鼻内镜下真菌性上颌窦炎的治疗体会

目的 探讨鼻内镜下中、下鼻道双径路与鼻内镜下中鼻道两种手术方式治疗真菌性上颌窦炎的疗效. 方法 40例真菌性上颌窦炎患者行鼻内镜下中、下鼻道上颌窦联合开窗术治疗(A组),53例采用鼻内镜下中鼻道开窗术治疗(B组).术后随访1~2年,定期行鼻窦冲洗及鼻内镜复查.根据1997年海口标准评定手术疗效.结果 A组治愈36例(90%),好转4例(10%),无效0例,有效率为100%;B组治愈45例(84.9%),好转1例(1.9%),无效及复发7例(13.2%),有效率为86.8%.两组有效率差异有统计学意义(χ²=5.713, P=0.018). 结论 鼻内镜下鼻窦术治疗真菌性上颌窦炎有效,可先行中鼻道开窗术,对真菌球不能彻底清除者,加用下鼻道开窗术治疗,可以达到理想的效果.     

鼻内镜下两种入路治疗上颌窦内翻性乳头状瘤的围手术期对比

目的　对鼻内镜下治疗上颌窦内翻性乳头状瘤的两种入路作围手术期对比。方法　回顾分析64例上颌窦内翻性乳头状瘤手术患者,按手术入路分为32例观察组和32例对照组,观察组采用鼻内镜下中鼻道联合改良泪前隐窝入路,对照组采用鼻内镜下中鼻道联合下鼻道开窗入路。对比两组的手术时间、术中出血量、术后并发症、术后复发率。结果　观察组的手术时间为（83.7±6.7）min,术中出血量为（93.5±3.9）ml,术后并发症为面部肿胀1例,术后复发1例。对照组的手术时间为（99.4±5.5）min,术中出血量为（101.7±5.0）ml,术后并发症为鼻泪管损伤3例,面部肿胀4例,术后复发3例。和观察组相比,对照组的手术时间更长,术中出血量更多,差异有显著统计学差异。结论　采用鼻内镜下中鼻道联合改良泪前隐窝入路治疗上颌窦内翻性乳头状瘤,疗效优于鼻内镜下中鼻道联合下鼻道开窗入路。     

上颌窦良性占位性病变手术入路的探讨

目的探讨鼻内镜下多种手术入路治疗上颌窦良性占位性病变的方法及疗效。方法采用鼻内镜下中鼻道扩大上颌窦自然开口术、鼻内镜下中-下鼻道联合上颌窦开窗术、鼻内镜下鼻腔外侧壁切开上颌窦手术、鼻内镜下上颌窦内侧壁切除术、鼻内镜下改良Denker术等多种入路对136例上颌窦良性占位性病变进行手术治疗。结果除2例上颌窦后鼻孔息肉和1例内翻性乳头状瘤复发,经再次手术治疗痊愈外,其他患者均无复发。结论根据上颌窦良性占位性病变的不同临床特点,采用不同手术入路既可有效治愈上颌窦病变,同时可最大限度地减少手术创伤。     

特殊类型上颌窦良性病变鼻内镜手术体会

目的 探讨特殊类型上颌窦良性病变鼻内镜手术的有效方法.方法 上颌窦良性病变29例均在鼻内镜下手术,采用扩大上颌窦自然口,扩大上颌窦自然口+下鼻道开窗,中下鼻道联合贯通径路,鼻腔外侧壁切开或切除四种径路.结果 上颌窦真菌病14例中13例患者术后头痛、涕血症状消失,1例复发;出血坏死性上颌窦炎4例,患者术后鼻腔通气畅;上颌窦囊肿5例患者术后头痛消失;上颌窦内翻性乳头状瘤6例患者术后鼻塞、面部胀痛消退.随访至今除1例上颌窦真菌病复发再手术外其余病例均未见复发,术后未出现并发症.结论 鼻内镜下手术治疗上颌窦良性病变具有手术安全、彻底,术后反应轻,面部无瘢痕等特点,关键是选择合理的手术径路.     

