青年军人白内障行超声乳化手术治疗临床特征分析

 目的 总结行超声乳化手术治疗的青年军人白内障的临床特点,并分析影响视力预后的因素。方法 回顾性研究31例(36眼)行超声乳化联合人工晶体置入术治疗的青年军人白内障患者的临床资料,将可能影响视力预后的因素纳入有序多分类logistic回归分析,筛选出视力预后的影响因素。结果 将是否有眼外伤史、玻璃体切除手术史、近视手术史、葡萄膜炎病史纳入有序多分类logistic回归分析,结果显示:眼外伤病史(OR=0.149)、玻璃体切除手术史(OR=0.059)是视力预后的危险因素,葡萄膜炎病史(OR=0.145)是视力预后的可疑危险因素。结论 青年军人白内障最常见的类型是外伤性白内障及玻璃体切除术后并发性白内障,均预后较差,平时应注意预防眼外伤及视网膜脱离的发生。     

影响双额脑挫伤临床恶化及预后的危险因素

 目的 探讨影响双额脑挫伤临床症状恶化和预后的相关危险因素。方法 回顾性研究2011-03到2013-03医院收治的双额脑挫裂伤患者,收集并分析患者年龄、性别、受伤机制,入院时格拉斯哥昏迷评分(Glasgow coma scale,GCS)、影像学表现等临床信息,分析影响临床症状恶化出现的相关危险因素;并对患者进行伤后1年随访,格拉斯哥结局量表(Glasgow outcome scale, GOS)评价临床预后并分析影响患者预后的相关因素。结果 入组患者共112例,17例出现临床恶化,预后不良者(GOS分级,Ⅰ~Ⅱ级)15例,预后良好者(GOS分级,Ⅲ~Ⅴ级)95例。患者性别(P=0.0039)、GCS评分(P=0.0063)、环池闭塞(P=0.0426)、血肿体积(P<0.0001)与临床症状恶化显著相关,年龄(P=0.0004)、GCS评分(P=0.0424)、鞍上池闭塞(P=0.0047)、血肿体积(P<0.0001)、SAH(P=0.0145)显著影响患者临床预后。结论 GCS评分及影像学表现是影响双额脑挫伤患者预后和临床症状恶化的重要评价指标。
     

无肝硬化乙肝患者肝癌发病影响因素分析

 目的 探讨无肝硬化乙肝相关肝癌患者的发病因素。方法 收集2004-01至2015-12月我院就诊的原发性肝癌共1000例。根据是否有肝硬化分为肝硬化组(n=934例)及无肝硬化组(n=66例),回顾性分析2组患者的一般情况及实验室检查指标等资料,对无肝硬化乙肝相关肝癌患者的发病因素进行χ²检验及Logistic回归分析。结果 单因素分析表明2组患者在年龄、是否饮酒、是否重叠丙型肝炎病毒感染、是否合并高血压、基线血清e抗原状态及血清HBV DNA水平、是否行抗病毒治疗与是否有肝癌家族史方面差异有统计学意义(P<0.05);将其纳入多因素非条件Logistic回归分析,结果提示饮酒(OR=0.176,P=0.002)、有高血压病史(OR=0.505,P=0.039)、基线血清HBV DNA水平偏低(OR=0.031,P＜0.001)、既往未行抗病毒治疗(OR=7.268,P＜0.001)、有肝癌家族史(OR=0.487,P=0.010)是无肝硬化慢性乙型肝炎患者直接进展为原发性肝癌的独立危险因素。结论 对于有饮酒史、有高血压病史、基线血清HBV DNA水平偏低、既往未行抗病毒治疗及有肝癌家族史的无肝硬化慢性乙型肝炎患者,应密切监测肝癌的发生。     

妇科门诊患者宫颈癌筛查认知程度及其影响因素

 目的 探讨妇科门诊患者宫颈癌筛查的认知程度及其相关影响因素。方法 选取840例妇科门诊就诊的患者进行问卷调查,分析就诊患者宫颈癌筛查的知晓率,采用单因素χ²检验和多因素Logistic回归法分别筛选认知程度的影响因素。结果 840例妇科门诊患者宫颈癌筛查的知晓率为52.38%(440/840);影响宫颈癌筛查认知程度的因素包括文化程度(OR=2.022,95%CI 1.251~3.268)、家族妇科肿瘤史(OR=2.918,95%CI 1.689~5.042)、宫颈癌筛查史(OR=4.031,95%CI 2.124~7.652)、“两癌筛查”社区宣教(OR=5.043,95%CI 2.757~9.223)、接受生殖健康信息(OR=3.337,95%CI 1.482~7.512)、社会支持程度(OR=2.593,95%CI 1.291~5.211)。结论 妇科门诊患者宫颈癌筛查的认知程度仍然较低,且影响认知程度的因素较多,应针对其特点及其影响因素,早期采取对策和措施,提高认知程度,降低宫颈癌的发生率。     

