Normalization of maxillary sinus mucosa after functional endoscopic sinus surgery in pediatric chronic sinusitis

OBJECTIVES: To observe the recovery of maxillary sinus mucosa after endoscopic sinus surgery in children with chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) was used to perform a middle meatal antrostomy, leaving the antral mucosa intact for later observation. METHODS: Between January 1998 and December 2003, 43 children with chronic sinusitis were enrolled in the study. Pre-operative patient profiles, including a history of symptoms, signs and allergies, were collected. Phidiatap test was used to check allergy. Saccharine transit time tests were performed for each side of the nasal cavity. Under endoscopic observation, the antral mucosa was macroscopically divided into edematous and polypoid types. RESULTS: Sixty-four (76.2%) of the 84 antrums had edematous type mucosa in which 73.4% (48/64) of cases were found to have returned to normal within 8 weeks. The polypoid antral mucosa exhibited a slower recovery with 80% (16/20) returning to normal within 4 months. The preoperative saccharine transit time significantly correlated with recovery of the antral mucosa (p < 0.05), but allergy did not (p > 0.05). CONCLUSION: The antral mucosa in children with chronic maxillary sinusitis was predominantly of the edematous type. Most recovered within 2 months of having FESS. The prolonged saccharine transit time and polypoid type antral mucosa were associated with delayed mucosal recovery, warranting follow-up of more than 4 months.     

Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery

OBJECTIVES: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis. STUDY DESIGN: METHODS: This study was conducted on 88 maxillary sinuses of 74 patients after ESS. The maxillary sinus fontanel was broadly opened via the middle meatus using an endoscope, and a saccharin granule was adhered to the bottom of the maxillary sinus mucosa The time until the patient recognized the sweet taste was recorded. Before the ST test, the bilateral maxillary sinuses were classified into the following four groups on the basis of the post-ESS severity of mucosal edema and swelling as revealed by endoscopic observation: normal (45 sinuses), mild mucosal edema and swelling (24), moderate mucosal finding (14), and severe mucosal finding or filling of the sinus with a polyp(s) (5). RESULTS: The mean ST values in the normal group and the groups with mild, moderate, and severe mucosal edema and swelling were 35.7, 38.1, 63.6, and 88.0 minutes, respectively. Thus the ST increased with the post-ESS severity of the mucosal lesion. However, for the group with mild mucosal edema and swelling, scanning electron microscopic observation of three maxillary sinuses in which the ST exceeded 120 minutes and four sinuses in which the ST was 40 minutes revealed extensive cilia loss in the former sinuses, but not in the latter. A second post-ESS endoscopic observation was performed in 17 patients, revealing improvement in 11 sinuses, no change in 5 sinuses, and aggravation in 1 sinus (compared with the initial test). The ST test was also repeated, revealing that the ST became shorter in most of the endoscopically improved sinus group. However, a few sinuses showed a discrepancy between the change in the endoscopic findings and the ciliary function (ST). CONCLUSION: Measurement of the maxillary sinus ST is a simple, accurate, and useful technique for assessing the post-ESS mucociliary function in conjunction with endoscopy, and the information gained can help in deciding subsequent therapy.     

The effect of endoscopic sinus surgery on mucociliary activity and healing of maxillary sinus mucosa

