鼻窦球囊导管扩张术的远期疗效分析

目的 评估鼻窦球囊导管扩张术的安全性和有效性.方法 应用鼻窦球囊导管扩张术治疗48例(94侧)慢性鼻窦炎伴或不伴鼻息肉以及霉菌性鼻窦炎和鼻窦囊肿患者,随访1年、2年,分析手术前后鼻内镜检查、冠状位鼻窦CT检查结果,用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评分观察手术效果,以SNOT-20调查表评价预后.结果 患者主观症状均有不同程度改善,SNOT-20评分表中各项与术前比较差异有统计学意义(P＜0.01).鼻内镜检查见窦口通畅,与术前比较差异有统计学意义(P＜0.01),7例(8侧)窦口肿胀、狭窄可在术后随访过程重新扩大处理.1例出现眶周淤斑,无颅底和眼眶等严重并发症.结论 鼻窦球囊导管扩张术操作简便,能有效解除窦口阻塞,同时能够保留鼻腔鼻窦的正常结构,手术微创,出血少,安全有效.鼻内镜检查和鼻窦CT客观上反映了手术的良好转归.对合适的伴或不伴鼻息肉的鼻窦炎病例,可单独应用鼻窦球囊导管扩张术或联合标准的鼻内镜鼻窦手术.     

鼻窦球囊扩张术治疗慢性鼻窦炎的临床观察

目的评价鼻窦球囊扩张术治疗慢性鼻窦炎的临床疗效及安全性。方法10例慢性鼻窦炎患者行鼻窦球囊扩张术，术后随访3个月至1年，观察患者的临床疗效。结果10例患者症状明显改善，鼻内镜检查开放的26个窦口中有25个窦口开放完好，1个出现窦口狭窄；无其他并发症发生。结论鼻窦球囊扩张术治疗慢性鼻窦炎的临床疗效较好、安全性高，值得临床应用。     

鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿

目的 评价鼻内镜鼻窦手术和鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿的疗效。方法 分析14例(19个上颌窦,3个额窦)应用鼻窦球囊导管扩张术联合纤维鼻咽喉镜手术切除鼻窦囊肿(球囊组)和16例(23个上颌窦,8个额窦)采用常规鼻内镜鼻窦手术方式切除鼻窦囊肿(常规组)病例的临床资料。依视觉模拟量表(visual analogue scale, VAS)记录手术难度评分和手术时间。手术前后均行鼻内镜检查、冠状位鼻窦CT检查,采用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评价预后。结果 球囊组手术难度高于常规组,手术时间也较长,两组间差异有统计学意义（P<0.001）。术后观察8、24周, 鼻内镜检查见窦口通畅,Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分结果显示,所有病例术腔恢复良好,术后鼻窦CT影像示改善明显,但两组比较差异无统计学意义（P>0.05）。结论 球囊组与常规组行鼻窦囊肿手术可获得同-良好的疗效。球囊组的手术方式能够保留鼻腔鼻窦的正常结构,手术微创。由于纤维鼻咽喉镜手术器械的限制,手术难度较常规组高,手术时间较长。     

鼻窦球囊扩张术治疗慢性上颌窦炎的非随机对照前瞻性临床研究

目的 评价鼻窦球囊扩张术与传统鼻内镜鼻窦开放术治疗慢性上颌窦炎的临床疗效、安全性及患者接受程度的差异。方法 将50例慢性上颌窦炎患者随机均分入两组,其中A组25例行鼻窦球囊扩张术,B组25例行鼻内镜下上颌窦开放术。术后随访12个月,评价临床疗效、安全性、患者手术舒适度。结果 术后检查及随访期间,A组脱落病例2例,B组脱落病例3例,共对45例患者进行评价。45例患者症状均明显改善,术后鼻内镜检查A组开放的33个窦口中有30个窦口开放、黏膜恢复良好,1个窦口狭窄,2个窦口周围黏膜水肿;B组开放的32个窦口中,27个开放完好,2个窦口狭窄,3个窦口黏膜水肿。两组患者术后均无视力改变、眼部肿胀及脑脊液鼻漏等其他并发症发生。A组与B组术后3个月、随访结束（术后12个月）SNOT-20评分以及CT评分均无统计学差异;术后3个月、随访结束后（术后12个月）Lund -Kennedy内镜黏膜形态评分得分以及手术舒适度评分（出院当天）A组明显优于B组（P<0.05）。结论 鼻窦球囊扩张术与传统内镜在治疗慢性上颌窦炎方面均具有较好的临床疗效及安全性,但在术后远期黏膜恢复及手术舒适度方面,鼻窦球囊扩张术明显优于传统鼻内镜手术,值得临床推广及应用。     