乙肝表面抗原阴性恶性肿瘤患者化疗后乙肝病毒再激活的影响因素

 目的 探讨乙肝表面抗原(hepatitis B surface antigen,HBsAg)阴性恶性肿瘤患者化疗后乙肝病毒(hepatitis B virus,HBV)再激活的相关危险因素。方法 收集2006-01至2014-12在武警上海总队医院接受化疗的HBsAg阴性恶性肿瘤患者570例。根据化疗后HBV是否出现再激活将患者分为再激活组25例及未被激活组545例,回顾性分析两组患者一般情况、化疗方案及实验室检查指标,对HBV再激活的潜在影响因素进行χ²检验及Logistic回归分析。结果 单因素分析表明两组患者在性别、乙肝表面抗体状态、e抗体状态、核心抗体状态及是否使用免疫抑制药方面差异有统计学意义(P<0.05),将其纳入多因素非条件Logistic回归分析,结果提示男性(OR=7.700,P<0.001)、乙肝表面抗体阴性(OR=0.056, P<0.001)、核心抗体阳性(OR=4.670, P<0.01)及使用免疫抑制药(OR=7.978, P<0.01)是导致化疗后HBV再激活的独立危险因素。结论 对于男性、乙肝表面抗体阴性、核心抗体阳性及使用免疫抑制药的HBsAg阴性的恶性肿瘤患者行化疗时,应密切监测HBV是否出现再激活或及早采取抗病毒治疗防止HBV再激活。     

cN0期甲状腺乳头状癌中央区淋巴结转移的危险因素分析

 目的 探讨cN0期甲状腺乳头状癌患者中央区淋巴结转移相关危险因素。方法 纳入北京协和医院行双侧中央区淋巴结清扫的cN0期甲状腺乳头状癌患者570例,回顾性分析患者术前甲状腺超声图像及临床病理资料特征,分析预测cN0期甲状腺乳头状癌中央区淋巴结转移相关危险因素。结果 570例cN0期甲状腺乳头状癌患者中发生中央区淋巴结转移282例,占49.5%;其中男性(OR=1.787, 95% CI:1.066-2.997, P=0.028)、年龄小于45岁(OR=2.063, 95% CI:1.366-3.115, P=0.001)、多发病灶(OR=1.764, 95% CI:1.134-2.743, P=0.012)、肿瘤直径＞1 cm(OR=1.844, 95% CI:1.201-2.831, P=0.005)、伴有微钙化(OR=1.965, 95% CI:1.296-2.979, P=0.001)且有被膜侵犯(OR=2.868, 95% CI:1.880-4.377, P=0.000)是中央区淋巴结转移的独立危险因素。结论 对于男性、年龄小于45岁、多发病灶、肿瘤直径＞1 cm、伴有微钙化且有被膜侵犯的cN0期甲状腺乳头状癌应根据影像学及临床病理资料考虑采取积极的手术方式或更加密切的随访。     

新冠肺炎疫情下某部队三甲医院官兵员工心理健康状况调查分析

 目的 探索新冠肺炎(COVID-19)疫情下官兵员工心理健康状况,为进一步开展官兵员工心理干预提供理论依据。方法 抽取某部队三甲医院642名官兵员工完成一般情况调查表、焦虑自评问卷(GAD-7)、抑郁症自评问卷(PHQ-9)。采用Logistic回归模型分析焦虑、抑郁的影响因素。结果 (1)焦虑、抑郁状态检出率分别为29.44%、36.45%;(2)Logistic回归分析显示,对自己或家人感染COVID-19的担忧[OR=1.86,95%CI(1.59,2.17),P<0.05]、自身健康状况欠佳[OR=2.84,95%CI(1.85,4.36),P<0.05]是焦虑的危险因素;对自己或家人感染COVID-19的担忧[OR=0.50,95%CI(1.38,1.85),P<0.05]、自身健康状况欠佳[OR=3.16,95%CI(2.03,4.91),P<0.05]是抑郁的危险因素。相比普通工作人员,一线医护人员和普通医护人员的职业背景是焦虑[OR=0.37,95%CI(0.21,0.64),P<0.05][OR=0.59,95%CI(0.36,0.95),P<0.05]、抑郁[OR=0.37,95%CI(0.25,0.70),P<0.05][OR=0.42,95%CI(0.31,0.79),P<0.05]的保护性因素。受教育程度与焦虑、抑郁无显著关联。结论 COVID-19疫情下官兵员工心理问题发生率较高,与负性认知及身体健康相关。     