下鼻道开窗黏骨膜瓣外移术在上颌窦良性病变中疗效与安全性评价

目的　探讨鼻内镜下下鼻道开窗黏骨膜瓣外移术在治疗上颌窦良性病变中的疗效和安全性。方法　将57例病例随机分为A、B两组,A组行下鼻道开窗黏骨膜瓣外移术,B组行常规下鼻道开窗术。术后经0.5～1年随访,观察并发症、手术时间、出血量及下鼻道开窗处术后闭合程度等情况。结果　术后并发症中鼻腔粘连率：A组6.7%（2/30）,B组11.1%（3/27）。复发率：A组6.7%（2/30）,B组7.4%（2/27）。溢泪率：A组0%（0/30）,B组3.7%（1/27）。出血量：A组（69.98±34.69）ml,B组（79.64±43.17）ml ,手术时间：A组（1.57±0.59）小时,B组（1.51±0.53）小时,下鼻道开窗处术后3个月闭合程度：A组0.85±0.06,B组0.61±0.07,下鼻道开窗处术后6个月闭合程度：A组0.55±0.09,B组0.28±0.11。两组并发症、出血量及手术时间比较无统计学意义（P >0.01）,下鼻道开窗处术后3个月、6个月闭合程度比较有统计学意义（P <0.01）。结论　鼻内镜下鼻道开窗黏骨膜瓣外移术治疗上颌窦良性病变中创伤小,不良反应少,操作简便、易掌握,有利于术后随访及处理,是上颌窦良性病变手术的一个不错的选择。     

下鼻道泪后开窗上颌窦手术47例临床分析

目的：探讨经鼻内镜下鼻道泪后开窗处理上颌窦病变的疗效。方法：对47例上颌窦病变的患者,采取在鼻内镜鼻窦手术基础上进行下鼻道泪后开窗,经下鼻道窗和扩大的自然窦口对上颌窦息肉、内翻性乳头状瘤、侵袭性鼻窦真菌病等病变进行清理。结果：47例患者上颌窦腔清洁,上颌窦窦口引流好,黏膜转归良好,中鼻道引流好,无囊泡水肿等黏膜病变。仅2例（4．25％）下鼻道窗口约2个月闭锁,1年后上颌窦腔清洁,无病灶复发。结论：经鼻内镜下鼻道泪后开窗联合扩大的自然窦口完全满足处理上颌窦良性病变的需要,同时保留下鼻道窗可在术后起到机械性重力引流作用,在鼻腔鼻窦黏膜纤毛运输系统功能修复前尤为重要。     

经鼻内镜中下鼻道联合开窗治疗非侵袭性真菌性上颌窦炎

目的 探讨经鼻内镜中、下鼻道联合开窗治疗非侵袭性真菌性上颌窦炎的疗效.方法 对48例非侵袭性真菌性上颌窦炎实施鼻内镜中、下鼻道联合开窗术.结果 48例术后效果良好,经6个月～3年随访,无复发及并发症发生.结论 经鼻内镜中、下鼻道联台开窗治疗非侵袭性真菌性上颌窦炎能彻底清除窦腔死角病变,便于术后冲洗、观察,避免复发,临床疗效肯定.     

鼻内镜下泪前隐窝入路治疗上颌窦良性病变

目的经鼻内镜下泪前隐窝入路治疗上颌窦良性病变,并探讨其适应证、并发症及手术方式。方法回顾性分析43例经鼻内镜下泪前隐窝入路治疗上颌窦良性病变的病例,其中术前及术后病理确诊的上颌窦内翻性乳头状瘤15例,窦内病变镜下检出菌丝或孢子的真菌性上颌窦炎8例,上颌窦囊肿12例,上颌窦后鼻孔息肉6例,上颌窦异物2例。所有病例手术前均行鼻窦冠状位或水平位CT扫描。患者在局麻下以下鼻甲前缘为中心切口,解剖内移鼻泪管-下鼻甲瓣经泪前隐窝进入上颌窦腔处理上颌窦内病变,复位鼻泪管-下鼻甲瓣,缝合手术切口并行下鼻道开窗。结果 43例患者术中均完全清除窦内病变,术后随访6～24个月,下鼻甲形态愈合良好,术腔上皮化,无溢泪、面部麻木等并发症。2例上颌窦内翻性乳头状瘤术后6个月局部复发,原手术入路切除,随访1 8个月无复发。3例术后鼻腔粘连,局部分离,随访12个月无复发。结论经鼻内镜下泪前隐窝入路进入上颌窦是一种微创、安全、有效的处理上颌窦良性病变的手术方式,可作为鼻内镜下经中鼻道行上颌窦自然口开窗无法彻底切除窦内病变组织的首选治疗方法。     