鼻窦球囊扩张治疗儿童慢性鼻窦炎的系统评价及Meta分析

目的 探讨鼻窦球囊扩张术治疗儿童慢性鼻-鼻窦炎的可行性、有效性和安全性。 方法 对采用鼻窦球囊扩张术治疗儿童慢性鼻窦炎的前瞻性临床研究进行系统评价。 结果 8个前瞻性临床研究符合纳入标准。可行性研究:纳入7个研究,235例患儿,549个病变的鼻窦,Meta分析结果显示术中98%成功开放窦口, 95%可信区间［0.95; 1.00］。有效性研究:纳入5个研究,172例患儿,比较手术前后SN-5数值的变化, Meta分析结果显示术后89%的患儿症状得到改善,95%可信区间［0.84; 0.93］。安全性研究:仅1篇研究有1例患儿术后出现眶周肿胀,1周后自行消退。 结论 鼻窦球囊扩张术治疗儿童慢性鼻窦炎,可行性好,疗效好,安全性好。     

塑料管扩张上颌窦口在鼻内窥镜术后的应用

目的：探讨鼻内窥镜术后用塑料管扩张上颌窦口避免上颌窦口闭塞及术腔黏连的临床效果。方法：为106例、190侧慢性鼻窦炎、鼻息肉患者在鼻内窥镜术后应用塑料管扩张上颌窦口。结果：随访12个月以上,根据内窥镜鼻窦手术疗效评定标准（1997,海口）,治愈率为87．9％（167／190）,好转率为12．1％（32／190）。无1例术腔黏连及上颌窦口闭塞。结论：鼻内窥镜术后用塑料管扩张上颌窦口方法简便,效果满意,可作为常规方法应用。     

鼻内镜下经上颌骨额突-鼻丘径路的额窦手术

目的改进鼻内镜下的额窦开放手术,提高额窦炎的治愈率。方法显微镜下观察10例解剖标本的钩突位置,并测量鼻丘的大小,结合39例(61侧)复发性慢性额窦炎患者鼻窦CT扫描结果进行分析,采用鼻内镜下经上颌骨额突-鼻丘径路额窦开放术式,对上述患者进行额窦开放术。结果10例(18侧)标本鼻丘气房的前后径、左右径和高度分别为(5.6±1.3)mm、(4.1±1.1)mm和(6.2±2.5)mm,所有钩突均附着于上颌骨额突及中鼻甲骨与额突的交界处,上端单纯附着于眶纸板14侧(70%),单纯附着于颅底3侧(15%),交叉附着于眶、颅底或中鼻甲3侧(15%)。CT扫描结果显示,慢性额窦炎复发与鼻丘气房未完全切除相关(P<0.001)。39例患者经改进的术式治疗后,治愈率为90.2%。结论额窦开口周围的钩突和鼻丘气房变异大,鼻丘气房清除不彻底可能是慢性额窦炎复发的主要原因,鼻内镜下经上颌骨额突-鼻丘径路额窦开放是治疗复发性慢性额窦炎的有效方法。     

鼻内镜下额窦开放术治疗额窦炎

目的探讨额窦炎经鼻内镜行额窦功能保全性开放手术的方法和疗效.方法慢性额窦炎和鼻息肉患者56例、108侧,术前鼻窦CT扫描均证实为额窦炎.依据钩突附着方式确定额窦引流通道,术中彻底切除额隐窝气房,开放额窦口.结果56例、108侧均顺利找到额窦开口,对额窦开口狭窄者行扩大术治疗,术后随访1～3年,内镜下观察额窦开口保持通畅102例.结论鼻内镜下彻底切除额隐窝气房能够保持额窦开口长期引流通畅,此手术是治疗额窦炎的有效方法.     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦术后上颌窦口黏膜恢复过程观察