急性脑梗死患者静脉溶栓后早期神经功能恶化的危险因素

 目的 探讨急性脑梗死(acute cerebral infarction, ACI)患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的危险因素。方法 选择2014-01至2019-01发病4.5 h内行阿替普酶静脉溶栓的ACI患者,根据溶栓后是否发生END将患者分为END组和非恶化组,比较两组人口统计学、临床特征和实验室指标。采用多变量Logistic回归分析ACI患者静脉溶栓后END的危险因素。结果 共纳入ACI患者108例,其中END组19例。END组年龄、体重、心房纤颤比例、基线NIHSS评分、责任大血管狭窄或闭塞、白细胞计数、纤维蛋白原水平均显著高于非恶化组。多变量 Logistic回归分析显示,年龄(OR=3.285;95%CI:2.023～5.682;P=0.028)、体重(OR=2.679;95%CI:1.690～6.287;P=0.039)、心房纤颤(OR=2.551;95%CI:1.980～4.235;P=0.027)、基线NIHHSS评分(OR=3.627;95%CI:6.267～13.331;P=0.018)、纤维蛋白原水平(OR=2.016;95%CI:4.650～7.823;P=0.031)均与ACI患者静脉溶栓后END显著相关。结论 ACI患者静脉溶栓后END发生率较高,年龄、体重、心房纤颤、基线NIHSS评分、纤维蛋白原为ACI患者静脉溶栓治疗后发生END的危险因素。     

新生儿败血症临床特点及其预后的影响因素

 目的 探讨新生儿败血症临床特点及其预后的相关影响因素。方法 选择深圳市龙华区人民医院2016-01至 2018-06的新生儿败血症147例,采集所有患儿血液标本,分离鉴定病原菌。分析新生儿败血症患儿临床表现和病原菌特点, 采用多因素分析影响新生儿败血症患儿预后危险因素。结果 新生儿败血症患儿147例,临床表现以反应差、面色灰白和呼吸困难为主。147例中培养病原菌106株,以革兰阴性菌为主,分离出59株;其次为革兰阳性菌,分离出43株。所有患儿根据相关感染指标检测及血培养后给予抗菌药物经验治疗,存活组109例,死亡组38例。经单因素分析表明,两组性别、年龄、精神状况、血压、尿量和WBC比较无统计学意义;两组低出生体重儿、早产儿、MODS、PLT和休克评分比较具有统计学意义(P＜0.05)。多因素Logistic回归分析显示,MODS (OR:1.532, 95%CI: 1.089~2.109) PLT( OR:2. 115,95% CI: 1.481~2.897)和休克评分(OR:1.809,95% CI: 1.276~2.468)为影响新生儿败血症患儿预后的独立危险因素。结论 新生儿败血症临床表现以反应差、面色灰白和呼吸困难为主,培养病原菌以革兰阴性菌为主,MODS、PLT和休克评分均是影响新生儿预后的相关危险因素,为改善患儿应采取针对性预防措施,值得临床借鉴。     

