鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎35例分析

目的探讨非侵袭性真菌性鼻-鼻窦炎的病因、临床特点和鼻内镜手术方法及疗效。方法对35例非侵袭性真菌性鼻-鼻窦炎患者采用鼻内镜手术治疗,回顾性分析患者的临床资料。结果术后随访6个月,患者症状消失,无复发病例。结论非侵袭性真菌性鼻-鼻窦炎具有独特的鼻内镜及CT表现,鼻内镜手术清除病灶是治疗非侵袭性真菌性鼻-鼻窦炎的有效手段,术中应尽量扩大鼻窦的自然开口,术后定期冲洗窦腔以及定期复查可降低复发。     

非侵袭性真菌性鼻窦炎46例临床分析

目的探讨非侵袭性真菌性鼻窦炎的临床表现、诊断和手术疗效。方法回顾性分析46例非侵袭性真菌性鼻窦炎患者的临床资料。结果 46例患者平均随访2.6（1～5）年,筛窦、蝶窦单发真菌感染鼻内镜手术5例,术后均无复发。上颌窦真菌感染鼻内镜手术33例,2例复发,复发率6.1%;鼻内镜联合改良柯-陆氏手术8例,术后均无复发。结论非侵袭性真菌性鼻窦炎经鼻内镜手术是一种有效的治疗方法,鼻内镜联合改良柯-陆氏手术清除上颌窦真菌更彻底,能减少复发。     

鼻内镜下真菌性蝶窦炎手术治疗分析

目的探讨真菌性蝶窦炎的治疗方式及预防复发的方法。方法对19例真菌性蝶窦炎患者在鼻窦内窥镜下行蝶窦开放及引流术。术后鼻内镜下清理术腔,定期复查随访。结果 19例真菌性蝶窦炎患者术后随访12个月,其中18例痊愈,I期治愈率94.73%。复发1例,行全麻鼻内镜下再次手术后治愈。未发生其他术后并发症。结论真菌性蝶窦炎鼻内镜下术中充分扩大开放自然口,彻底清除窦口及窦腔病变物,保留正常窦腔黏膜,定期复查换药随访,有利于抑制复发,提高临床治愈率。     

鼻内镜手术治疗非侵袭性真菌性鼻窦炎32例分析

目的探讨鼻内镜手术治疗非侵袭性真菌性鼻窦炎的疗效。方法对32例非侵袭性真菌性鼻窦炎患者,采用鼻内镜下手术治疗,彻底清除病灶,充分开放引流。结果 32例患者随访6～36个月,复查窦腔无病变和炎症,全部治愈,无复发。结论采用鼻内镜手术治疗非侵袭性真菌性鼻窦炎,治愈率高,复发率低,疗效确切,是理想的治疗方法。     

鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤

目的探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的方法及可行性,观察其疗效。方法回顾性分析2008年1月～2012年12月57例鼻腔鼻窦内翻性乳头状瘤的临床资料,均行鼻内镜下切除手术。根据病变程度和范围,选择经典式鼻内镜手术,鼻内镜中鼻道、下鼻道联合上颌窦开窗术,鼻内镜辅助下Caldwell—Luc手术。观察术后复发率。结果随访1～3年,（23±9）月。复发率10．5％（6／57）,其中经典式鼻内镜手术9．7％（3／31）,鼻内镜中鼻道、下鼻道联合上颌窦开窗术10．0％（2／20）,鼻内镜辅助下Caldwell—Lue手术16．7％（1／6）。复发6例均行二次鼻内镜手术,随访6—12个月,平均7．5月,无再次复发。结论鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤手术损伤小,术后复发率低,临床疗效较好。     

鼻内镜下单纯下鼻道进路治疗孤立性上颌窦良性病变临床观察

目的：探讨内镜下单纯下鼻道进路治疗孤立性上颌窦良性病变的手术疗效。方法采用鼻内镜下单纯下鼻道进路手术治疗37例上颌窦囊肿及5例上颌窦后鼻孔息肉,复位下鼻道粘骨膜瓣（或伴下鼻道骨质）,封闭切口,不造瘘;12例真菌性上颌窦炎（非侵袭性型）,并下鼻道造瘘引流。结果术后随访6月～1年,54例患者术后症状均改善或消失,无病变复发。术后无溢泪、鼻腔粘连等并发症发生。内镜下检查可见40例下鼻道切口完全愈合,有2例上颌窦囊肿术后切口愈合后有小瘘孔;12例真菌性上颌窦炎术后造瘘引流畅。结论鼻内镜下单纯下鼻道进路治疗孤立性上颌窦良性病变微创、易行,可避免对窦口鼻道复合体的损伤。     

