复发性鼻窦炎鼻息肉修正性内镜手术

修正性内镜鼻窦手术是指针对内镜鼻窦手术或传统鼻窦手术之后复发性鼻窦炎、鼻息肉再次或多次手术。由于既往手术造成正常解剖学标志的缺失、改变或紊乱不清，再次手术易出血倾向，使修正性内镜鼻窦手术的难度及风险增大，对术者是一挑战。作者自2003～2004年间对46例复发性鼻窦炎鼻息肉患者行鼻内镜下修正手术，并进行随访。现对46例鼻窦炎鼻息肉复发原因、鼻内镜修正手术的安全性及疗效分析如下。     

影响鼻内窥镜鼻窦手术预后的多元回归分析（摘要）

影响鼻内窥镜鼻窦手术预后的多元回归分析（摘要）兰信堂，王其有，谭中和，张瑞华应用微机对影响鼻内窥镜鼻窦手术疗效进行多元回归分析。共２０６例鼻窦炎病人，男１４８例，女５８例，年龄１１～６１岁。鼻窦炎伴发鼻－鼻窦息肉１３８例，伴鼻腔结构异常５２例，合并变...     

鼻内窥镜鼻窦手术中中鼻甲的处理方法和意义

中鼻甲在鼻腔生理功能方面发挥重要作用，又是鼻内窥镜鼻窦手术中极重要的解剖参考标志，所以强调术中保留中鼻甲。但中鼻甲自身解剖结构异常或存有病变，却可导致鼻腔鼻窦功能障碍，并有可能成为鼻窦炎的发源地。本文综合了１２１３例接受鼻内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患者中９７５例ＣＴ扫描和鼻内窥镜检查结果，并总结了鼻内窥镜鼻窦手术中和术后随访的体会，归纳提出中鼻甲与上颌骨额突（钩突附着缘）及鼻中镉的解剖结构     

鼻内镜鼻窦手术治疗儿童慢性鼻窦炎

目的探讨鼻内镜鼻窦手术治疗儿童慢性鼻窦炎的疗效。方法对36例66侧儿童慢性鼻窦炎患者行鼻内镜鼻窦手术。结果36例患儿治愈28例(77.78%),好转6例(16.67%),无效2例(5.56%),总有效率94.44%。结论在严格掌握适应证的情况下,鼻内镜鼻窦手术治疗儿童慢性鼻窦炎疗效确切,是治疗儿童慢性鼻窦炎的有效方法。     

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。     

鼻内窥镜鼻窦手术中中鼻甲的处理方法和意义

中鼻甲在鼻腔生理功能方面发挥重要作用，又是鼻内窥镜鼻窦手术中极重要的解剖参考标志，所以强调术中保留中鼻甲。但中鼻甲自身解剖结构异常或存有病变，却可导致鼻腔鼻窦功能障碍，并有可能成为鼻窦炎的发源地。本文综合了1213例接受鼻内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患者中975例CT扫描和鼻内窥镜检查结果，并总结了鼻内窥镜鼻窦手术中和术后随访的体会，归纳提出中鼻甲与上颌骨额突（钩突附着缘）及鼻中隔的解剖结构关系MFS分型及鼻内窥镜鼻窦手术中中鼻甲的处理方法。手术原则和方法主要采用矢状切除中鼻甲外侧部分，并对其进行矫形的方式，重建MFS解剖结构关系。本文讨论了鼻内窥镜鼻窦手术中中鼻甲处理的必要性，并强调指出在去除病变的基础上保留中鼻甲及其功能作用是鼻内窥镜鼻窦手术中一项重要内容。     

经鼻内镜鼻窦手术237例临床分析

目的探讨经鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉的远期疗效及影响疗效的相关因素。方法回顾性分析1999～2003年237例接受经鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉患者资料，术后随访7-24个月。结果本组病例治愈175例（73.8％)，好转41例(17.3％)，无效21例(8．9％)，总有效率91．1％。结论经鼻内镜鼻窦手术具有较好的疗效，其疗效与临床分型、手术前后用药、定期换药等综合因素有关。     

鼻内镜手术治疗慢性侵袭性真菌性鼻窦炎45例

目的探讨鼻内镜下治疗慢性侵袭性真菌性鼻窦炎的疗效。方法在鼻内镜下对45例慢性侵袭性真菌性鼻窦炎患者行鼻窦清创术,部分病例加行下鼻道开窗术,彻底清除鼻窦病变组织及鼻病变黏膜和骨质,充分开放鼻窦,术后应用大扶康冲洗术腔,并定期行鼻内镜检查。结果随访6个月至6年,治愈41例,复发4例。复发病例经再次鼻内镜手术后治愈,无手术并发症。结论鼻内镜下鼻窦清创术是治疗侵袭性真菌性鼻窦炎的重要手段,术后定期复查并辅以大扶康术腔冲洗,疗效良好。     

