦基板的层次性结构,对指引内镜下筛窦开放过程实现层次性、标准化有重要指导价值。     

以星状裂解剖标志定位经筛泡前径路行额窦开放术

目的实施以星状裂解剖标志定位经筛泡前径路行额窦开放术,评价该术式的有效性及安全性。方法对225例（407侧）慢性额窦炎患者行星状裂解剖标志定位的筛泡前径路额窦开放术。术前常规鼻窦CT扫描,确定额窦自然开口与钩突及筛泡的关系。术中保留筛泡,依据星状裂解剖标志定位额窦开口行额窦开放手术。结果220例患者按该手术步骤开放了额窦自然开口;5例（8侧）术中暴露额窦开口困难,通过经皮额窦穿刺,注水时在内镜下观察,确定额窦自然开口位置后继续手术获得成功。无一例出现筛前动脉破裂出血和前颅底骨折等术中并发症,2例患者纸样板损伤出现眶周血肿。术后随访6～12个月,293侧（72％）可见额窦窦口开放良好,完全上皮化。201例患者（89％）主观感觉症状缓解。结论以星状裂为解剖标志定位经筛泡前径路行额窦开放术术中能较准确地寻找额窦开口,提高了额窦手术成功率,可减少手术并发症的发生。     

前组筛窦相关解剖变异的CT影像学观察及临床意义

目的：探讨国人前组筛窦的相关解剖变异,为临床手术提供参照数据和资料。方法:回顾性分析263例患者前组筛窦的影像学资料,对前组筛窦相关解剖变异进行统计和评估,并进行年龄相关性比较。结果:筛泡肥大和中鼻甲气化的出现率在成年组和未成年组差异有统计学意义。结论:CT检查不仅可以评估病变,而且可以检出与鼻腔-鼻窦疾病手术危险性相关的解剖变异,有助于预防鼻内镜手术并发症的发生。     

Computed tomographic and anatomical analysis of the basal lamellas in the ethmoid sinus

OBJECTIVES: To investigate the exact anatomical structure of the lamellas in the ethmoid sinus by computed tomography (CT) and anatomical analysis. STUDY DESIGN: Cadaver dissections and CT scans were used to compare lamellar structures and their radiological images. METHODS: Anatomical microdissection of 100 midsagittal sections from adult cadaver head specimens were examined and compared with those of sagittal CT scans at 1-mm intervals. RESULTS: The posteroinferior end of the uncinate process attaching to the inferior turbinate divided the fontanelle into the anterior and posterior portions in the majority of cases. The basal lamellas of the bulla ethmoidalis were subdivided into three major types. The posteroinferior portion of its basal lamella was connected to the lower horizontal portion of the third basal lamella in all cases. The anterior indentation of the third lamella was identified in nine cases, but there was no indentation in the posterior direction. The basal lamella of the superior turbinate was attached to the skull base superiorly either separately or fused to the third lamella, and its posteroinferior portion was attached to the lowest portion of the anterior wall of the sphenoid sinus. The supreme turbinate existed in 50 cases; however, its basal lamella was identified in only 15 cases. CONCLUSIONS: Our results indicate that the lamellas of the ethmoid sinus have relatively uniform patterns, although there is variability in shape. It is hoped that this study will provide surgeons with a more detailed structure of the basal lamellas for better surgical results and lower complication rates.     

Functional anatomy of the uncinate process and its role in endoscopic sinus surgery

Background  A basic step of Functional Endoscopic sinus surgery—the most modern and revolutionary surgical treatment for chronic and recurring sinusitis, is removal of uncinate process to expose the infundibulum. The purpose of this study is to explore the functional role of uncinate process with special reference to endoscopic sinus surgery. Methods  A fixed dose of sterile methylene blue was sprayed into the nasal cavities of post endoscopic sinus surgery cases, 20 without uncinate process preservation and 20 with uncinate process preservation. The area of staining/deposition of the stain in the ethmoidal cavity and the maxillary sinuses was endoscopically observed. Results  Deposition of methylene blue was consistently found to be occurring in a larger area of the ethmoidal cavity including the maxillary sinus in post endoscopic sinus surgery cases without uncinate process preservation. Conclusion  Uncinate proces probably acts as a protective wall by directing the allergen bearing and contuminated inspired air away from the sinuses and facilitating ventilation of the sinuses in the mucocilliary pretreated expiratory phase. Injudictious removal of the uncinate process especially in cases with allergic rhinosinusitis should thus expose the sinus mucosa to contaminated air.