中国人群先天性白内障危险因素的Meta分析

 目的 探讨中国人群先天性白内障的危险因素,为降低先天性白内障的发生率提供依据。方法 检索CNKI、VIP、WanFang Data、Pubmed和Embase数据库,收集以上各数据库从建库至2021-11-30公开发表的有关先天性白内障危险因素的文献,运用RevMan5.4软件行 Meta分析。结果 本研究共纳入文献6篇,累计病例650例,对照1353例。Meta分析结果显示,中国人群先天性白内障的危险因素主要有:出生后给氧治疗(OR=5.50,95%CI:1.66～18.20)、家族遗传史(OR=6.97,95%CI:2.76～17.62)、孕期感染(OR=2.06,95%CI:1.38～3.06)、孕期营养状况不佳(OR=2.55,95%CI:1.17～5.56)、孕期服用药物(OR=4.49,95%CI:1.74～11.59)、患缺血缺氧性脑病(OR=6.42,95%CI:1.35～30.53)、早产(OR=2.14,95%CI:1.28～3.60)、低出生体重(OR=4.04,95%CI:2.11～7.75)、外周血血清补体C₃水平下降(OR=1.04,95%CI:1.02～1.07)以及CRYAA和CRYAB基因单核苷酸多态性:CRYAArs7278468 GT+TT等位基因(OR=6.03,95%CI:1.27～28.53)、CRYABrs370803064 AA+GA等位基因(OR=5.81,95%CI:1.57～21.56)、CRYABrs387907338 TT+TC等位基因(OR=2.47,95%CI:1.34～4.58)、CRYAB基因TA单倍型(OR=1.80,95%CI:1.10～2.95)。结论 出生后给氧治疗、孕期感染、家族遗传史、孕期营养状况不佳、孕期服用药物、出生后诊断为缺血缺氧性脑病、早产、低出生体重、外周血血清补体C₃水平下降、CRYAA和CRYAB基因单核苷酸多态性为先天性白内障发病的重要危险因素。     

Significance of CT and MR findings in sphenoid sinus disease

Disorders of the paranasal sinuses, particularly the sphenoid sinus, can be associated with significant disorders of the optic and other cranial nerves. We examined 100 consecutive routine CT scans, 100 posterior fossa CT scans, and 100 MR scans to look for evidence of sinus disease, especially of the sphenoid sinus. The sphenoid sinus was abnormal in 7% of scans by all methods. Other sinuses were more frequently abnormal, including maxillary (23%), ethmoid (34%), and frontal (16%). Although MR was more sensitive in detecting sinus inflammation in the ethmoid and maxillary sinuses, the frequency of visible sphenoid sinus abnormalities detected by MR was not significantly greater when compared with CT. Of those patients with abnormal sphenoid sinuses, 24% had visual problems associated with the abnormality.     

视神经管骨折的CT诊断

本文对８５例视神经管骨折的临床与ＣＴ所见进行了回顾性分析。受伤原因中车祸３６例，撞伤１３例，摔伤１１例，击伤或砸伤１２例，其他伤少见。均有明显视力下降，其中失明无光感达７８例。８５例均行骨算法高分辨率ＣＴ扫描，显示视神经管内壁骨折６６例，内、上壁骨折１１例，上壁骨折３例，粉碎骨折５例，伴有邻近眶壁或蝶窦骨折７１例。视神经管骨折容易造成失明，因此外伤失明的患者早期行ＣＴ检查，对临床诊断及选择治疗方案具有指导意义     

视神经损伤鼻内镜减压术疗效观察

 目的 观察视神经损伤患者鼻内镜减压术治疗效果。方法 回顾性分析武警总医院耳鼻咽喉头颈外科2012-08至2014-04收治的28例(28只眼)视神经损伤患者的临床资料。所有患者均实施经鼻内镜视神经减压术,观察患者的临床治疗效果,并对患者的术后视力进行分析评价。结果 15例术后视力有所改善;24例术前无光感患者中,12例术后恢复光感;3例术前视力下降患者术后视力均有不同程度恢复。结论 针对视神经损伤患者行经鼻内镜视神经减压术进行治疗,并根据患者视神经损伤的程度和类型给予针对性的手术治疗,可帮助改善患者视力,并且具有手术创伤小、术后恢复快、并发症少等优点,有较好的临床疗效。     

Protrusion of the optic nerve into the ethmoid and sphenoid sinus: prospective study of 150 CT studies

Damage to the optic nerve is a serious complication of intranasal sinus surgery. Protrusion of the optic canal into the sphenoid sinus is a major risk factor. In this prospective study of 150 CT studies, we found this anatomical variation in 8% of cases. It was consistently associated with pneumatisation of the ipsilateral anterior clinoid process. Protrusion of the optic nerve into the posterior ethmoid cells was never observed. CT is a useful part of the preoperative investigation of patients undergoing intranasal sinus surgery. Axial and coronal images obtained or by direct acquisition by reconstructions are necessary to show the position of the optic nerve.     