鼻内镜下三种不同入路治疗上颌窦黏膜囊肿的比较

目的探讨因上颌窦黏膜囊肿位置不同,应用不同入路行鼻内镜下上颌窦黏膜囊肿治疗方法的临床比较。方法统计2010年1月-2012年1月收入我院的上颌窦囊肿62例行鼻内镜手术,25例经上颌窦自然窦口行囊肿摘除,20例经下鼻道黏膜下开窗囊肿摘除,17例行鼻内镜辅助下尖牙窝穿刺摘除上颌窦囊肿。结果62例均行鼻内镜手术,术后经病理检查,证实为黏膜囊肿,随访6个月～2年。结论经鼻内镜辅助下不同手术方式治疗上颌窦黏膜囊肿效果明显,损伤较小,治愈率高。     

鼻内镜下中下鼻道联合开窗治疗难治性上颌窦炎76例分析

目的总结鼻内镜手术治疗难治性上颌窦炎的守住技巧及疗效。方法鼻内镜手术治疗的76例难治性上颌窦炎患者,回顾性分析其临床资料,总结手术技巧及疗效。结果均采用鼻内镜联合下鼻道开窗术治疗,术中已彻底清除病变,术后鼻内镜随访3~6月以上。除1例患者双侧鼻腔内仍有脓性分泌物外,其余75例均临床治愈,术腔上皮化,无脓性分泌物。结论鼻内镜联合下鼻道开窗术是治疗难治性上颌窦炎的有效方法,可彻底清除上颌窦病变,便于术后复查,复发率低。     

上颌窦冲洗在鼻内镜治疗真菌球型上颌窦炎中的应用

目的 探讨鼻内镜手术结合术中冲洗治疗真菌球型上颌窦炎的疗效。方法 2009年12月至2012年12月我科共诊治55例真菌球型上颌窦炎患者,随机分成两组。A组27例,采用单纯鼻内镜中鼻道径路治疗;B组28例,采用鼻内镜中鼻道径路结合术中冲洗治疗。术后随访,比较两组疗效。结果 术后随访至少6个月,两组术中、术后均无并发症发生。A组治愈21例,有6例复发,在第2次手术时术中冲洗最终治愈;B组治愈28例,无1例复发。B组疗效明显优于A组。结论 相比较单纯鼻内镜中鼻道径路手术,鼻内镜中鼻道径路手术结合术中冲洗治疗真菌球型上颌窦炎具有更确切的疗效,符合微创理念,值得临床推广。     

What are the advantages of the endoscopic canine fossa approach in treating maxillary sinus aspergillomas?