钩突增生肥大与前组鼻-鼻窦炎的关系探讨

目的　探讨钩突异常增生肥大与局限于前组的鼻-鼻窦炎的关系。方法　回顾分析5例有钩突增生伴慢性鼻-鼻窦炎的患者资料（2015～2018年），所有患者均有鼻 堵和脓涕症状，术前行相关检查以明确诊断。其中1例患者在3年前曾行CT扫描，显示钩突增生伴有鼻-鼻窦炎。患者均接受手术治疗，术后常规处理。结果　鼻内镜和CT扫描确定患者存在钩突向内下方倾斜、增生及鼻-鼻窦炎征象。排除手术禁忌后，全麻鼻内镜下切除钩突，3例症状重的患者同时开放鼻窦，而另外2例患者仅仅切除钩突并且扩大上颌窦口，保留筛漏斗后壁。随访3～32个月，所有患者恢复良好。结论　钩突角度改变及增生可以堵塞鼻窦引流引发范围局限的慢性鼻-鼻窦炎，鼻内镜手术是首选治疗。     

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。     

窦口鼻道复合体各结构间隙狭窄与慢性鼻窦炎的相关性研究

目的：探讨窦口鼻道复合体(OMC)各结构间隙与中鼻甲、鼻中隔间隙狭窄与慢性鼻窦炎的关系及狭窄的主要原因。 方法:采用鼻窦冠状位CT扫描，高空间分辨率算法成像分析经鼻内镜手术治疗的89例（171侧）患者的正常鼻窦和炎症鼻窦的OMC各结构间隙的变异情况。 结果:正常鼻窦与有炎症鼻窦间OMC各结构间隙狭窄的发生率差异均有统计学意义（P＜0.01)，OMC各结构间隙与慢性鼻窦炎分别行Logistic回归分析，差异均有统计学意义（P＜0.01）。 结论:OMC间隙狭窄为鼻窦炎发生的重要危险因素；在鼻窦内窥镜手术治疗鼻窦炎疾病时，必须矫正OMC间隙狭窄。     

窦口鼻道复合体间隙狭窄与慢性鼻窦炎(附94例分析)

目的：探讨窦口鼻道复合体（OMC）间隙狭窄与慢性鼻窦炎的关系及其狭窄的原因。方法：对94例（179侧）有鼻塞、流涕、头痛等症状的患者,采用PICKER IQ CT机冠状位扫描,高空间分辨率算法成像,对比分析正常鼻窦和有炎症鼻窦的OMC间隙狭窄及其OMC变异情况。结果：正常鼻窦与有炎症鼻窦间OMC间隙狭窄发生率的差异有统计学意义（均P〈0.01）,但OMC解剖变异发生率的差异无统计学意义（P〉0.05）。结论：OMC间隙狭窄与鼻窦炎有重要关系,了解鼻窦炎患者各种OMC间隙狭窄的特点,有助于功能性内镜鼻窦手术。     

Diagnosis of surgical sinusitis using nasal endoscopy and computerized tomography

The ability to identify surgical sinus disease using diagnostic nasal endoscopy and coronal CT scanning of the paranasal sinuses is studied prospectively. Fifty consecutive patients with symptoms of chronic sinusitis lacking surgical indications by traditional work-up comprise the patient population. Sixty percent had endoscopic or CT indications for surgery. There was a 90% correlation between endoscopy and CT examination with the combined work-up being more accurate than either modality alone. Functional endoscopic sinus surgery was performed in 18 cases. There were no major complications. Approximately 89% of the postoperative group report significant improvement, with 55.6% reporting total relief of symptoms. A complete endoscopic sinus work-up can often identify surgically correctable sinusitis despite normal routine rhinoscopic and plain-film examination. It is therefore, warranted in those patients with a suggestive history.     

窦口鼻道复合体纤毛上皮CT及电镜观察

为探讨窦口鼻道复合体（ＯＭＣ）在鼻窦炎发生中的重要作用。对２２例（３０侧鼻腔）因慢性鼻窦炎而接受功能性鼻窦内窥镜手术的患者，术前应用冠状ＣＴ影像进行定量分析，同时对术中取出的ＯＭＣ区粘膜（中鼻甲、钩突、筛泡）行扫描电镜检查，用图像分析仪定量测定纤毛覆盖面积。结果发现ＣＴ影像病变程度与纤毛上皮损伤成正相关。提示：作为各鼻窦引流口集中部位的ＯＭＣ区的病变引起纤毛上皮的损害，进而使粘液纤毛清除均能降低，     

Cystic fibrosis and sinusitis

Children from the University of Alberta Cystic Fibrosis Clinic were evaluated for nasal polyposis and sinusitis. The results of office examination, coronal CT scanning, and functional endoscopic sinus surgery are compared. Sinonasal disease was found to be ubiquitous in children with cystic fibrosis evaluated with coronal CT scanning. Coronal CT scanning was found to be an accurate predictor of sinonasal disease, and useful for defining the complex anatomy of this region. Outpatient endoscopic sinus surgery, after pre-op assessment by a pediatric pulmonologist, was found to be a safe procedure, with lesser morbidity, than conventional sinus surgery.     

