鼻内镜术后病情迁延的细菌学分析

目的:探讨慢性鼻-鼻窦炎(CRS)鼻内镜术后迁延不愈者鼻腔分泌物的细菌学特征。方法:选取单纯鼻中隔偏曲患者20例(对照组),取其中鼻道分泌物;选取首次接受鼻内镜手术的CRS患者30例(手术组),术中取中鼻道分泌物;取FESS术后随访3个月以上未达治愈标准的患者20例(迁延组),在鼻内镜下取中鼻道分泌物,分别做细菌培养和药物敏感试验,3组结果进行比较分析。结果:对照组检出细菌13株,手术组检出15株,迁延组检出15株,其检出阳性率差异无统计学意义;迁延组G-菌检出率明显高于对照组和手术组;对常用抗生素耐药的菌株比例迁延组显著高于手术组。结论:需氧菌可存在于正常鼻腔内;CRS术后迁延不愈者,G-杆菌的感染和细菌的耐药性明显增加。因此,强调要合理应用抗生素,对术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上。     

慢性鼻-鼻窦炎患者细菌学检测及药敏分析

目的　探讨慢性鼻-鼻窦炎（CRS）患者细菌学分布及药敏分析。方法　63例确诊为CRS的手术患者,取中鼻道脓性分泌物行普通细菌培养,对有临床意义的细菌 行药敏试验。结果　63例患者中,43例普通细菌培养结果为阳性,阳性率为68.25%,共分离出细菌15种,排在前3位的是甲型链球菌/黄色奈瑟菌、金黄色葡萄球菌、表皮葡萄球菌。27株行药敏试验,排在前4位的抗生素是环丙沙星81.48%,复方新诺明66.67%,庆大霉素59.26%,左氧氟沙星51.85%。结论　对于CRS患者,应根据药敏结果选择抗生素,若未能行药敏试验,应首选喹诺酮类抗生素。     

慢性鼻-鼻窦炎患者鼻腔灌洗液细菌学研究

目的　探讨慢性鼻-鼻窦炎（CRS）患者鼻腔灌洗液中细菌分布和耐药性特征，为临床治疗用药提供依据。方法　收集90例CRS患者（CRS组）和40名健康受试者（对照组）的双侧鼻腔灌洗液进行细菌培养、鉴定和药物敏感试验。结果　CRS组鼻腔灌洗液中细菌培养阳性率为80%（72/90），全部为需氧菌，未检出厌氧菌，常见菌种为凝固酶阴性葡萄球菌、草绿色链球菌、肺炎克雷伯菌、奈瑟氏球菌，对照组鼻腔灌洗液中细菌培养阳性率为77.5%（31/40），细菌种类与CRS组一致，无显著性差异 （P >0.05）。CRS组菌株对2种或2种以上抗生素耐药的比例显著高于对照组（P <0.05）。结论　CRS患者鼻腔灌洗液中检出细菌菌谱广，属条件致病菌且菌群耐药性较高，提示临床应动态监测细菌谱的变化，选择抗生素治疗时不能经验用药，应以药物敏感试验结果为依据。     

鼻内镜手术治疗非侵袭性真菌性鼻窦炎

真菌性鼻窦炎的主要致病菌为曲霉菌,在临床上有增多趋势,据报道占各类慢性鼻-鼻窦炎的6%~13%〔1〕,过去多采用上颌窦根治术或Li ma手术来清除病灶。随着鼻内镜技术的发展,此类疾病现在倾向于采用鼻内镜下清除病灶。现将我科采用鼻内镜手术治疗非侵袭性真菌性鼻窦炎34例的完整资料报告如下。1资料与方法1.1临床资料临床经病史、CT及术后病理检查确诊非侵袭性真菌性鼻窦炎34例,其中男28例,女6例;年龄36~68岁。按1997年海口标准,慢性鼻-鼻窦炎Ⅰ型2期4例,Ⅱ型2期26例,Ⅲ型4例。真菌感染的鼻窦:右上颌窦20例,左上颌窦14例,累及筛窦12例。伴鼻中隔偏曲19例。1.2治疗方法34例患者均在局部麻醉下行患侧鼻内镜下鼻窦手术,行钩突切开,开放中鼻道,咬除筛泡,行上颌窦窦口扩大,用筛窦钳、筛窦刮匙和吸引管清除真菌团块及炎性息肉,上颌窦内下角病灶较难清除,采用自制的弯度较大的吸引管(利用吹张管做成“?”型)将真菌团块破碎后吸出,其中12例筛窦发现有真菌团块,行前筛或全筛切除,均能彻底清除窦内真菌团块、炎性息肉。术后第3天开始用生理盐水冲洗鼻腔2~3个月,冲洗后,鼻内镜下用10ml氟康唑冲洗窦腔1周。同时,采用氟...     