Aspergilloma of the maxillary sinus is a non-invasive mycotic infection of the immunocompetent host. Nowadays its treatment remains surgical removal, and endoscopic endonasal middle meatus antrostomy is retained as the most popular approach. In our experience, a complementary endoscopic canine fossa approach is often needed to achieve a complete resection of the fungus ball. This fact led us to ask ourselves if an isolated endoscopic canine fossa approach had any advantages over the endonasal middle meatus antrostomy. In this paper we retrospectively analyse the results of the surgical treatment of 31 patients presenting maxillary sinus aspergillomas. These patients were all operated between January 1997 and January 2003 in our Otolaryngology Department. They were divided in three groups. Group A included 10 patients operated through an endonasal middle meatotomy only, group B included 9 patients who were operated through a combined approach (endonasal middle meatus antrostomy and endoscopic canine fossa approach), and group C included 12 patients who were operated through an endoscopic canine fossa approach alone. No recurrences were noted in any group, but in group B three patients presented mild complications like persistent purulent discharge through the meatotomy and nasal crusting. The endoscopic canine fossa approach offers several advantages over other techniques. These include an optimal visualization of all maxillary sinus walls and recesses, the possibility of performing the procedure under local anaesthesia and on an outpatient basis, the preservation of the anatomy and physiology of the natural maxillary ostium and an easy removal of the eventual foreign bodies of dental origin in the sinusal cavity that could favourite the development of an aspergilloma.     

Endoscopic transnasal surgery in antrochoanal polyp

The current treatment of antrochoanal polyp is simple avulsion of the nasal part with or without removal of the antral part. The antral part is removed through a Caldwell-Luc antrostomy, inferior meatal antrostomy, or middle meatal antrostomy. In this study, endoscopic surgery was performed in 22 cases of antrochoanal polyps where the antral part was removed through the middle meatus. Two new instruments were designed to help complete removal of the antral part of the polyp through the maxillary ostium. Some points of controversy concerning the antrochoanal polyp are discussed according to the diagnostic and therapeutic endoscopic findings. Endoscopic follow-up of these cases for periods ranging between 6 and 30 months, with an average of 20 months, showed no recurrence. It was concluded that endoscopic surgery of the antrochoanal polyp through the middle meatus could be performed as an outpatient procedure, and is safe and reliable.     

上颌窦囊肿手术进路的选择

目的探讨鼻内镜下3种摘除上颔窦囊肿进路的选择。方法本组上颌窦囊肿共32例,术前均经鼻窦CT扫描和鼻内镜检查,明确鼻腔情况、囊肿的大小及位置。其中8例伴鼻窦炎鼻息肉者,经中鼻道自然口开放术进路行Messerkling术;19例单纯上颌窦囊肿患者,鼻内镜下经改良柯-陆进路行囊肿摘除术,另5例采用下鼻道开窗进路行囊肿摘除术。结果术后随访6个月～1年,鼻窦CT冠状位扫描或鼻内镜检查,19例经改良柯-陆进路者术后无复发;8例经中鼻道自然口开放术进路者,2例复发,1例术后窦口闭锁,中鼻甲与鼻腔外侧壁粘连;5例经下鼻道开窗进路者,1例复发,2例失访。结论3种术式各有优缺点,临床中应根据不同情况酌情选用。     

Results of Caldwell-Luc after failed endoscopic middle meatus antrostomy in patients with chronic sinusitis

OBJECTIVES/HYPOTHESIS: The Caldwell-Luc operation for treatment of medically refractory chronic maxillary sinusitis has largely been replaced by functional endoscopic sinus surgery. Despite this change, the Caldwell-Luc procedure still has well documented indications including treatment of both failed endoscopic middle meatus antrostomy and irreversible mucosal changes. The purpose of the study was to review the authors' experience and results of Caldwell-Luc procedure after failed endoscopic middle meatus antrostomy in patients clinically deemed to have irreversible mucosal changes. STUDY DESIGN: Retrospective review of preoperative and postoperative results of patients who underwent Caldwell-Luc procedure for refractory chronic maxillary sinusitis after failed endoscopic middle meatus antrostomy. METHODS: The preoperative and postoperative clinical course of patients treated with Caldwell-Luc procedure performed by a single surgeon between 1996 and 2001 were reviewed. Only patients with a history of chronic sinusitis after failed maximal medical therapy, no prior Caldwell-Luc procedure, prior endoscopic middle meatus antrostomy, and at least 6 months of follow-up were included. Outcome measurements including documented endoscopic examinations and the need for repeat surgery, and postoperative computed tomography scan results were evaluated to assess treatment success. RESULTS: The study involved 11 men and 26 women who underwent 50 Caldwell-Luc procedures. Caldwell-Luc procedure was performed bilaterally in 13 patients. The average number of prior endoscopic middle meatus antrostomies before Caldwell-Luc procedure was 2. Of all patients, 92% responded to surgical treatment as demonstrated by an endoscopic examination or computed tomography scan revealing a disease-free maxillary sinus. Repeat Caldwell-Luc procedure was required in 8.0% (n = 3) because of continued sinusitis. Two of the three cases with repeat Caldwell-Luc procedures demonstrated clinical improvement during follow-up. Average follow-up was 23.5 months. CONCLUSION: Caldwell-Luc procedure seems to be highly effective in the management of medically refractory chronic sinusitis after failed endoscopic middle meatus antrostomy. Caldwell-Luc procedure should remain in the otolaryngologist's surgical repertoire for these selected cases.     

