鼻窦CT冠位扫描对鼻窦内窥镜手术的指导意义

为探讨鼻窦ＣＴ冠位扫描对鼻窦内窥镜手术的指导意义，将２６０例（４６６侧）鼻窦疾病患者的ＣＴ冠位扫描所见与内窥镜鼻窦手术结果进行对比分析。结果显示鼻窦ＣＴ冠位扫描与临床诊断符合率为９９．２％。认为，通过影像学检查指导鼻内窥镜手术，有助于术中识别鼻腔鼻窦的各种解剖变异，这对于手术的难易估计及并发症的预防均起着积极作用，并同时指出ＣＴ冠位扫描尚存在一定局限性。     

前组筛窦相关解剖变异的CT影像学观察及临床意义

目的：探讨国人前组筛窦的相关解剖变异,为临床手术提供参照数据和资料。方法:回顾性分析263例患者前组筛窦的影像学资料,对前组筛窦相关解剖变异进行统计和评估,并进行年龄相关性比较。结果:筛泡肥大和中鼻甲气化的出现率在成年组和未成年组差异有统计学意义。结论:CT检查不仅可以评估病变,而且可以检出与鼻腔-鼻窦疾病手术危险性相关的解剖变异,有助于预防鼻内镜手术并发症的发生。     

孤立性蝶窦占位性病变的诊断与治疗

进一步认识孤立性窦占位性病变,提高对其诊断和治疗水平。方法在鼻内窥镜下摘除蝶窦囊肿２０例,行蝶窦探查术６例,经鼻外径路摘除囊肿３例,前颅底径路病变切除＋视神经减压术１例。结果２４例随０．５－４年无复发,１例术后不久囊肿复发,１例术后１年复发再次手术后随访１年无复发,１例正在放疗中３例失访。     

Paranasal sinus aspergilloma: a case report

Aspergilloma, though rare, is a benign condition of the paranasal sinuses affecting young males with reasonable morbidity. Besides diagnosis, optimal surgery and prolonged adequate medical therapy under vigilant supervision is mandatory to treat this condition effectively, We are presenting one such ease of aspergilloma who was appropriately managed.     

Synovial sarcoma of the ethmoid sinus

IntroductionSynovial sarcoma is a malignant mesenchymal tumour typically occurring in the extremities. Its occurrence in the head and neck region, particularly in the paranasal sinuses is extremely rare.Case reportHere, we report a case of primary synovial sarcoma of the ethmoid sinus in a 36-year-old female and review the literature of synovial sarcomas arising from the ethmoid sinus. Histopathology was essential in confirming the diagnosis. The patient underwent endoscopic excision of the tumour followed by postoperative radiotherapy.DiscussionAs per our knowledge, only 2 cases of ethmoid sinus synovial sarcoma have been reported in the English literature till date. Although synovial sarcomas rarely involve the paranasal sinuses, they should be included in the differential diagnosis of paranasal sinus tumours. The accepted treatment modality is wide local excision followed by post operative radiotherapy.     

鼻腔,鼻窦冠状位CT扫描解剖学观测及其指导意义

对１００例无明显鼻部疾病的成人行鼻腔，鼻窦冠状位ＣＴ扫描，从不同层面观测鼻腔，鼻窦重要解剖结构的值限范围和形态。结果昌：高台型筛板与筛顶间的平均高度差为５．１７ｍｍ，筛泡宽度为１１．１５ｍｍ，中鼻甲的宽度为５．４０ｍｍ；Ｈａｌｌｅｒ气房的出现率为１４．０％，中鼻甲气化为１４．０％，Ｏｎｏｄｉ气房的出现率为８．５％。     

蝶窦恶性肿瘤误诊原因分析

目的：探讨蝶窦恶性肿瘤的临床特点、治疗效果和误诊原因,以提高诊疗水平。方法：将我科1996～2005年间收治的18例蝶窦恶性肿瘤进行回顾性分析。结果：蝶窦恶性肿瘤以鼻咽癌浸润性为最多见,其次为脊索瘤和非霍奇金淋巴瘤,临床表现为头痛（78％）、视力改变（50％）、颅神经麻痹（39％）、回吸性涕血或鼻出血（11％）;临床诊断误诊率达56％。结论：蝶窦恶性肿瘤的影像学诊断有一定局限性,应常规行鼻内镜检查。     

Frontal sinus schwannoma

IntroductionNasal sinus schwannomas are rare tumors, particularly in the frontal sinus.Case reportThe authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage.DiscussionThe pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.     

