鼻内窥镜术上颌窦自然开口的处理

探讨内窥镜鼻窦手术治疗慢性鼻窦炎，鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法 配对研究５６例双侧鼻窦炎，鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果 窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分分别为９２．９％和８０．４％。     

鼻内窥镜下中鼻道上颌窦开窗术

内窥镜鼻窦手术中经中鼻道行上颌窦开窗术可重建上颌窦通气和引流，为符合鼻窦生理的功能性手术方法。对７５例接受内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患各行中鼻道上颌窦开窗术９４侧，下鼻道上颌窦开窗术６４侧，开窗孔开放情况经３～１５个月随访观察，术后６个月时窗口开放者为８６．７％，闭合者为１３．３％，下鼻道开窗孔开放者为５４．７％，闭合者占４５．３％，两者比较Ｐ＜０．０１，差异有显著性，表明中鼻道上颌窦开窗术优于下鼻道上颌窦开窗术。并从解剖、生理方面讨论中鼻道上颌窦开窗术的临床应用价值。     

鼻窥镜下中鼻道上颌窦口扩大术的理论、方法和疗效

作者首先复习了文献中有关赞成和反对中鼻道上颌窦口扩大术治疗鼻窦炎的意见。赞成者认为,中鼻道区的解剖变异以及窦口周围、前组筛窦的病变是鼻窦炎的原因,窦口扩大术可去除中鼻道的病变;反对者认为,窦口手术可造成永久性损伤,引起窦口闭塞,而下鼻道开窗引流可获较满意效果。上颌窦口解剖各异,其直径小于5 mm,长度可为1～22mm。鼻窥镜检查及 CT 证实了窦口及中鼻道的病变可使鼻窦炎久治不愈或上颌窦根治术失败。鼻内窥镜直视下,中鼻道窦口扩大术可作宽敞的     

鼻内窥镜下中鼻道下颌窦开窗术

内窥镜鼻窥手术中经中鼻道行上颌窦开窗术可重建上颌窦通气和引流，为符合鼻窦生理的功能性手术方法，对７５例接受内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患者中鼻道上颌窦开窗术９４例，下鼻道下颌窦开术６４例，开窗孔开放情况经３－１５个月随访观察，术后６个月时窗口开放者为８６．７％，闭合者为１３．３％，下鼻道下窗孔开放者为５４．７％，团合者占４５．３％，两者比较Ｐ＜０．０１差异有显著性，表明中鼻道下颌窦开窗术优于     

鼻内窥镜鼻窦开放98例效果观察(摘要)

自1994年12月以来我科采用鼻内窥镜行鼻窦开放术98例，术后随访6个月以上。98例（172侧），男58例，女40例；年龄11～69岁，平均31岁，病程最短半年，最长35年；鼻阻98例，流脓涕89例，伴头昏头痛72例，嗅觉减退5例；根据病史，术前专科检查，鼻窦CT，鼻窦摄片。反复发作性鼻窦炎15例，中鼻道息肉十鼻窦炎37例；全鼻腔息肉十鼻窦炎21例；有前期手术史25例。鼻息肉摘除十筛窦开放36例，鼻息肉摘除十筛窦、额窦开放18例，鼻息肉摘除十全鼻窦开放5例，上颌窦自然口扩大、下鼻道联合开窗35例，上颌窦自然口扩大十上颌窦根治术4例。本组98例中，…     

鼻内镜下上颌窦口处理方法的探讨

目的：探讨内窥镜鼻窦手术中上颌窦自然开口处理方法与预后的关系。方法：对慢性鼻窦炎、鼻息肉患者682例采用不同途径寻找上颌窦开口并根据窦口的形态和上颌窦本身的病变情况,决定开口方式与处理方法。结果：随访6个月,发现窦口开发率为84.22%(574/682例),闭锁率为16.88%（106/682）。结论：上颌窦口的处理方法是鼻内窥镜手术重要步骤,也是影响疗效与预后的关键因素之一。     

功能性鼻窦内窥镜手术77例报告

采用鼻窦内窥镜进行鼻窦手术７７例，术式包括筛窦切除，上颌窦窦口扩大术，蝶窦口扩大术主上颌窦下鼻道进路等。术后对其中６０例进行了随访，９１．６％患者术后症状明显改善，６３．３％症状人武部消失。笔者认为此术是开放闭塞鼻窦，改善引流及治愈鼻窦炎的术式。并对鼻窦内窥镜手术并发症，手术有关事项等进行讨论。     