鼻内镜下中鼻道联合泪前隐窝入路治疗真菌性上颌窦炎

目的 探讨鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎的适应证及疗效。 方法 回顾分析2008年6月至2014年6月行鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎32例患者的临床资料,分析联合入路的适应证、疗效及并发症。 结果 患者均完整彻底清除病变,无并发症发生。随访1年半以上,均无复发。 结论 鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路视野清晰,对上颌窦暴露充分,上颌窦霉菌清除彻底,创伤小,疗效确切,可作为鼻内镜下经中鼻道行上颌窦扩大或辅助下鼻道开窗仍无法彻底清除窦内霉菌的首选方法。     

单侧上颌窦良性占位性病变手术入路临床分析与疗效

目的：探讨单侧上颌窦良性占位性病变的手术治疗方法及疗效。方法：对2005—06—2012-06接受鼻内镜手术治疗且有完整随访资料的84例单侧上二颌窦良性占位性病变患者的临床资料进行分析。其中采用单纯鼻内镜手术59例,采用鼻内镜联合改良Caldwell-Luc术式18例,采用鼻内镜联合F鼻道开窗15例,采用鼻内镜F泪前隐窝入路12例,并对术后情况进行随访。结果：全部患者随访4个月～7年,仅5例在手术后复发,其余81例在随访期内均未见复发。所有患者术前行鼻内镜、CT或MRI检查,并经术后病理检查证实。结论：上颌窦良性占位性病变以囊肿、真菌性上颌赛炎多见;根据上颌窦良性占位性病变的不同临床特点,可采用不同手术人路,既可有效治愈上颌窦病变,又可最大限度地减少手术创伤。鼻内镜手术是治疗上颌窦良性占位性病变的首选术式。     

A comparison between middle and inferior meatal antrostomy in the treatment of chronic maxillary sinus infection

Intranasal antrostomy has been performed in a series of 38 adult patients with either bilateral chronic or recurrent acute maxillary sinusitis which had failed to respond to medical treatment. In each patient, the antrostomy opening was made in the middle meatus of one side and in the inferior meatus of the opposite nasal cavity, laterality being randomised. A points' system was employed for comparing the pre- and post-operative symptoms, clinical and roentgenological findings. Symptoms and clinical findings were significantly improved following both types of antrostomy, while the roentgenological findings were essentially unchanged. Comparison of middle and inferior meatal antrostomies revealed no significant difference.     

内窥镜鼻窦手术治疗儿童慢性鼻窦炎

儿童鼻窦的解剖特点决定了在儿童的慢性鼻窦炎中，上颌窦炎最常见，自１９９０年以来，我院对５１例（９７侧）经药物和上颌窦穿刺冲洗失败患儿行内窥镜下鼻窦手术。其中大部分（５０例）有慢性上颌窦炎，１０冽有中鼻甲水肿和息肉样变，６例有筛窦炎。行上颌窦中鼻道开窗术１００侧次，筛窦开放术１２侧次，中鼻甲部分或全部切除术３２侧次，手术后２０例头痛消失，４３例鼻呼吸通畅，３７例黄脓涕消失，疗效满意，故内窥镜鼻窦手术是目前治疗儿童慢性上颌窦炎较为理想的方法。