Hyperintense Optic Nerve due to Diffusion Restriction: Diffusion-Weighted Imaging in Traumatic Optic Neuropathy

BACKGROUND AND PURPOSE:Abnormal signal intensity of the optic nerve due to diffusion restriction may be seen in traumatic optic neuropathy. In addition to evaluating optic nerve hyperintensity on diffusion-weighted imaging, we compared the group differences of ADC values between the injured and uninjured contralateral nerve and identified the relation between measured ADC values and admission visual acuity.MATERIALS AND METHODS:We retrospectively evaluated 29 patients with traumatic optic neuropathy who underwent MR imaging with DWI. Uninjured contralateral optic nerves were used as controls. Two attending radiologists, blinded to the side of injury, independently reviewed the DWI for the presence of signal-intensity abnormality and obtained ADC values after manually selecting the ROI.RESULTS:Hyperintensity of the optic nerve was demonstrated in 8 of the 29 patients, with a sensitivity of 27.6% (95% CI, 12.8–47.2) and a specificity of 100% (95% CI, 87.9–100). ADC values were obtained in 25 patients. The mean ADC in the posterior segment of the injured nerve was significantly lower than that in the contralateral uninjured nerve (Welch ANOVA, F = 9.7, P = .003). There was a moderate-to-strong correlation between low ADC values and poor visual acuity in 10 patients in whom visual acuity could be obtained at admission (R = 0.7, P = .02). Patients with optic nerve hyperintensity presented with worse visual acuity.CONCLUSIONS:Hyperintensity of the optic nerve due to diffusion restriction can serve as a specific imaging marker of traumatic optic neuropathy. When paired with reduced ADC values, this finding may be an important surrogate for visual acuity.

Traumatic optic neuropathy (TON) is an acute injury of the optic nerve (ON), typically presenting with severe impairment of visual function. TON is often classified on the basis of the location of the injury. Anterior ON injury is usually associated with ON head avulsion and disruption of circulation at the ON head. These patients present with intraocular hemorrhage and disruption of anatomy at the ON head on funduscopy. Posterior TON involves the nerve at a site proximal to where the ophthalmic artery enters the ON.¹ Clinical diagnosis of posterior TON is based on the presence of a relative afferent pupillary defect, decreased visual acuity (VA), normal funduscopic examination findings, and no apparent intraocular pathology.^2–4 The focus of this study was limited to posterior TON. Contusion, necrosis, concussion, hemorrhage, nerve fiber tears, and infarction due to vascular thrombosis or spasm have all been implicated as potential mechanisms of TON.^5,6 Specific causes include motor vehicle collisions, falls, assaults, blunt force effects of penetrating trauma, and surgical mishaps in and around the optic nerve, with a reported high prevalence among young men.⁷The architecture of the orbit facilitates transfer of impact forces from facial trauma to the region of the optic canal, where the nerve is vulnerable to injury due to the shearing effect between its fixed and mobile portions.^7–9 The concept of primary and secondary injury in TON has been proposed by Walsh.¹⁰ Primary injury results from immediate shearing of the retinal ganglion cell axons of the nerve. Secondary injury occurs from a complex biochemical cascade of events that follows the primary injury, resulting in edema of the ON within the inflexible optic canal.¹¹ Edema of the nerve in the optic canal produces a compartment syndrome, resulting in nerve ischemia due to compression of the pial vascular plexus.^12,13Conventional MR imaging findings are normal in most patients with TON.^3,5 An earlier study with DTI in TON showed decreased axial diffusion and ADC values in the posterior segment of the injured ON.³ In this retrospective study, we aimed to determine the ability of abnormal signal intensity of the ON due to diffusion restriction on DWI to diagnose TON, compare the group differences of ADC values between the injured and uninjured contralateral nerves, and identify the relation between the measured ADC values and admission VA.     

手术治疗间接性视神经损伤19例

目的 探讨颅脑损伤合并视神经损伤的有效治疗方法。方法 手术治疗１９例颅脑损伤合并视神经损伤病人,其中无光感１１例,光感６例,眼前手动１例,眼前数指１例。１６例行额部冠状切开头皮,一侧额部开颅清除眶骨骨折片或出血,矫正额眶骨折错位畸形。有视神经管骨折者,用微钻磨开视神经管,剪开视神经鞘进行神经减压。３例眶尖综合征者行额颞切口,经眶尖外侧壁磨开眶上裂和视神经管神经减压。结果 １２例有效,其中３例眼球突     

