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     

鼻内镜手术治疗鼻窦真菌病

目的讨论鼻内镜手术治疗鼻窦真菌病的疗效。方法对27例鼻窦真菌病患者施行鼻内镜手术，术后不用抗真菌药。结果全部患者均获治愈，随访6个月～3年未见复发。结论在本病的治疗中，应用鼻内镜手术可减轻对患者的侵袋性操作，并缩短诊疗时间，避免或减少复发。鼻内镜手术是诊断、治疗鼻窦真菌病较为理想的方法。     

鼻内镜手术治疗鼻腔鼻窦真菌病12例

<正>鼻腔、鼻窦真菌病以往的发病率较低,近年来发病率有逐年上升的趋势[1],临床上以非侵袭型为主。2003年1月～2008年6月我们采用鼻内镜手术及术后窦腔治疗鼻腔鼻窦真菌病12例,术后疗效     

鼻内镜扩大鼻窦开放术研究进展

鼻内镜扩大鼻窦开放术（extended endoscopic sinus surgery,EESS）是在功能性内镜鼻窦手术（functional endoscopic sinus surgery,FESS）基础上进行的一种改良术式,其目的是为更广泛的切除病灶和扩大窦口,提供更大的引流途径,便于有效的术后监测和局部给药,从而减少复发。EESS主要用于治疗伴哮喘、过敏、纤毛功能不良等难治性鼻窦炎鼻息肉患者。     

经鼻内镜儿童鼻窦异物取出术

由于一些高速运动的小物体击中颜面部,造成颜面部开放性损伤,形成鼻窦异物,因异物位置较深,定位困难,有时比邻重要的结构,给异物的取出造成很大的困难,有时需要多次手术,常常给患者留下明显的瘢痕.随着鼻内镜技术的普遍开展,内镜鼻窦手术具有传统鼻窦外科无法代替的诸多优点;为鼻窦及其周边异物的临床治疗开辟了一种新的途径,手术视野清晰,简单易行[1,2].我们经鼻内镜治疗儿童鼻窦异物8例,取得了很好的效果,报告分析如下.     

鼻内镜在诊治鼻腔鼻窦真菌病中的应用

目的：评价鼻内镜技术在鼻腔鼻窦真菌病的诊断和治疗中的应用价值。方法：对54例非变态反应性真菌性鼻窦炎患者应鼻内镜技术诊断与治疗的经验进行总结。结果：全部患者均获治愈,随访1-5年未见复发。结论：在本病的诊断与治疗中,应用鼻内镜技术可减轻患者的侵损性操作,并缩短诊治时间,避免或减少复发。鼻内镜技是诊断治疗鼻腔鼻窦真菌病较为理想的方法。     

鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎

目的探讨非侵袭性真菌性鼻-鼻窦炎的临床特征,鼻内镜手术方法及疗效。方法回顾性分析102例非侵袭性真菌性鼻-鼻窦炎患者临床资料。结果所有患者均行鼻内镜手术治疗,随访6个月至4年,治愈77例,好转20例,复发5例。结论鼻腔鼻窦解剖异常是非侵袭性真菌性鼻-鼻窦炎的主要致病因素。鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎的有效手段,术后复发与手术的彻底性、术后鼻腔鼻窦处理有关。     

鼻侧切开联合鼻内镜术治疗近颅底的鼻及鼻窦病变

1995年5月～2002年4月我科采用常规鼻侧切开，术中联合鼻内镜术处理贴近颅底的鼻及鼻窦肿瘤6例，明显减少了手术创伤，效果较为理想，现报道如下。     

内镜鼻窦手术治疗非侵袭性真菌性鼻窦炎12例

真菌性鼻窦炎为鼻腔的真菌感染性疾病,可分为非侵袭型真菌性鼻窦炎与侵袭型真菌性鼻窦炎,随着鼻内镜技术在临床的应用及诊断水平的提高,真菌性鼻窦炎在临床上不断被发现并有上升趋势,我科自2005年5月～2006年10月共收治12例患者,现报告如下.     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

Aneurysmal bone cyst of paranasal sinuses

Aneurysmal hone cyst is rare in paranasal sinuses. It may be uni or multilocutar It occurs alone or with other benign bone lesions. The exact pathogenesis of it is still unknown. The aggressiveness of the disease needs early diagnosis and proper management to prevent recurrence. This report describes a case of aneurysmal bone cyst involving the ethmoid and maxillary sinuses which was successfully managed.     