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.     

Computed tomography anatomy of the anterior ethmoid canal

The roof of the anterior ethmoid swings up anteriorly from its more or less horizontal course at the point where the anterior ethmoid canal (AEC) is situated. The AEC is an important structure in endoscopic sinus surgery since its injury results in bleeding into the nasal cavity and may result in intraorbital bleeding. We therefore investigated the location of this canal and the anatomic characteristics of the area surrounding the canal using coronal computed tomography (CT) of the paranasal sinuses. One hundred sides of 50 paranasal coronal CT images in patients with sinusitis were analyzed to assess the location of the AEC, the shape of the superolateral wall of the ethmoid sinus anterior and posterior to the AEC, and pneumatization of the roof of the anterior ethmoid sinus. The AEC is situated in the second quarter of the roof of the ethmoid sinus. The superolateral wall anterior to the AEC demonstrated an acute angle in 99% of sides, while the superolateral wall posterior to the AEC showed an obtuse angle in 87% of sides. The ethmoid cell anterior to the AEC pneumatized posteriorly over the AEC in 26% of sides. We conclude that coronal CT confirmation of the anatomic characteristics of the AEC, and the area surrounding the canal, is invaluable for preoperative planning for endoscopic sinus surgery.     

79例复发性鼻窦炎修正性鼻内镜手术

目的探讨慢性鼻窦炎鼻息肉术后复发的原因及影响修正性鼻内镜手术疗效的相关因素。方法对79例(105侧)复发性鼻窦炎鼻息肉患者实施修正性鼻内镜手术,并对所有患者进行围手术期用药及术后鼻内镜定期复查。结果 79例(105侧)患者,术后经12个月以上随访,治愈55例(70侧),好转14例(22侧),无效10例(13侧),治疗总有效率87.34%,无严重的并发症发生。结论术前CT检查、术中有效的止血及找准解剖标志是手术成功的关键。     

Relationship between pediatric sinusitis and middle turbinate pneumatization--ethmoidal sinus pyocele thought to be caused by middle turbinate pneumatization

OBJECTIVE: To investigate whether the presence of pediatric middle turbinate pneumatization causes narrowing of the ostiomeatal complex (OMC) and is associated with the development of paranasal sinusitis. METHODS: CT scans of 190 nasal sides of 95 children (1-15 years old) were analyzed for the presence of middle turbinate pneumatization and mucosal thickness in the paranasal sinus. RESULTS: Middle turbinate pneumatization was detected in nine (4.6%) of the nasal cavities. Only one of these sides was in a patient younger than 10 years of age, while the other eight sides were in patients at least 13 years old. In six of those nine sides with pneumatization, paranasal sinusitis was also found. However, the images showed that in five sides the middle turbinate pneumatization itself did not obstruct the OMC. In addition, the mean +/- standard deviation (S.D.) of the total score for the paranasal sinus opacification on the side which had the middle turbinate pneumatization was 5.67 +/- 2.95. The corresponding value for the 76 sides without pneumatization was 5.29 +/- 2.53, and the difference between these mean total scores was not statistically significant. However, in one side, the OMC was obstructed or narrowed due to the middle turbinate pneumatization, and an ethmoidal sinus pyocele formed on this side. CONCLUSION: A causal relationship was not found between middle turbinate pneumatization and the mechanism of development of paranasal sinusitis in children. However, in the event that the OMU becomes obstructed at some time, frequent cycles of improvement and aggravation of pediatric paranasal sinusitis may occur and lead to the development of a serious condition.     

孤立性蝶窦疾病的诊断及其鼻内镜手术治疗

目的：探讨孤立性蝶窦疾病的临床特点、影像学特征和鼻内镜手术的疗效。方法：38例孤立性蝶窦疾病患者,35例行鼻窦CT（其中5例同时行MRI）,3例行单纯鼻窦MRI,1例行脑池CT造影。所有患者均行鼻内镜下蝶窦开放术,其中有33例采用经鼻腔嗅裂径路,5例采用经前筛一后筛径路（即Messerklinger技术）。结果：术后随访6个月以上,34例病情完全控制,4例部分控制。术中和术后均未出现严重并发症。结论：孤立性蝶窦疾病临床症状不典型,无特异性,鼻部检查多无阳性体征,仅有以头痛为主诉的神经系统症状,早期常难以确诊。鼻窦CT和MRI是诊断孤立性蝶窦炎的最佳手段,而鼻内镜手术则是治疗该病的首选方法。