鼻窦传统手术的转归

目的：通过询问病史、ＣＴ扫描及鼻内窥镜检查观察上颌窦根治术后鼻窦炎复发患者的面部症状、鼻窦骨及软组织,从病理生理学角度分析探讨上颌窦根治术后局部组织病理学变化对术后转归的影响,并以此观察分析作为基础,建议合理掌握传统手术及鼻内窥镜手术适应证范围。方法：对２８７例（３８２侧）既往曾行上颌窦根治术（Ｃａｌｄｗｅｌｌ－Ｌｕｃ）后鼻息肉复发患者进行再手术前鼻窦ＣＴ扫描,并观察前期手术后患者面部感觉,上颌窦骨质增生及窦腔容积缩小程度及中鼻道或下鼻道自然口或人工开窗口情况。结果：术后出现慢性鼻窦炎症状的全部被观察患者,２７．５％出现面部症状,４３．６％出现骨质增生引起窦腔容积变小甚至消失。此外还出现上颌窦自然口或下鼻道开窗口完全瘢痕闭锁。结论：有必要重新对各种传统鼻窦手术的适应证重新定义,对手术适应证的概念进行调整修正,以达到在彻底清除病变的基础上减低并发症、控制复发率。     

根治性鼻窦手术自然窦口处理的临床分析

目的探讨根治性鼻窦手术中更为完善的上颌窦自然孔开窗术.方法为慢性鼻窦炎伴多发性鼻息肉66例行根治性鼻窦手术自然窦口扩大术,术后随访10～42个月,对慢性鼻窦炎伴多发性鼻息肉手术疗效与相关因素进行临床分析.结果患者均未发生并发症.结论根治性鼻窦手术中自然窦口的处理是治疗慢性鼻窦病变伴多发性鼻息肉的有效方法.     

Ⅲ型慢性鼻窦炎鼻息肉综合治疗方法的探讨

目的：探讨Ⅲ型慢性鼻窦炎鼻息肉有效的综合治疗方法。方法：57例Ⅲ型慢性鼻窦炎鼻息肉（均有一次以上鼻腔鼻窦手术史），其中21例筛窦骨质明显增生，窦腔融合，15例（24侧）为上颌窦根治术后复发，采用Messerkinger法彻底开放筛窦，充分扩大自然孔，术后用内镜电离子技术处理术腔水肿样肉芽组织及早期息肉与逐步处理上颌窦病变组织，冲洗窦腔，控制感染等综合治疗方法的随访观察。结果：大部分病例术后6－9个月症状明显改善，鼻腔，中鼻道，筛窦腔均已上皮化，12例（18例）上颌窦腔充分扩大且上皮化，3例（4侧）1年后除上颌窦前下壁少许粘膜水肿外均上皮化，全部病例均随访1年－1年半，治愈36例（63．2％），结论：Ⅲ型慢性鼻窦炎鼻息肉鼻内镜手术只是治疗的重要一环，内镜电离子技术是术后处理早期病变和上颌窦内病变促进上皮化的有效方法，术中充分扩大自然孔，开放筛窦和术后有效的抗感染是重要环节。     

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％     

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.     