目的 试图通过对内镜鼻窦手术(endoscopic sinus surgery,ESS)后患者鼻腔鼻窦黏膜的内镜、光镜、透射电镜和扫描电镜下连续动态观察,揭示病变黏膜转归的过程。方法 选取2001年1-12月行ESS的慢性鼻-鼻窦炎伴鼻息肉患者31例(53侧)作为研究对象,其中Ⅱ型2期11例(20侧)、3期12例(20侧),Ⅲ型8例(13侧)。分别于ESS术前、术后2-3周、8-11周、13-16周钳取上颌窦口后囟相同部位的黏膜组织进行观察。结果 术前均可见上皮剥蚀、鳞状上皮化生、腺体及纤维组织增生(53侧);微管结构异常、线粒体减少(53侧)。术后2-3周,形态学观察与术前比较没有明显的改变。术后8-11周,纤毛柱状细胞增多,并可见许多带有微绒毛的柱状细胞和大量短纤毛,所有病例均可见病理性腺体及纤维组织增生。术后13-16周,Ⅱ型2、3期和Ⅲ型患者术腔光滑干净,上皮化较好(50侧),窦口通畅(53侧)。纤毛覆盖面积增加,方向一致(50侧)。微管结构清晰,线粒体狭长致密(49侧)。3侧无纤毛柱状细胞排列整齐,形成病理性修复。结论 ESS术后,黏膜形态的基本恢复一般需要3个月左右;有些病理改变是不可逆的;病变程度与黏膜修复情况有关;术中尽可能多地保留黏膜组织、术后局部及时清理换药,有利于黏膜纤毛的形态和功能的恢复。     

鼻内窥镜下治疗额窦炎

常规治疗无效的急、慢性额窦炎,自开展鼻内窥镜手术后,取鼻内径路可直达额隐窝,开放闭塞的鼻额管,重建额窦引流。报告200例鼻内窥镜下鼻窦手术中的51例额窦开放术,其中45例为慢性额窦炎,6例为筛窦术后继发的急性额窦炎。手术步骤。患者取标准的内窥镜鼻窦手术位。用4%可卡因表面麻醉鼻粘膜,1%利多卡     

Frontal sinus stents

OBJECTIVES: The formation of scar tissue, synechiae, or osteogenesis in the narrow frontal outflow tract after instrumentation of the frontal sinus has led to attempts to enlarge the frontal duct or stenting. STUDY DESIGN: Prospective pilot study. RESULTS: Sixty-four Freeman frontal sinus stents were used to maintain patency in 46 patients. Stents were inserted using an endoscopic technique in 26 sinuses containing polyps, 20 with pansinusitis, and 18 cavities with stenosis of the frontal duct. External incisions with frontal sinusotomy were required to remove the stenosis and insert the stent in nine sinuses. Polypoid degeneration, granulation, purulent drainage, and lateralization of the middle turbinate were encountered infrequently. Frontal obliteration was subsequently required in six sinuses. CONCLUSION: The Freeman frontal sinus stent prevented blockage of the outflow tract in patients who had removal of disease in the sinus or duct or treatment of frontal stenosis.     

鼻内镜下额窦口开放的远期疗效观察

目的 探讨鼻内镜下额窦口开放的远期疗效。方法 112例（204侧）慢性额窦炎患者鼻内镜下行额窦开放术。清理阻塞额窦口引流的病变组织，并开放额窦口直径〉7mm。结果 术后6个月、1年、2年额窦口开放良好率分别为91．2％（186／204）、87．3％（178／204）、86．3％（176／204），三者之间疗效比较无统计学意义（χ^2=2．45，P〉0．05）。狭窄和闭锁者再次手术成功率仅31．3％（5／16）。结论 准确寻找并开放额窦开口且保持引流通畅是手术成功的关键，钩突上端附着点是一个重要的参考标志，应彻底清理额隐窝并尽可能保留窦口周围的黏膜，正确开放后可获得满意疗效。     

The Completely Opacified Frontal or Sphenoid Sinus: A Marker of More Severe Disease in Chronic Rhinosinusitis?