鼻内镜下手术治疗非侵袭性真菌性鼻窦炎的临床观察

目的探讨鼻内镜下手术治疗非侵袭性真菌性鼻窦炎的疗效。方法对30例非侵袭性真菌性鼻窦炎患者,采用鼻内镜下手术治疗,观察临床疗效。结果 30例患者术后病理证实均为非侵袭性真菌性鼻窦炎,全部症状消失。随访0.5～2年,28例治愈,1例上颌窦炎及1例蝶窦炎术后复发,给予二次手术后治愈。结论鼻内镜下治疗非侵袭性真菌性鼻窦炎将作为一种最佳的手术治疗方法,值得在临床上推广。     

鼻内镜手术治疗慢性鼻窦炎及鼻息肉252例疗效观察

目的:观察鼻内镜手术治疗慢性鼻窦炎、鼻息肉的临床疗效.方法:对252例慢性鼻窦炎、鼻息肉患者行鼻内窥镜下手术局麻或全麻下采用Messerklinger术式,术后随访1年.结果:治愈186例(73.8%),好转56例(22.2%),无效10例(2.7%).总有效率96.0%.无效病例中多为中鼻道瘢痕粘连、筛窦区瘢痕粘连、窦口闭塞、上颌窦开口闭塞、中鼻道引流不畅.手术并发症7例其中上颌窦开口狭窄或闭锁4例、眶内淤血1例、鼻腔粘连2例.结论:鼻内窥镜下鼻窦炎、鼻息肉手术治疗具有良好的疗效,术前准备充分,熟练的麻醉技术,术者丰富的操作经验,术中正确处理中、下鼻甲及鼻中隔,术后定期随访可提高治愈率,减少并发症.     

上颌窦霉菌病的鼻内镜手术治疗

目的探讨鼻内镜下单纯上颌窦口扩大术治疗非侵袭性霉菌球型上颌窦炎的疗效. 方法回顾分析16例非侵袭性霉菌球型上颌窦炎的临床资料. 结果手术时间30～120 min,平均60 min.无手术并发症发生.住院5 ～7 d,平均6 d.16例术后病理找到菌丝和孢子,9例霉菌培养为曲霉菌.16例术后随访3～24个月,平均18个月,14例无症状,内镜示窦口通畅,窦腔粘膜正常;2例复发,再次扩大窦口,分别随访6、13个月无复发. 结论非侵袭性霉菌球型上颌窦炎鼻内镜下单纯上颌窦口扩大术可达到根治和微创的临床效果,但应特别注意窦口处理.     

低温等离子辅助下鼻内镜下中下鼻道联合开窗治疗真菌性上颌窦炎临床分析

目的通过对低温等离子辅助鼻内镜下中下鼻道联合开窗治疗真菌性上颌窦炎患者的术前、术后的临床观察,探讨该术式临床疗效。方法选取2012年3月-2014年6月我院收治的真菌性上颌窦炎15例患者作为研究对象,术后对患者的主观症状及局部变化过程进行6-12个月的随访观察。结果 1例患者出现间断鼻腔流涕,1例患者偶感面颊部不适,余患者鼻腔通气良好,无流浓涕、涕中带血、鼻塞、头痛等明显不适。鼻内镜下复查,上颌窦口通畅,窦口边缘光滑,窦腔内粘膜色泽正常,未见脓性分泌物及真菌分泌物团块。Lund-Kennedy评分术前与术后6个月差异有统计学意义（z=-2.293,P〈0.05）。结论低温等离子辅助下鼻内镜下中下鼻道联合开窗治疗真菌性上颌窦炎效果良好,出血少、痛苦小、恢复快,是治疗真菌性上颌窦炎的理想方法,值得推广。     

Repetitive endoscopic sinus surgery failure: a role for radical surgery?

OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the inflammatory burden and optimization of drainage of the sinuses has been suggested as a last resort for these patients. STUDY DESIGN: A prospective, questionnaire-based study was conducted in a group of 23 patients who underwent Denker's procedure for refractory chronic rhinosinusitis. Symptoms were evaluated before Denker's procedure and 12 months and 2 years after surgery. RESULTS: Patients reported improvement of feelings of congestion in 74%, rhinorrhea in 70%, and nasal obstruction in 60% of the cases. The following postoperative improvements were statistically significant: rhinorrhea (P = 0.001), feelings of congestion (P = 0.02), and nasal obstruction (P = 0.03). Reduced olfactory perception and asthma did not improve. CONCLUSION: Radical surgery may be a viable treatment option in case of recurrent ESS failure. EBM rating: C-4.     