The aim of this study was to determine histologic findings in the maxilaarysinus mucosa by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), and ciliary activity within the nasal cavity by measuring the speed of mucociliary transport and after endoscopic sinus surgery (ESS). Thirty patients were enrolled. Thirty-eight antral mucosae of 24 24 patients were investigated according to ultrastructural changes and 6 patients were accepted as controls. At the 12th week, 12 antral nasal mucosae specimens of 8 patients were evaluated. All the specimens were taken from the medial rear wall of the antrum. The specimens were observed under a SEM and TEM. The mucociliary activity was measured within the nasal cavity by a saccharin test in all patients before the operation and after 12 weeks. Twenty people served as controls. In the specimens of the preoperative mucosa, the ciliated epithelium was heavily deciliated, interdigitation of the cell was loosened. In the samples taken 12 weeks after the operation, the ciliated cells were irregularly seen, the number of goblet cells was about the same as in the preoperative group and in the control, the number of the gland openings was higher than in the preoperative group and in the control. Also the interdigitation of the cells was enhanced. The histological and morphological features of the mucosa had improved. The period of the preoperative saccharin test was 12.15 minutes, whereas the period of the postoperative test was 9.08 minutes. The improvement was significant but both results were also significantly longer compared to the controls. These observations suggest that the histological, morphological and mucocilliary activity of the mucosa have not yet improved completely, it takes more than 12 weeks to recover, and the patients should be closely monitored in the postoperative months.     

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。     

The effect of endoscopic sinus surgery on mucociliary clearance in patients with chronic sinusitis

The saccharin test was used to measure mucociliary clearance in 50 patients with symptoms of chronic sinusitis. Samples of the nasal mucosa were also examined under transmission electron microscopy before and after functional endoscopic sinus surgery (FESS). Before surgery, the mean saccharin clearance (ST) was 37.0 ± 15.7 min, with nasal mucosa exhibiting ciliary loss as well as other ultrastructural changes. Three months after surgery, the mean ST had improved to 20.3 ± 7.5 min and significant regeneration of cilia was observed. It was therefore concluded that FESS had successfully corrected mucociliary dysfunction in these patients. Received: 22 July 1997 / Accepted: 23 March 1998     

功能性内镜手术前后上颌窦及筛窦粘膜的改变

目的回顾近年来文献,综述慢性鼻窦炎病人经功能性内镜鼻窦手术前后上颌窦及筛窦粘膜病变与转归.方法分析近年有关的文献13篇.结果慢性鼻窦炎病人经功能性内镜鼻窦手术治疗后病变粘膜均有不同程度恢复.结论功能性内镜鼻窦手术是治疗慢性鼻窦炎的有效手段,了解手术前后粘膜病变与转归对指导术后治疗与护理大有帮助.     

慢性上颌窦炎置管药物冲洗治疗前后窦腔粘膜纤毛的电镜观察

目的:观察慢性上颌窦炎置管药物冲洗后的治疗效果,利用扫描电镜观察窦腔粘膜纤毛变化。方法:经CT诊断慢性上颌窦炎27例,在鼻内镜下经下鼻道行上颌窦钻孔后置硅胶管,定期用甲硝唑加庆大霉素反复冲洗窦腔3个月,治疗前后取窦腔粘膜行扫描电镜观察。结果;27例中25例治愈,电镜观察结果显示:治疗前窦腔粘膜细胞间隙扩大,纤毛大部分脱落缺失,治疗后纤毛再生,数目增多,恢复正常形态。结论:慢性上颌窦炎行置管加药物冲洗可获得一定疗效,利用扫描电镜观察可见窦腔粘膜纤毛恢复正常。     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦术后上颌窦口黏膜恢复过程观察

目的 试图通过对内镜鼻窦手术(endoscopic sinus surgery,ESS)后患者鼻腔鼻窦黏膜的内镜、光镜、透射电镜和扫描电镜下连续动态观察,揭示病变黏膜转归的过程。方法 选取2001年1-12月行ESS的慢性鼻-鼻窦炎伴鼻息肉患者31例(53侧)作为研究对象,其中Ⅱ型2期11例(20侧)、3期12例(20侧),Ⅲ型8例(13侧)。分别于ESS术前、术后2-3周、8-11周、13-16周钳取上颌窦口后囟相同部位的黏膜组织进行观察。结果 术前均可见上皮剥蚀、鳞状上皮化生、腺体及纤维组织增生(53侧);微管结构异常、线粒体减少(53侧)。术后2-3周,形态学观察与术前比较没有明显的改变。术后8-11周,纤毛柱状细胞增多,并可见许多带有微绒毛的柱状细胞和大量短纤毛,所有病例均可见病理性腺体及纤维组织增生。术后13-16周,Ⅱ型2、3期和Ⅲ型患者术腔光滑干净,上皮化较好(50侧),窦口通畅(53侧)。纤毛覆盖面积增加,方向一致(50侧)。微管结构清晰,线粒体狭长致密(49侧)。3侧无纤毛柱状细胞排列整齐,形成病理性修复。结论 ESS术后,黏膜形态的基本恢复一般需要3个月左右;有些病理改变是不可逆的;病变程度与黏膜修复情况有关;术中尽可能多地保留黏膜组织、术后局部及时清理换药,有利于黏膜纤毛的形态和功能的恢复。     

Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps

Objective

Long-term retrospective evaluation was performed of computed tomography (CT) images and endoscopic findings after endoscopic sinus surgery for 88 cases of chronic pediatric sinusitis with nasal polyps. The objective was to determine the appropriate duration of such postoperative evaluation for children.

Methods

Fifty-one patients had both sinusitis and nasal polyps (BSP group), and the surgical procedure was decided in consideration of each patient's age (for less than 10 years of age, polypectomy (n = 12); for 10–13 years old, anterior ethmoidectomy plus opening of the fontanelle and nasofrontal duct (n = 20); and for serious cases older than 13 years, total sinusectomy (n = 19)). On the other hand, for cases of unilateral sinusitis with antrochoanal polyps (USP group), anterior ethmoidectomy plus opening of the fontanelle was performed regardless of the patient's age (n = 37, 5–15 years old).

Results

The postoperative endoscopic findings indicated that the polyps had been eliminated in approximately 91% of total patients. Good postoperative findings of CT images in most patients of USP group are observed at one year after the operation like the same of the postoperative course of adult chronic sinusitis. On the other hand CT images in BSP group evaluated one year after the operation were rated as unchanged or worsened in approximately half of the patients. However, at 4 years after the operation nearly all the patients were rated as improved or better. In addition, comparison of the age at final observation and the postoperative course found a striking decrease in the proportion of unchanged and worsened patients aged 12 and above.

Conclusion

Accordingly, it was concluded that there is difference of healing process after the operation between USP and BSP group. Postoperative evaluation of BSP group should be performed for 4 years and up to an age of at least 12 years although post-ESS following of USP group is similar to that of adult sinusitis.     

鼻内镜下慢性蝶窦炎手术

目的：探讨经鼻内镜手术治疗慢性蝶窦炎的方法和疗效。方法：50例84侧慢性蝶窦炎患者，均采用鼻内镜手术治疗。结果：经6～12个月随访复查，根据内镜鼻窦手术疗效评定标准，治愈61侧，占72．62％；好转13侧，占15．48％；无效10侧，占11．90％；有效率为88．10％。结论：经鼻内镜手术治疗慢性蝶窦炎具有视野清楚，手术进路安全，创伤小，患者痛苦小，疗效好等优点。     