CT findings of aspergillosis in the paranasal sinuses

Summary The diagnosis of aspergillosis in the paranasal sinuses is preoperatively difficult to make in spite of the increasing number of reports showing its prevalence. However, because symptoms are usually non-diagnostic and infection is usually confined to a single sinus, X-ray findings are often suspect for possible neoplasm. We have studied six patients with aspergillosis, all of whom were suspected of having sinus tumors, but were otherwise healthy persons. Affected sinuses were examined by CT and the diagnosis of non-invasive aspergillosis was confirmed by operation. In this report, we have compared the CT and X-ray findings in our cases of aspergillosis. These findings indicate that CT is useful in the preoperative diagnosis of sinus aspergillosis.     

Fungus balls of the paranasal sinuses: a review

In the past 30 years, thanks in part to the advance of both endoscopic technology and imaging possibilities, the classification, diagnosis, and management of rhinosinusitis caused by fungi have been better defined. These are basically divided into invasive and non-invasive forms based on the presence or absence of microscopic evidence of fungal hyphae within the tissues. Among the non-invasive fungal sinus diseases, fungus ball has been increasingly reported and large published series have allowed better characterization of the disease and the treatment strategies. Fungus ball of the paranasal sinuses is defined as the non-invasive accumulation of dense fungal concrements in sinusal cavities, most often the maxillary sinus. To describe this entity, confusing or misleading terms such as mycetoma, aspergilloma or aspergillosis would be best avoided. Clinical presentation is non-specific and the diagnosis is usually suspected on imaging studies. Surgical treatment, usually through an endonasal endoscopic approach, is curative. In this paper, we review the clinical, radiological, and pathological presentation of the fungus ball of the paranasal sinuses as well as the surgical management with emphasis on the transnasal endoscopic approach.     

儿童鼻窦正常气化规律初探

目的 利用磁共振成像探讨儿童鼻窦正常气化规律.方法 选取280例无鼻窦炎的年龄17 d(＜1岁患儿本研究中称为0岁)至14岁患儿的鼻窦MRI图像,观察各组鼻窦的气化规律,测量左侧上颌窦轴位与矢状位最大面积值.结果 0～1岁患儿上颌窦气化率为85%;至3岁时,气化率达95%,且男女患儿上颌窦气化率差异无统计学意义(x2=0.741,P=0.389);4岁以后全部气化.0～14岁患儿筛窦气化率达100%.＜1岁患儿蝶窦未见气化;至5岁时平均气化率为49%,且男女患儿气化率差异无统计学意义(x2=2.452,P=0.117);7岁以后气化率达100%.＜5岁患儿额窦未见气化;5～9岁额窦平均气化率为62%;10岁以后额窦气化率达到95%,男女患儿额窦气化率差异无统计学意义(x2=0.124,P=0.724).女性患儿上颌窦气化轴位、矢状位最大面积分别为(689.28±221.79)、(659.76±263.31)mm2,男性分别为(668.13±206.38)、(638.60±207.67)mmz,差异均有统计学意义(t=-19.78,P＜0.001;t=-19.89,P＜0.001).结论 了解儿童鼻窦正常气化规律有助于对不同年龄儿童鼻窦病变,特别是炎性病变的诊断提供参考.     

经鼻内窥镜治疗真菌性蝶窦炎

目的探讨经鼻内窥镜治疗真菌性蝶窦炎的手术方法。方法9例真菌性蝶窦炎患者,均采用鼻窦内窥镜手术治疗。结果经6～36个月随访,9例均治愈。结论经鼻内窥镜手术治疗真菌性蝶窦炎具有手术进路安全,患者痛苦小,疗效肯定,术后不易复发等优点。     

Normal wound healing of the paranasal sinuses: Clinical and experimental investigations

Summary Twenty-two patients underwent partial or complete ethmoidectomies and were subjected to standardized postoperative follow-ups including endoscopic photography of healing tissues. Sequential biopsies were also taken from the regenerating mucosa and compared with endoscopic findings. On this basis wound healing could be divided into four different phases, allowing for the diagnosis of healing disturbances and clinical planning of stage-dependent therapy. Additionally, a model of wound healing in the maxillary antrum of the rabbit was developed for better understanding the clinical observations. Regeneration of standardized mucosal defects was studied with three-dimensional histomorphological analysis. Circular wounds were found to regenerate concentrically, with wound closure starting by epithelial migration. Within 120 h, granulation tissue covering the wound surface started to become hyperplastic and bone apposition occurred with the formation of osteoid. The systemic application of prednisolone (2 mg/ kg per day i.m.) and topical 5% dexpanthenol ointment resulted in an acceleration of late epithelial wound closure together with a reduction in hyperplastic granulation tissue. Local applications of epidermal growth factor had no significant effect.