Surgical treatment of Aspergillus mycetomas of the maxillary sinus: review of the literature.

The present study reviews the literature concerning the surgical treatment of Aspergillus mycetoma (AM) in the last 20 years to identify a gold standard surgical technique. Aspergillus mycetoma of the maxillary sinus, or mycetoma (fungus ball), is a noninvasive or extramucosal mycotic infection. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the traditional Caldwell-Luc (CL) procedure or endoscopic sinus surgery (ESS). Results of this review suggest that the gold standard surgical technique for AM is ESS with middle meatal antrostomy. General or local antifungal drugs are not indicated. Combined approach with an intraoral surgical access from the anterolateral wall of the maxillary sinus has to be reserved for selected cases in which ESS doesn't permit complete extraction of all fungal concretions or foreign bodies. The CL procedure should be avoided, because it has detrimental consequences for sinus physiology.     

鼻内镜手术治疗少年患者的鼻腔结构异常

目的探讨药物治疗无效的少年慢性鼻-鼻窦炎患者的内镜治疗方式与效果。方法因鼻腔结构异常伴发慢性鼻-鼻窦炎行鼻内镜手术治疗的少年患者112例,年龄12~17岁。在鼻内镜下行鼻中隔成形术,酌情行中鼻甲、下鼻甲成形术,合并腺样体肥大及鼻息肉者同期处理。结果随访6~23个月,平均13个月,术后症状消失110例(98.2%),无明显改善2例(1.8%)。结论鼻内镜下鼻中隔成形术,结合中鼻甲或下鼻甲成形,手术细致、微创,可以有效纠正少年患者鼻腔结构异常,解决药物不能解决的解剖问题,为鼻腔生理功能的恢复创造条件。     

Transantral revision of recurrent maxillary and ethmoidal disease following functional intranasal surgery.

Recurring disease in the maxillary sinus, despite inferior meatal antrostomies, has led to the widespread use of middle meatal antrostomy or simple decompression of the natural ostium of the middle meatus in attempts to restore function to the maxillary sinus. We have reported recurrent disease in the maxillary sinus in patients with stage III or stage IV hyperplastic rhinosinusitis in whom attempts at functional surgery of the middle meatus were unsuccessful in reversal of retrograde changes. One hundred patients who had previously undergone intranasal sphenoethmoidectomy with removal of the middle turbinate, decompression of the maxillary ostium, and removal of overt hyperplastic disease of the middle meatus underwent revision transantral ethmoidectomy. All recurrent or residual diseased mucosa was removed, including polyps, occasional mucoceles, and hyperplastic changes that occurred despite patency of a middle meatal maxillary ostium. In many of these patients the maxillary sinus was widely marsupialized secondarily into the posterior nasal vault. While the initial overall polyp recurrence rate after intranasal sphenoethmoidectomy in these patients was as high as 19.2%, the rate of polyp recurrence after transantral revision was less than 5% in from 18 to 48 months postoperatively. The experience in this series suggests that mucosal changes have played a primary role in unsuccessful treatment, independent of whether or not adequate functional egress for maxillary secretion, drainage, or ventilation has been created or restored.(ABSTRACT TRUNCATED AT 250 WORDS)     

单鼻孔经蝶窦入路治疗鞍区囊性垂体病变

目的总结单鼻孔经蝶窦入路显微手术治疗鞍区囊性垂体病变的经验。方法 2006～2010年,显徽镜下单鼻孔经蝶窦入路治疗15例囊性垂体病变,病变直径11～28 mm,其中〉20 mm者6例。将鼻窥器缓慢插入右鼻孔向上经中鼻甲直至蝶窦前壁,横行切开鼻中隔黏膜约1.5 cm,保持窥器尖呈闭合状态向对侧偏移,使鼻中隔骨折移位。然后将窥器张开,可见中线骨性隆起结构蝶嵴及两侧蝶窦开口。凿除蝶窦前壁约1.0～1.5 cm,显露蝶窦腔,咬除蝶窦分隔,剥离电凝蝶窦黏膜,显露凸形鞍底,凿开并扩大至1.2～1.5 cm骨窗即见硬脑膜,电凝硬膜后穿刺,证实病变后＂十＂字切开,显露病变并予钳取和刮除。结果手术过程顺利,病变全切除14例,次全切除1例。病理结果为垂体脓肿4例,Rathke囊肿7例,囊性垂体腺瘤4例。无死亡及病残,术后无脑脊液鼻漏。1例囊性垂体腺瘤次全切除患者术后行伽玛刀治疗,随访10个月未见肿瘤增大。余14例随访8～19个月,平均14个月,无复发。结论鞍区囊性垂体病变术前鉴别诊断虽然较困难,但仍有很多特征可以鉴别;应用单鼻孔经蝶窦入路可取得简捷、安全、高效的治疗效果。     