成年人慢性鼻-鼻窦炎鼻内镜术后的细菌学研究

目的探讨成年人慢性鼻-鼻窦炎（chronicrhinosinusitis，CRS）患者鼻内镜手术（endoscopicsinussurgery，ESS）后的细菌分布和耐药性特征。方法实验组来自87例CRS患者ESS术中中鼻道、上颌窦、筛窦和术后1、3、6个月复诊时的术腔分泌物；对照组为30例鼻中隔偏曲（无鼻炎、鼻窦炎）患者的中鼻道分泌物。所取标本分别作细菌培养、药物敏感实验及B内酰胺酶菌株检测。结果464份标本共检出细菌645株26种，总细菌检出阳性率78．9％（366／464）。其中革兰阴性菌（Gramnegativebacteria，GNB）占51．2％（330／645）；革兰阳性菌（Grampostivebacteria，GPB）占48．8％（315／645）；73．6％（64／87）的患者为混合菌生长。需氧菌为主占95．3％（615／645），厌氧菌仅占4．7％（30／645）。CRS患者术后GNB检出阳性率较术前明显增加，以产气肠杆菌、铜绿假单胞菌和流感嗜血杆菌最为常见；术后1个月、3个月组厌氧菌检出阳性率为3．4％（3／87）和2、3％（2／87），较术前9．2％（8／87）明显降低，而迁移不愈组反而升高，占15．4％（2／13）。术后多重耐药（mutipledrugresistance，MDR）菌株检出阳性率较术前明显增加。迁移不愈组B内酰胺酶检出率为30．8％（4／13），其中以铜绿假单胞菌最为常见；而术前阳性检出率为19．5％（17／87），以金黄色葡萄球菌为主，两组间差异有统计学意义（X2=4．85，P〈0．05）。痊愈组与对照组间B内酰胺酶阳性率和菌种分布的差异无统计学意义。结论GNB是CRS患者术后不容忽视的重要条件致病菌或致非条件病菌，CRS术后迁延不愈与MDR-GNB的优势生长有一定的关系。术后痊愈患者鼻腔和鼻窦的细菌微生态逐步恢复平衡。     

慢性鼻-鼻窦炎鼻息肉患者内镜术后主观症状无改善原因初步分析

我们对1998--2003年间内镜鼻窦术后主观症状无改善的70例患者临床资料进行回顾性总结，并初步分析其原因。     

慢性鼻-鼻窦炎鼻息肉内镜鼻窦术后上颌窦口黏膜恢复过程观察

目的 试图通过对内镜鼻窦手术(endoscopic sinus surgery，ESS)后患者鼻腔鼻窦黏膜的内镜、光镜、透射电镜和扫描电镜下连续动态观察，揭示病变黏膜转归的过程。方法 选取2001年1～12月行ESS的慢性鼻一鼻窦炎伴鼻息肉患者31例(53侧)作为研究对象，其中Ⅱ型2期11例(20侧)、3期12例(20侧)，Ⅲ型8例(13侧)。分别于ESS术前、术后2～3周、8～11周、13～16周钳取上颌窦口后囟相同部位的黏膜组织进行观察。结果 术前均可见上皮剥蚀、鳞状上皮化生、腺体及纤维组织增生(53侧)；微管结构异常、线粒体减少(53侧)。术后2～3周，形态学观察与术前比较没有明显的改变。术后8～11周，纤毛柱状细胞增多，并可见许多带有微绒毛的柱状细胞和大量短纤毛，所有病例均可见病理性腺体及纤维组织增生。术后13～16周，Ⅱ型2、3期和Ⅲ型患者术腔光滑干净，上皮化较好(50侧)，窦口通畅(53侧)。纤毛覆盖面积增加，方向一致(50侧)。微管结构清晰，线粒体狭长致密(49侧)。3侧无纤毛柱状细胞排列整齐，形成病理性修复。结论 ESS术后，黏膜形态的基本恢复一般需要3个月左右；有些病理改变是不可逆的；病变程度与黏膜修复情况有关；术中尽可能多地保留黏膜组织、术后局部及时清理换药，有利于黏膜纤毛的形态和功能的恢复。     

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。     

修正性鼻内窥镜手术治疗复发性鼻窦炎、鼻息肉的临床效果

［摘要］目的：探讨修正性鼻内窥镜手术治疗复发性鼻窦炎、鼻息肉的手术效果。方法：对46例复发性鼻窦炎、鼻息肉患者行修正性鼻内窥镜手术,其中32例采用Messerklinger技术,14例采用改良Wigand技术［1］。结果：病变清除满意39例（78.3%）,欠满意10例（21.7%）。无1例出现严重并发症。结论：修正性鼻内窥镜手术是治疗复发性鼻窦炎、鼻息肉的有效方法。术前CT扫描可以减少并发症的发生。     