慢性鼻-鼻窦炎手术前后鼻腔细菌学研究及药敏试验分析

目的:探讨慢性鼻-鼻窦炎（CRS）患者手术前后鼻腔细菌感染状况的变化及药敏试验分析。方法:实验组来自50例CRS患者术前中鼻道分泌物、鼻息肉组织和功能性内镜鼻窦手术术后1、3、6个月复诊时的中鼻道分泌物;对照组选取30例单纯鼻中隔偏曲或鼻出血患者的中鼻道分泌物。结果:对照组与实验组术前、术后1个月及术后3个月中鼻道分泌...     

72例非侵袭性真菌性鼻-鼻窦炎鼻内镜手术

目的:评价鼻内镜手术在治疗非侵袭性真菌性鼻-鼻窦炎的疗效。方法:采用Storz鼻内镜对72例非侵袭性真菌性鼻-鼻窦炎病例行鼻内镜手术,彻底清除鼻腔、鼻窦病变组织,充分开放鼻窦,扩大上颌窦自然口,使其直径达1.0cm以上,术后应用大扶康冲洗术腔3次。结果:随访6个月~6年,全部病例均治愈,无复发。术前症状如鼻塞、流脓涕、血涕、鼻腔异味及头痛症状消失,经鼻内镜检查:全部病例中鼻道、上颌窦口通畅,鼻腔及窦腔内黏膜正常,腔内无真菌团块及异常分泌物。结论:鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎的主要手段,辅以大扶康液冲洗术腔,疗效更好。     

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.     

内镜鼻窦手术后随访及雷诺考特喷鼻的疗效观察

目的 :探讨慢性鼻窦炎、鼻息肉内镜鼻窦术后随访的时间和糖皮质激素鼻内用药的效果。方法 :对 30例鼻窦炎、鼻息肉患者行内镜鼻窦手术 ,术后定期随访 ,行内镜下术腔护理、鼻窦冲洗和糖皮质激素雷诺考特鼻内局部应用 ,观察临床疗效。结果 :术后 3个月 ,2 5例鼻腔、鼻窦已干燥、上皮化 ;术后 6个月 ,2 8例鼻腔、鼻窦已干燥、上皮化 ,鼻塞、头痛均消失。 4例伴变应性鼻炎者 ,鼻腔有少许分泌物 ;10例嗅觉障碍者中 3例无改善。结论 :内镜鼻窦手术后的鼻内镜随访、术腔护理及糖皮质激素鼻内应用 ,在慢性鼻窦炎、鼻息肉的治疗过程中起着同样重要的作用。     

鼻内镜鼻窦手术治疗青少年慢性鼻窦炎临床观察——附43例报告

目的 探讨鼻内镜鼻窦手术治疗青少年慢性鼻窦炎的适应证、并发症及手术疗效。方法 本组43例（78侧）全部采用Messerkling′s术式，视病变范围，鼻腔解剖变异情况切除钩突，摘除息肉。扩大上颌窦自然开口，开放筛窦，酌情开放额窦。同期处理相关病变。结果 43例病人总的治经为86．05％，好转率为9．3％，无效为4．65％，同期成人鼻窦炎鼻肉镜手术治愈率为59．26％，两者相比差异具有非常显著性（P＜0．01），术后并发症主要是术腔粘连。结论 鼻肉镜鼻窦手术治疗青少年慢性鼻窦炎是目前较为理想的治疗方法。     

内镜鼻窦手术后处理对其疗效的影响

内镜鼻窦手术的疗效取决于设备的配置、术者的熟练程度及术后定期随访中的正确处理等 ,后者是极为重要的环节。本文总结我科 1 998年 1月～2 0 0 0年 1 2月 335例患者术后处理中发现的问题 ,探讨内镜鼻窦手术后的一般处理原则。1　资料与方法1 .1 　 临床资料1 998年 1月～ 2 0 0 0年 1 2月因鼻窦炎行内镜鼻窦手术者 335例 ,男 2 0 8例 ,女 1 2 7例 ;年龄 8～85岁 ,平均 2 8岁。病程 1～ 40年。首次手术者2 98例 ,再次手术者 37例 ,其中术前行鼻息肉摘除术最多者达 8次。按照 1 997年海口会议“慢性鼻窦炎鼻息肉临床分型分期及内镜鼻窦手术…     

鼻内镜下手术治疗慢性侵袭性真菌性鼻-鼻窦炎的探讨

目的：评价鼻内镜手术治疗慢性侵袭性真菌性鼻-鼻窦炎的效果。方法：回顾性分析鼻内镜下手术治疗的术后病理确诊为慢性侵袭性真菌性鼻-鼻窦炎的63例患者资料。结果：随访6个月～1年,全部痊愈,少数有轻度并发症。结论：鼻内镜手术是治疗鼻-鼻窦真菌性疾病的有效方法,可不使用抗真菌药。     