Biofilm and persistent inflammation in endoscopic sinus surgery

Bacterial biofilms have been observed in many patients with chronic rhinosinusitis, but their importance is still being investigated. This study examines the association between biofilms and other clinical findings in chronic rhinosinusitis patients.Twenty-four patients with chronic rhinosinusitis who failed medical management underwent endoscopic sinus surgery (ESS). Tissue was collected from the ethmoid sinus and analyzed for the presence of biofilm by hematoxylin and eosin staining, fluorescent in situ hybridization, and confocal scanning laser microscopy. Biofilms were classified as extensive (> 50% of mucosal surface in sample) or present (< 50% of surface). The surgeon remained blinded to the biofilm status of patients until postoperative follow-up was complete.The presence of bacterial biofilm was strongly associated with persistent mucosal inflammation after ESS (53% of biofilm-positive patients vs 0% of biofilm-negative patients, P = 0.009). The amount of biofilm was not important as there was no significant difference between the extensive and present biofilm classifications with respect to inflammation. The presence of biofilm was not associated with prior ESS, allergies, eosinophils, polyps, or presence of fungal elements.     

Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis.

There have been several reports on the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis. Whether ESS has a positive effect on the clinical course of asthma still remains controversial. There have been several subjective evaluations but few objective results. We performed a study to evaluate the effectiveness of ESS in 19 patients with asthma who underwent ESS for rhinosinusitis. The use of antiasthma medication and postoperative asthma symptoms was analyzed. Objective changes of pulmonary function tests were evaluated. There was a significant improvement in diurnal and nocturnal asthma symptoms. Improvements in asthma medication scores were also confirmed, and individual asthma symptoms (dyspnea, cough, wheezing, and sputum production) improved significantly. Despite a reduction in use of antiasthma medication after ESS, the parameters of the pulmonary function tests did not change. Both subjectively and objectively, it seems that ESS, when used to treat asthmatic patients with chronic rhinosinusitis, can play a significant role in the clinical improvement of asthma.     

Detection of fungi in the sinus mucosa using polymerase chain reaction.

OBJECTIVE: To compare the presence of fungi in the sinus mucosa of patients with and without chronic rhinosinusitis. STUDY DESIGN AND SETTING: Prospective observational study using polymerase chain reaction and conventional culture to detect fungi in the sinus mucosa. Middle meatus mucosal samples were collected from 31 patients with chronic rhinosinusitis and 14 control subjects. RESULTS: Fungi were detected in 6.5% of subjects with chronic rhinosinusitis and in none of the control subjects using polymerase chain reaction. Fungi were detected in 29% of subjects with the combination of inhalant allergies, nasal polyposis, and asthma. Fungi were detected in none of the subjects without the combination of these three comorbidities (P = 0.03). CONCLUSION: Polymerase chain reaction assay appears to be able to detect fungi in chronic rhinosinusitis. SIGNIFICANCE: Fungi may not be implicated in the pathogenesis of most chronic rhinosinusitis. EBM rating: B-3b.     

Predictive and monitoring value of matrix metalloproteinase-9 for healing quality after sinus surgery

Functional endoscopic sinus surgery is considered the standard therapeutic procedure for chronic rhinosinusitis and nasal polyposis after failure of medical treatment. We tested the hypothesis that the healing outcome after surgery was correlated to the secretion profile of gelatinase-B (matrix metalloproteinase-9 [MMP-9]) and transforming growth factor-beta1 (TGF-beta1) in nasal fluid. We performed a prospective study in 36 patients bilaterally operated for chronic rhinosinusitits or nasal polyposis and the healing quality was evaluated until 6 months after surgery by standardized nasal endoscopy, using a visual analog scale. Before functional endoscopic sinus surgery and during the postoperative period, TGF-beta1 and MMP-9 in nasal secretions were measured by enzyme-linked immunosorbent assay. Both MMP-9 and TGF-beta1 showed a significant increase initially after surgery. The healing quality after 6 months was significantly and independently correlated to preoperative MMP-9 concentrations in nasal secretions (p = 0.03), initial disease (p = 0.03), and previous sinus surgery (p = 0.004). Furthermore, concentrations of MMP-9 were significantly lower in patients with good healing (visual analog scale < 3) from week 3 to month 6 compared to patients with poor healing. MMP-9 is the first objective factor suitable to predict and monitor the healing quality after sinus surgery, indicating MMP-9 as a possible therapeutic target.