慢性鼻窦炎鼻息肉再次内镜鼻窦手术

目的　探讨需行再次内镜鼻窦手术的原因 ,评价再次内镜鼻窦手术的疗效。方法　对114例 (16 1侧 )需行再次内镜鼻窦手术的患者术前行鼻内镜和鼻窦CT扫描检查 ,术后随访 2年以上。结果　 114例 (16 1侧 )中复发性鼻窦炎 98例 (12 9侧 ) ,复发性鼻息肉 16例 (32侧 )。额隐窝狭窄 2例 (3侧 ) ,前组筛窦炎 18例 (2 4侧 ) ,前组筛窦炎和上颌窦自然开口堵塞 31例 (46侧 ) ,中鼻甲粘连 6例 (7侧 ) ,后组筛窦炎 18例 (2 4侧 ) ,后组筛窦和蝶窦炎 36例 (5 4侧 ) ,蝶窦炎 3例 (3侧 )。伴有鼻中隔偏曲者 15例。经 2年以上随访 ,复发性鼻窦炎者 88例 (111侧 )痊愈 ,10例 (18侧 )症状缓解 ,16例 (32侧 )复发性鼻息肉患者 11例 (2 2侧 )痊愈 ,5例 (10侧 )症状缓解。结论　行再次内镜鼻窦手术的原因主要是前次手术未彻底清除病变 (首先与术者经验不足有关 ) ;其次为鼻息肉病。再次内镜鼻窦手术效果满意 ,无严重并发症     

慢性鼻窦炎、鼻息肉的修正性鼻内窥镜手术治疗

目的 :探讨修正性内窥镜鼻窦手术治疗复发性鼻窦炎、鼻息肉的临床意义。方法 :采用内窥镜鼻窦手术对 112例复发性鼻窦炎、鼻息肉患者进行了修正性治疗 ,术中采用 Messerklinger技术、Stryker切削器 ,并辅以控制性降压。结果 :病变清除满意 89例 (79.5 % ) ,手术欠满意 17例 (15 .2 % ) ,6例失败。并发脑脊液鼻漏 1例、眼眶血肿 4例、术后溢泪 3例 ,大出血 12例。结论 :修正性手术适用于鼻窦内窥镜手术后出现的术腔随访清理难以控制的鼻窦炎病变。但该术对于堵塞、粘连性病变效果较好 ,鼻息肉病效果欠佳。中鼻甲残根和后鼻孔上穹窿为手术重要的安全标志 ,术前 CT扫描可以减少并发症的发生。     

慢性上颌窦炎鼻内镜下开窗方式的选择与疗效观察

目的观察鼻内镜下上颌窦开放术治疗慢性上颌窦炎,不同开窗方式的选择与疗效分析。方法 56例单侧慢性筛、上颌窦炎伴鼻息肉患者,术前Lund-Mackay CT评分,CT评分=2者纳入研究对象,术中随机分为A组28例、B组28例,分别行中鼻道开窗和中下鼻道联合开窗,以鼻腔鼻窦结局测试-20（sino-nasal outcome test-20,SNOT-20）量表中文版、Lund-Kennedy评分及糖精试验黏液纤毛传输时间（mucociliary transport time,MTT）对比术后疗效,另外,用亚甲蓝染色观察黏液纤毛传输途径。结果术后6个月时,A、B两组SNOT评分、Lund-Kennedy评分及MTT值差异均有统计学意义（P〈0.05）;50例亚甲蓝从上颌窦口下缘流出,5例亚甲蓝从上颌窦口前缘流出。结论①对于慢性上颌窦炎Lund-Mackay CT评分=2的病例,行中、下鼻道联合开窗可取得更好的疗效;②上颌窦口下缘黏膜是黏液纤毛传输的重要途径,对上颌窦的引流起着极为重要的作用。