筛蝶窦囊肿的临床和影像学诊断

目的:分析总结筛蝶窦囊肿的临床表现和影像学特点,探讨影像学检查在筛蝶窦囊肿诊断中的意义.材料和方法:回顾性分析20例手术证实的筛蝶窦囊肿病例(男16例,女4例;年龄10～68岁,中位数为44岁),病理显示均合并囊肿壁黏膜慢性炎症,其中伴胆固醇肉芽肿2例和内翻性乳头状瘤样改变1例.影像学检查包括CT检查14例、MRI检查16例,其中3例完成了CT增强检查.结果:临床表现以头痛(14例)和眼部症状(7例)(包括视力下降、复视、突眼、上睑下垂等)为主,其他还有鼻部症状4例(鼻塞、鼻出血等)以及短暂意识丧失、性功能障碍、泌乳、月经减少、面部麻木等.病程1～48个月,中位数17个月.CT显示囊肿为窦腔内膨胀性占位,CT值15～57Hu,部分有骨质吸收,边缘清晰;MRI显示囊肿为T1WI上信号强度不一,T2WI高信号.3例CT增强有环形或结节状强化,对应病理为合并肉芽肿形成或乳头状瘤样变.结论:筛蝶窦囊肿的临床表现结合影像学表现有一定特点,影像学检查在其诊断中有重要作用.     

和血明目片联合雷珠单抗治疗湿性年龄相关性黄斑变性的临床效果

 目的 观察和血明目片联合抗血管内皮生长因子(vascular endothelial growth factor, VEGF)药物雷珠单抗治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration, wAMD)的临床效果。方法 选择2016-06至2018-06收治的96例(96只眼)wAMD患者,按照随机数字表法分为治疗组和对照组,每组48例(48只眼)。治疗组给予雷珠单抗球内注射联合和血明目片口服治疗,对照组仅给予雷珠单抗球内注射治疗。两组均连续治疗3个月,治疗结束后随访3个月,观察最佳矫正视力(best corrected visual acuity,BCVA)、黄斑区视网膜中央厚度(central retinal thickness,CRT)、黄斑出血面积、渗出面积及累积损伤面积等情况,随访结束后黄斑水肿复发情况,并进行统计学评价。结果 (1)BCVA:治疗3个月后,两组均比治疗前升高(t=8.320,t=4.689,P＜0.01),且治疗组高于对照组(t=2.509,P＜0.01);随访3个月后,两组均比治疗前高,差异有统计学意义(t=7.909,t=3.808,P＜0.01),且治疗组高于对照组(t=3.164,P＜0.01)。(2)CRT:治疗3个月后,两组均低于治疗前(t=16.864,t=14.175,P＜0.01),但两组间差异无统计学意义(t=1.402);随访3个月后,两组均低于治疗前,差异有统计学意义(t=14.478,P＜0.01),且治疗组低于对照组(t=2.687,P＜0.05)。(3)治疗后3个月,两组眼底出血、渗出及总的累积损伤面积均较治疗前明显缩小(P均＜0.05),且治疗组眼底出血面积(t=2.893,P＜0.05)和累积损伤面积缩小幅度(t=2.164,P＜0.05)较对照组更明显,均有统计学意义。(4)两组复发率比较,差异有统计学意义(χ²=4.937,P＜0.05)。结论 抗VEGF球内注射联合和血明目片治疗wAMD的临床疗效肯定,联合治疗在控制黄斑出血及水肿复发方面有优势。     

CT检查在FESS术前计划制定中的价值

目的:探讨蝶窦与视神经、颈内动脉等邻近结构的CT影像解剖关系,为经蝶窦手术及诊断提供准确的影像解剖学依据。方法:CT扫描病例128例,年龄20～72岁,平均46.2岁;其中男79例,女49例。使用日本TOSHIBA公司生产的Aquilion 4螺旋CT。后台处理采用Vitrea 1处理系统。测量数据采用x±SD,百分数,t检验。结果:视神经管与蝶窦的关系:隆起型视神经管38例(29.69%),压迹型视神经管73例(57.03%),远离型视神经管17例(13.28%)。视神经走行与蝶窦外侧的关系:全程与蝶窦外侧壁毗邻者71侧(27.73%),全程与后组筛窦毗邻者66侧(25.78%),全程同时与蝶筛外侧壁毗邻者95侧(37.11%),全程穿过骨质者22侧(8.59%)。颈内动脉与蝶窦的关系:隆起型48侧(18.75%),压迹型101侧(39.45%),远离型107侧(41.80%)。结论:CT扫描结合MPR重组,能够清楚显示颈内动脉、视神经等与蝶筛外侧壁的解剖毗邻关系。CT检查有利于FESS手术进路的选择及手术方案的确定,为手术安全提供了保证。