鼻内镜术后不同填塞材料对术后黏膜转归的影响

目的 探讨鼻内镜手术后,鼻腔不同填塞材料对慢性鼻窦炎患者鼻窦术腔黏膜转归的影响。 方法 对入选的167例鼻窦炎患者按填塞材料的不同分为纳吸棉组(A组,n=93)和膨胀海绵组(B组,n=74)。两组患者均执行同样的入院前治疗,由同一高年资医师手术,并给予相同的术后用药及复查换药周期安排,通过比较视觉模拟评分法(VAS)、术前Lund-Mackay鼻窦CT评分、术后鼻内镜Lund-Kennedy评分,比较两组术后鼻窦术腔黏膜恢复情况。 结果 A、B组间术前Lund-Mackay、VAS和Lund-Kennedy分值差异均无统计学意义(P>0.05);两组Lund-Kennedy术后评分差异有统计学意义(P<0.01),且各时间点A组分值低于B组(P<0.01);两组VAS术后不同时间点评分组间差异均有统计学意义(P<0.01),术后4周及12周均显示A组评分低于B组,A组症状后期改善更佳。A组5例、B组7例12周时术腔局部水肿明显,囊泡增生,组织重塑不良,有息肉复发迹象,结合术后病理,给予个体化治疗方案等处理后,黏膜修复明显改善。 结论 鼻内镜术后纳吸棉填塞可促进术腔黏膜良性转归过程。     

Chronic rhinosinusitis and endoscopic sinus surgery

Olfactory dysfunction is a major symptom reported by patients with chronic rhinosinusitis (CRS). Surgical treatment of this disease requires close surveillance of such dysfunction because of wide ranging implications for safety, quality of life, and impact on the flavor of foods and beverages. This review highlights key findings regarding the influences of endoscopic sinus surgery (ESS) on olfactory function across the unique presentations of CRS. Such findings provide information useful for informing patients of potential complications and for obtaining informed consent prior to surgical intervention. ESS has been shown to improve olfaction across all types of CRS as assessed through quantitative testing and subjective reports. The presence of nasal polyposis (NP) and eosinophilia have been identified as predictors of significant postoperative olfactory improvement. When indicated, judicious partial resection of the middle turbinate may result in improved olfactory function without a risk of long term complication. Careful attention to the olfactory cleft and frontal sinus recess are important in limiting olfactory complications by avoiding indiscriminate disruption of olfactory epithelium. Given the chronic nature of the disease, surveillance of olfactory function in patients with CRS is a lifelong activity that will evolve as emerging technologies become available.     

鼻内镜下治疗非侵袭性真菌性鼻-鼻窦炎的术式选择与疗效

目的探讨鼻内镜手术与传统术式结合治疗非侵袭性真菌性鼻-鼻窦炎的疗效。方法对我科2003年6月～2009年6月有完整随访资料的接受鼻内镜手术治疗的58例非侵袭性真菌性鼻-鼻窦炎患者的临床资料进行分析。其中采用单纯鼻内镜手术32例,鼻内镜联合改良柯-陆术式11例,鼻内镜联合下鼻道开窗15例,并对所有患者术后情况进行随访。结果随访1年以上,仅3例手术后复发,其余55例在随访期内均未见复发。结论鼻内镜手术是治疗非侵袭性真菌性鼻-鼻窦炎安全且有效的手段,可基本完整保留鼻腔、鼻窦正常的解剖结构。彻底清除真菌团块、术后定期随访是治疗成功的关键。     

Olfactory changes after endoscopic sinus surgery in patients with chronic rhinosinusitis

Objective

To address the controversy over whether olfactory function is improved or not after endoscopic sinus surgery (ESS) in patients with eosinophilic (ECRS) and non-eosinophilic chronic rhinosinusitis (non-ECRS).

Methods

Between June 2006 and March 2012, 89 adult patients with CRS underwent ESS at Hyogo College of Medicine. There were 55 men and 34 women with a mean age of 53 years old, ranging from 23 to 79 years. The average follow-up period was 10.7 months (3–24) after ESS. Peripheral blood examination, sinonasal CT imaging, and four kinds of olfaction tests [self-administered olfaction test (SAOQ), visual analog scale (VAS), T&T recognition threshold tests (T&T) and intravenous olfaction test using prosultiamine] were performed. We diagnosed ECRS when (i) symptoms of nasal congestion and olfactory disorder, (ii) bilateral chronic rhinosinusitis with nasal polyps (CRSwNPs), (iii) peripheral blood eosinophilia (>7.0%), and (iv) ethmoid sinus dominant opacification in preoperative CT findings (i.e. ethmoid sinuses (E) were more bilaterally occupied than those of maxillary sinuses (M), E/M ≥ 1), were completely fulfilled. We divided the patients into two groups of ECRS (group A) and non-ECRS (group B). Olfaction tests before operation, and at the 3rd, 6th, 12th, and 24th month postoperation were analyzed. The severity and therapeutic evaluation of olfaction were based on criteria of T&T recognition thresholds.