原发性额窦癌三例临床分析

目的 总结诊断和治疗原发性额窦癌的经验与教训.方法 回顾性分析2006-2010年在解放军总医院诊治的3例原发性额窦恶性肿瘤的临床资料.3例均为鳞状细胞癌,其中基底细胞样鳞癌1例,内翻性乳头状瘤癌变(中分化鳞癌)1例,乳头状鳞癌1例.所有病例均通过内镜+额部颅骨切开进路切除肿瘤,手术后给予放疗+化疗.结果 例1放疗结束后半年复查,发现沿发际内冠状切口多发转移癌,遂给予化疗,术后16个月死亡.例2手术后40d(放疗期间)复查,左侧眶内和左侧额窦内上部肿瘤复发,遂行第二次手术(眶内容切除术+肿瘤切除术),第二次术后继续放疗+化疗,3个月后复查,发现骨转移.第一次术后10个月患者死亡.例3手术后出现右侧眶尖综合征,视力丧失.手术+放疗后14个月复查,肿瘤复发,侵犯颅内,患者拒绝再次手术,自动出院,手术后21个月电话随访,患者带瘤生存.结论 原发性额窦恶性肿瘤少见,早期诊断困难.确诊后应积极施行扩大切除术,彻底切除肿瘤,手术后辅助放疗和化疗.原发性额窦恶性肿瘤的预后不佳.     

孤立性蝶窦病变误诊分析

目的提高对孤立性蝶窦病变的诊断水平,降低该病的误诊率。方法回顾1991～1998年12例孤立性蝶窦病变的病例,分析其误诊因素。结果12例患者中9例为蝶窦炎性病变,其中5例首诊时曾误诊。误诊病种包括视神经炎2例,神经痛、肺结核和癫痫各1例;3例为蝶窦恶性肿瘤,首诊时均曾误诊,误诊疾病分别为鼻窦炎、眼部炎症及鼻出血。结论孤立性蝶窦病变并非罕见,但临床症状无特征性表现,医师对该病认识不足是导致误诊的主要原因。CT与磁共振成像（magnetic resonance     

额窦成骨肉瘤1例并文献复习

目的：探讨额窦成骨肉瘤的病因,临床及影像学表现,治疗方法。方法：对1例以反复鼻出血及眶上胀痛为主诉,鼻窦CT表现为额窦内占位及窦壁骨质破坏,经2次鼻内镜手术探查及病理活检确诊为额窦成骨肉瘤的患者,行扩大右鼻侧切开术,术后行化疗及放疗。结果：随访1年9个月未见复发和转移。结论：额窦成骨肉瘤易漏诊,误诊,诊断需结合鼻窦CT,病理及鼻内镜探查等检查,治疗需根治性手术切除结合术后化疗,放疗。     

Chondrosarcoma of nose and paranasal sinus - a rare presentation

Chondrosarcoma, the most malignant cartilageneous tumor, constitute only 4% of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rarest malignancies. Here we present a case of Grade 1 chondrosarcoma involving nose, maxillary sinus, ethmoids and sphenoid sinus managed surgically by wide excision. 12 months follow-up reveled no recurrence or complication.     

鼻腔及鼻窦解剖结构在CT仿真内窥镜下的显示

目的 :探讨鼻腔及鼻窦解剖结构在螺旋CT仿真内窥镜 (VE)和常规冠状位扫描图像上的显示特点。方法 :经过螺旋CT冠状位扫描或轴位扫描的原始数据被传输到工作站上 ,然后利用NAVIGATOR软件行VE成像 ,调节阈值 ,观察窦口 鼻道复合体等解剖结构 ,测量必要的参数。结果 :鼻甲、鼻道和窦口 鼻道复合体等结构在仿真内窥镜下能更好地被显示 ,骨性解剖显示尤其清晰 ,VE和冠扫两种方法的显示效果有显著性差异(P <0 .0 5 )。因VE显示级别较高 (秩和大 ) ,所以VE的显示效果优于冠扫。钩突、筛泡、半月裂和筛漏斗在VE和冠扫图像上的显示率基本一致 ,额隐窝、鼻额管的显示率较低。结论 :VE显示在评价鼻腔及鼻窦解剖结构方面具有重要的价值 ,有助于放射科及耳鼻咽喉科医师更好地认识其特点     