OBJECTIVE: Determine whether complete opacification of the sphenoid or frontal sinus is associated with increased clinical severity of chronic rhinosinusitis (CRS). METHODS: Adult patients undergoing evaluation for CRS prospectively completed the rhinosinusitis symptom inventory (RSI) and underwent computed tomography of the paranasal sinuses. A cohort with at least one completely opacified frontal sinus was identified. To each patient in this opacified cohort, a control patient without complete frontal sinus opacification was matched with corresponding Lund score. Symptom scores for headache, facial pressure, RSI symptom domains, and medical resource consumption were statistically compared. Similar analysis was conducted for patients with complete sphenoid sinus opacification. RESULTS: Fifty-four patients with at least one completely opacified frontal sinus were matched for Lund score to the control group (mean Lund score 17.1). There was no statistically significant difference in headache (2.1 vs. 2.8) or pressure scores (2.0 vs. 2.3) or in the RSI symptom domains between those patients with completely opacified frontal sinuses and controls, respectively. Although completely opacified patients received more antibiotic treatment and missed more workdays, only the increased numbers of physicians visits (4.0 vs. 2.1, P = .02) was significant. Thirty-four of 35 completely opacified sphenoid patients were matched to control patients (mean Lund score 16.7). Again, differences in symptom scores for headache (2.5 vs. 2.5), facial pressure (2.3 vs. 2.3), and RSI symptom domains were not statistically significant. Increased use of antibiotics (9.6 vs. 3.9, P = .036) and physician visits (5.8 vs. 1.8, P = .024) for sphenoid opacification patients was statistically significant. CONCLUSIONS: Patients with a completely opacified sphenoid or frontal sinus do not necessarily manifest more severe clinical symptoms of CRS. Thus, a higher radiographic stage should not be automatically assigned to patients with a completely opacified sphenoid of frontal sinus in CRS.     

Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation

OBJECTIVES: Endoscopic sinus surgery (ESS) is an effective option for managing patients in whom medical therapy for rhinosinusitis fails. However, ESS is not always successful, and serious complications can occur. New techniques and instrumentation that improve outcomes and reduce complications would be seriously welcomed. Innovative catheter-based technology has improved treatment of several conditions such as coronary artery disease, peripheral vascular disease, and stroke. Recently, catheter devices have been developed for the paranasal sinuses. Cadaver studies confirm the potential use of these devices in rhinosinusitis. The objective of this investigation was to ascertain the feasibility and safety of these newly developed devices in performing catheter-based dilation of sinus ostia and recesses in patients with rhinosinusitis. METHODS: A nonrandomized prospective cohort of 10 ESS candidates was offered treatment with a new technique of balloon catheter dilation of targeted sinus ostia. The frontal, maxillary, and sphenoid sinuses were considered appropriate for this innovative catheter-based technology. The primary study end points were intraoperative procedural success and absence of adverse events. RESULTS: A total of 18 sinus ostial regions were successfully catheterized and dilated, including 10 maxillary, 5 sphenoid, and 3 frontal recesses. No adverse events occurred. Mucosal trauma and bleeding appeared to be less with catheter dilation than is typically observed with ESS techniques. CONCLUSIONS: Dilation of sinus ostial regions via balloon catheter-based technology appears to be relatively safe and feasible. Larger multicenter clinical trials are now warranted to further establish safety and to determine the role of this new technique.     

Effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis without polyposis

IntroductionBalloon sinuplasty is a minimally invasive endoscopic procedure, developed with the aim of restoring patency of the paranasal sinuses ostia with minimal damage to the mucosa.ObjectiveTo evaluate the effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis.MethodsThis was a prospective cohort study comprising 18 patients with chronic rhinosinusitis without polyposis who underwent balloon sinuplasty. Patients were evaluated for clinical criteria, quality of life (Sino-Nasal Outcome Questionnaire Test-20 [SNOT-20]), and computed tomography of the sinuses (Lund–Mackay staging) preoperatively and three to six months after the procedure.ResultsOut of 18 patients assessed, 13 were included, with a mean age of 39.9 ± 15.6 years. Ostia sinuplasty was performed in 24 ostia (four sphenoid, ten frontal, and ten maxillary sinus). At the follow-up, 22 (92%) ostia were patent and there was no major complication. There was symptomatic improvement (SNOT-20), with Cronbach coefficients for consistency of the questionnaire items of 0.86 (95% CI: 0.73–0.94) preoperatively and of 0.88 (95% CI: 0.77–0.95) postoperatively, the difference being statistically significant (p < 0.001). In addition, there was marked reduction of the computed tomography signs, an average of 4.2 point score (p < 0.001).ConclusionSinuplasty is effective in reducing symptoms and improving quality of life as a treatment option for chronic rhinosinusitis in selected patients.     

Computed tomographic staging and the fate of the dependent sinuses in revision endoscopic sinus surgery.

OBJECTIVES: To determine the patterns of disease recurrence in chronic sinusitis and to examine the influence of surgical intervention on the presence or absence of disease among sinuses at the time of revision. DESIGN: Retrospective review of case series in a 56-month period. Preoperative computed tomography (CT) scans at the initial surgery and at revision were staged using the Lund and Mackay system. Patterns of disease and CT stage were analyzed with respect to operative intervention, and statistical analysis was conducted to determine the influence of the initial surgical intervention on the patterns of disease at revision. SETTING: An academic general otolaryngology practice. RESULTS: A total of 42 paired cases of primary and revision endoscopic sinus surgery were identified with complete data. The average interval between procedures was 11.8 months, with a mean follow-up of 31.7 months. The average total Lund scores for the CT scan before the primary procedure and at revision were not significantly different at 10.5 and 9.7, respectively (P = .38). Analysis of 84 sides revealed that performance of a sinusotomy on an initially undiseased sinus resulted in a higher percentage of disease in that sinus at revision, although this was not significant (P = .15). A sinusotomy performed on an initially diseased sinus was associated with a higher likelihood of disease in that sinus at revision (P = .02). Similar data were found for the subset analysis of the sphenoid and frontal sinuses. CONCLUSIONS: The Lund and Mackay system can be applied in the setting of revision endoscopic sinus surgery. Sinusotomies should be performed only in sinuses with radiographic disease, and not prophylactically to prevent disease. The standard functional approach may allow disease initially present in the sphenoid or frontal sinuses to normalize without formal sphenoidotomy or frontal sinusotomy.     

Combined external and endoscopic frontal sinusotomy with stent placement: a retrospective review

OBJECTIVES: To examine the long-term results of combined external and endoscopic frontal sinusotomy using frontal sinus stents and to compare our results with those reported for the endoscopic Lothrop procedure. STUDY DESIGN: We performed a retrospective review of 40 patients with chronic frontal sinusitis refractory to medical management who underwent a total of 62 combined external and endoscopic frontal sinusotomies with stent placement. All procedures were performed by the senior author at Vanderbilt University Medical Center. MAIN OUTCOME MEASURES: Postoperative nasofrontal duct patency and subjective patient improvement based on the last clinical examination. RESULTS: The overall patency rate of the nasofrontal duct was 79% (95% confidence interval [CI] of +/-10%.) The overall subjective patient improvement rate was 78% (95% CI of +/-14%.). The average length of stent placement was 5 weeks. The mean patient follow-up time was 12 months. There were no surgical complications. The nasofrontal duct patency rate and patient improvement rate from our study did not differ statistically from results reported by other authors using the endoscopic Lothrop procedure. CONCLUSION: We have found endoscopic frontal sinusotomy, in conjunction with external frontal sinusotomy and placement of frontal sinus stents, to be as effective in obtaining frontal sinus patency rates and overall patient improvement rates as the endoscopic Lothrop procedure.