Results

The mean SAOQ and VAS scores showed significant improvement within 6 months after ESS in both group A and group B. In total, the improvement rates were 52.0% (26/50) at 3 months, 58.5% (24/41) at 6 months, 40.5% (15/37) at 12 months, and 41.2% (7/17) at 24 months. The significant improvement of T&T recognition thresholds in group B was maintained for 24 months, whereas those in group A, showing transient improvement, deteriorated after 12 months or more. A significant difference in postoperative T&T recognition between groups A and B was found at the 12th postoperative month. In both A and B, 84% of patients had a response to prosultiamine (positive group) in the preoperative stage. T&T thresholds in the positive group were significantly better that those in the negative groups in the postoperative stage.

Conclusion

Olfactory disorders due to ECRS showed transient improvement that deteriorated as time passed after surgery. The olfaction in the non-ECRS patients recovered comparatively well. Postoperative olfactory results were unfavorable in patients without a preoperative reaction to prosultiamine.     

鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估

目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者在鼻内镜术(endoscopic sinus surgery, ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效。方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入。治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月。对照组使用生理盐水鼻腔雾化吸入,方法相同。雾化前(术后第2天)、雾化5d和3个月后分别采用视觉模拟量表、Lund Kennedy评分系统、Lund Mackay评分法进行相关评估。结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义。结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效。     

鼻内镜治疗慢性鼻-鼻窦炎疗效及影响因素分析

目的探讨慢性鼻-鼻窦炎术后疗效及影响疗效的相关因素。方法回顾性分析200例经鼻内镜手术的慢性鼻一鼻窦炎患者的临床资料,通过t检验了解术后疗效,Logistic回归模型分析影响慢性鼻-鼻窦炎患者手术预后的诸因素。结果患者术后症状明显改善,相关因素分析表明慢性鼻-鼻窦炎患者是否伴有鼻息肉、是否长期应用鼻减充血剂、是否有前期鼻窦手术史、是否伴变应性鼻炎病史、是否坚持鼻内镜术后的综合治疗是影响慢性鼻-鼻窦炎手术预后的相关因素。结论功能性鼻内镜手术作为治疗慢性鼻-鼻窦炎、鼻息肉最有效的临床方法之一,能够明显地改善患者的症状,同时强调鼻内镜术后的综合治疗,包括术后随访和鼻腔清理,鼻内糖皮质激素、黏液稀化剂和抗生素的联合应用。     

Quality of life after endoscopic sinus surgery in refractory pediatric chronic rhinosinusitis

ObjectiveThe present study aims to evaluate the role of Endoscopic Sinus Surgery (ESS) in refractory pediatric Chronic Rhinosinusitis (CRS) and to assess the change in quality of life after ESS.Materials and MethodsThis prospective interventional study included 35 children (aged between 6 and 12 years) of refractory CRS, not responding to 4 weeks of maximal medical therapy attending the pediatric ENT clinic of a tertiary referral centre. Study period was from November 2013 to March 2016. This patient pool underwent Non Contrast Computed Tomography scan (NCCT) paranasal sinuses and diagnostic nasal endoscopy and those fulfilling the requisite inclusion criteria underwent Endoscopic sinus surgery. Global assessment of Rhinosinusitis Symptom severity score and SN-5 quality of life score of the patients was assessed preoperatively and 1 year after the surgery.Results91.4% children showed an improvement in the total symptom score with a statistically significant (p value < 0.001) reduction in the mean total score postoperatively. Similarly 91.4% of the children showed an improvement in their quality of life with a statistically significant (p value < 0.001) difference seen in the average SN-5 scores after ESS. No major complications were encountered in any of the cases.ConclusionESS is a safe and effective surgical management for children with CRS refractory to maximal medical therapy leading to an improvement in their quality of life.     

鼻腔冲洗在慢性鼻窦炎鼻内镜术后治疗中的应用研究

慢性鼻窦炎（CRS）是鼻窦黏膜的慢性炎症性疾病,其病因学及病理生理机制复杂。随着基础和临床研究不断深入,其诊断、治疗策略逐渐向个体化和精准化方向发展。手术治疗是CRS整体治疗的重要组成部分。鼻内镜手术因其功能性和微创性成为目前CRS首选的外科治疗手段,但是术后鼻腔、鼻窦黏膜仍处于炎症环境中,若处理不当会影响手术疗效。临床研究证实,鼻内镜手术后行鼻腔冲洗可改善症状,促进术腔恢复。本文将从冲洗液、冲洗方法、冲洗工具等方面进行综述,为鼻腔冲洗临床应用提供参考。