经鼻内窥镜鼻窦手术74例

探讨提高经鼻内镜鼻窦手术的疗效的措施。方法对行鼻窦内窥镜手术７４例鼻腔,鼻窦疾病的临床资料进行总结,结果７４例中随访６个月以上的６５例,治愈４４例,好转１８例,无效３例,有效率９５．４％;其中鼻塞,头痛,脓及失嗅症状消失率 分别为９５．２％、９２．０％,６６．７％,４２．１％;无严重手术并发症发生。     

鼻窦肿瘤术后并发脑脊液鼻漏

目的探讨鼻窦肿瘤特别是额、筛窦肿瘤手术并发脑脊液鼻漏的治疗。方法回顾性分析１４例鼻窦肿瘤术后并发脑脊液鼻漏的临床资料。结果１４例中有７例在术中发现瘘孔。修补采用额肌瓣２例，阔筋膜和肌肉一例，ＥＣ耳胶和鼻中隔粘骨膜３例，ＴＪ骨水泥１例。另７例术后抽纱条后发现脑脊液鼻漏，经保守治疗行降脑压、抗炎等自愈。无一例并发颅内感染。结论鼻窦肿瘤手术中应详细检查，发现瘘孔行一期修补术。     

Paraganglioma of the maxillary sinus

Primary paragangliomas of the paranasal sinuses are very rare conditions with only few cases described in the literature. Paragangliomas are locally aggressive, often recur and can metastasize. Usually, open surgery is used to resect such tumors from the sinonasal tract. Here, a case of a large paraganglioma of the left maxillary sinus and nasal cavity, which was successfully removed using the Onyx^® embolic agent two days prior to minimally invasive image guided endoscopic sinus surgery, is reported. This case demonstrates that large vascular tumors of the sinonasal tract can be successfully managed by endoscopic endonasal sinus surgery. The patient has no evidence of recurrence after 12 months of follow-up.     

鼻内窥镜手术治疗非侵袭性鼻窦真菌病

目的 :探讨鼻内窥镜手术代替传统柯 陆手术治疗非侵袭性鼻窦真菌病的疗效。方法 :采用Storz30°鼻内窥镜行病侧钩突切除 ,扩大上颌窦开口 ,行下鼻道开窗 ,双进路清除病灶。术后用 1%H2 O2 及生理盐水冲洗 ,不用抗真菌药。结果 :2 9例随访 6个月～ 3年 ,原有症状消失 ,未见复发。结论 :采用鼻内窥镜手术治疗非侵袭性鼻窦真菌病 ,较之柯 陆手术创伤小、照明好、清除病灶准确 ;不损害鼻腔正常生理功能 ;保证鼻窦通气引流 ,减少复发 ,治愈率高     

Paranasal sinus mucoceles: a comprehensive retroprospective study in Indian perspective

Paranasal sinus mucoceles are the most common expansile lesion of the paranasal sinuses. Hereby we present a comprehensive retroprospective study on the paranasal sinus mucoceles in our geographic area which is very significantly lacking till now which we hope would immensely help comparative analysis and management in near future.     

Ethmomaxillary sinus and hypoplasia of maxillary sinus.

In a series of 410 coronal CT scans performed to assess paranasal sinus disease, we have identified eight cases in which an ethmomaxillary sinus was present. The ethmomaxillary sinus was unilateral in five cases and bilaterally present in three. The sex incidence was equal. Four patients had generalized mucosal disease of their paranasal sinuses which included the ethmomaxillary sinus whereas four patients had osteomeatal complex disease and sparing of their ethmomaxillary sinus. The characteristic radiological features of an ethmomaxillary sinus were drainage into an enlarged superior meatus, reduction in the size of the maxillary sinus and a normal bony orbital cavity. The differential diagnosis of an apparently hypoplastic maxillary sinus is briefly discussed.     

低剂量CT扫描在鼻窦疾病诊断中的应用

目的 探求最合适的鼻窦低剂量CT扫描技术及其在鼻窦疾病诊断中的应用价值。方法 常规CT扫描确诊为鼻窦病变的39例患者随机分成A、B两组，在其他扫描参数不变的情况下，A组以50mAs条件、B组以30mAs条件再次扫描，以窦口鼻道复合体的显示情况为主要指标，比较两种低剂量扫描所得图像质量与常规剂量图像的质量差异。结果 两组低剂量扫描的曝光量分别降低了79．89％和87．99％。50mAs剂量扫描所得图像与常规剂量图像质量比较无明显下降，而30mAs扫描图像与常规剂量图像质量比较差异有统计学意义。结论 利用50mAs低剂量对鼻窦进行CT扫描，可以有效地应用于鼻窦疾病的临床诊断。