Patency of the maxillary sinus ostium in healthy individuals

In a group of 20 healthy subjects the patency of the maxillary ostium has been evaluated in 35 maxillary sinuses with three different techniques: simultaneous pressure recording in the sinus and the ipsi- and contralateral nasal cavity; simultaneous recording of differential pressure between the sinus and the ipsilateral nasal cavity and air-flow through the ostium during nasal breathing; recording of the pressure rise in the sinus with an artificial air-flow of 1 litre per minute applied to the sinus. The tests were carried out in sitting and recumbent positions. In 5 persons (10 sinuses) a retest was performed after 2 months. These subjects were also tested with an inflatable neck cuff in order to obtain an increased venous pressure. Rhinomanometry at rest and after physical effort was also performed. The pressure relationship between the maxillary sinus and the ipsilateral nasal cavity was 1:1 in both the sitting and the recumbent position, but less than 1 when the contralateral nasal cavity was measured. Pressure recording alone gives no quantitative information about the patency of the ostium. Determination of the ostial resistance during nasal breathing could be performed in 13 sinuses, but in the remaining 22 the ostia were too wide to give a measurable resistance. The equivalent ostial diameter during inspiration could be estimated in 12 of the sinuses from a diagram constructed from known ostial diameters in model experiments. With an artificial air-flow applied into the sinus, the equivalent ostial diameters could be estimated from the diagram in all cases. No statistical difference was found in comparable cases between the mean equivalent ostial diameters estimated with the two methods. The equivalent ostial diameters showed a statistically significant reduction in the recumbent position and after application of the neck cuff. A statistically significant relationship was also found between the airway resistance of the nasal cavity and the equivalent diameter of the ostium in sitting and recumbent positions. Such a relationship could not be found between the equivalent ostial diameters measured at rest and the nasal resistance recorded after physical effort.     

Development of maxillary accessory ostium following sinusitis in rabbits

OBJECTIVES/HYPOTHESIS: Maxillary accessory ostium is one of the anatomical variations that may play a role in the development of chronic maxillary sinusitis. Although some authors claim that accessory ostia develop following acute maxillary sinusitis, it is not clear whether they are congenital or acquired. STUDY DESIGN: Animal experimental study. METHODS: Ten New Zealand type rabbits were used in the study. In phase 1, lateral nasal walls of five New Zealand type rabbits were examined for the presence of natural and accessory ostia of the maxillary sinus and any area resembling fontanelles in humans. In phase 2, experimental sinusitis was induced in the right sides of the other five rabbits. Following sacrifice, lateral nasal walls were examined for the development of accessory ostia. RESULTS: Six of the ten sides of phase 1 animals contained a membranous part in the medial wall of the maxillary sinus resembling the fontanelles in humans (60%). None of them had an accessory maxillary ostium. Accessory ostia developed in two of the five sides with sinusitis (40%). CONCLUSIONS: We have shown for the first time that accessory maxillary ostia develop following experimental sinusitis in rabbits. Further studies in humans are indicated.     

Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.     

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.     

Pressure measurements in the normal and occluded rabbit maxillary sinus

Occlusion of the maxillary ostium is considered to be a key factor in the pathogenesis of maxillary sinusitis. In this study, the authors determined the effect of ostial occlusion on pressure in the rabbit maxillary sinus which, like most humans, has only one ostium. We compared pressures in the normal and occluded maxillary sinus and the nasal cavity during spontaneous breathing in anesthetized adult animals. Serial pressure measurements were obtained from sinuses with patent ostia in nasal-breathing rabbits and with occluded ostia in both nasal-breathing and tracheotomized animals. Sinuses with patent ostia showed pressure curves synchronous with the respiratory cycle. Inspiratory and expiratory pressures in the nasal cavity and the sinus were isobaric. Sinuses with occluded ostia initially developed a positive pressure followed by a negative pressure that reached a subatmospheric plateau of-28.2 ± 7.3 mm H₂O (mean ± standard deviation [SD]) within 20 to 50 minutes. This is the first quantitative study of sinus pressures using the rabbit as an animal model. The findings may contribute to a better understanding of the role of ostial occlusion in the pathogenesis of maxillary sinusitis in humans.     

慢性鼻窦炎鼻息肉鼻内镜术后随访的必要性

目的 探讨慢性鼻窦炎鼻息肉鼻内镜术后定期随访的意义。方法 2001年4月-2005年4月间在我科接受鼻内镜手术的慢性鼻窦炎鼻息肉患者308例（530侧），除了42例（68侧）患者的随访观察过程不规则外，其余266例（462侧）均进行了规律的随访与术腔清理。比较分析两组病例不同随访经历对疾病恢复过程的影响。结果经历规律、定期、及时复查处理的患者中，仅15例（27侧）出现息肉复发，其余均治愈；未经定期复查的患者中，37例（57侧）发生鼻腔粘连，26例（32侧）息肉复发，31例（54侧）窦口引流不畅。结论 慢性鼻窦炎鼻息肉患者接受鼻内镜手术后，定期、规律、及时的术后随访和术腔清理与规范、彻底的手术操作具有同等重要的意义。