鼻内窥镜手术的中鼻甲处理

探讨鼻内窥镜手术中鼻甲部分切除和保留中鼻甲与预后的关系。方法４０例双侧慢性窦炎鼻息肉患者,在鼻内窥镜手术中１侧切除术中鼻甲,另侧保留中鼻甲,观察术后鼻腔清理时间,粘连情况和手术前后觉变化。     

鼻内窥镜手术的中鼻甲处理

目的探讨鼻内窥镜手术中鼻甲部分切除和保留中鼻甲与预后的关系。方法４０例双侧慢性鼻窦炎鼻息肉患者,在鼻内窥镜手术中１侧切除部分中鼻甲,另侧保留中鼻甲,观察术后鼻腔清理时间、粘连情况和手术前后嗅觉变化。结果①术后鼻腔清理时间,中鼻甲部分切除侧（平均７．１ｄ）与中鼻甲保留侧（平均９．４ｄ）差异有高度显著性（ｔ＝３８４,Ｐ＜００１）;②中鼻甲保留侧术后发生鼻腔粘连１２例,中鼻甲部分切除侧无１例发生粘连;③中鼻甲部分切除侧嗅觉改善与中鼻甲保留侧差异无显著性,４０例中未见嗅觉下降者。结论鼻内窥镜手术中切除部分中鼻甲的优点：①缩短术后清理时间,促使术腔尽快干燥与上皮化;②防止术后粘连。     

中鼻甲的处理方式与鼻内窥镜手术

目的：探讨中鼻甲的处理方式五鼻内窥镜手术的关系。方法：对１９９５－１９９７年手术并随访６个月以上的１６９例完整资料,按照ＦＥＳＳ－９５广州标准对保留中鼻甲和部分切除中鼻甲两组病人进行分析。结果：１６９例中,治愈２０８侧,无效２２侧。结论：对不同分期的慢性鼻窦炎,鼻息肉患者进行鼻内窥交易手术时,合理地处理中鼻甲是保证疗效的重要因素。     

鼻窦内窥镜手术中鼻甲的处理

近年来功能性内窥镜鼻窦外科在国内外迅速发展，使鼻外科的临床治疗水平不了迅速提高。但是，手术在对中鼻甲的处理一直存在着争议。现就中鼻甲的形态、相关解剖、生理功能及术中对中鼻甲的处理作一综述。     

内窥镜鼻窦手术中不同中鼻甲处理方法对鼻气道阻力的影响

目的 :研究内窥镜鼻窦手术中不同中鼻甲处理方法对鼻气道阻力及主观鼻气流感觉的影响。方法 :采用主动前鼻测压法及视觉类比法对 32例 (侧 )中鼻甲完全切除患者、37例 (侧 )中鼻甲部分切除患者及 34例(侧 )中鼻甲完全保留患者内窥镜鼻窦手术前后鼻气道阻力和主观症状评分进行了研究。结果 :术后三组患者鼻气道阻力和主观症状评分均较术前明显下降 (P <0 .0 1) ,三组间鼻气道阻力及主观症状评分的差异均无显著性意义 (P >0 .0 5 )。结论 :中鼻甲不同处理方法对鼻气道阻力及主观鼻气流感觉无显著影响     

鼻内窥镜下中鼻甲处理

在１４５例鼻内窥镜手术中行中鼻甲重建术４５例，术后随访５个月￣３年，４０例临床效果优良，重建后的中鼻甲恢复至正常形态。将手术方式分为Ｉ、Ⅱ两型，介绍了手术方法，并对中鼻甲的生理学意义和手术适应证进行了讨论。     

鼻内窥镜下功能性下鼻甲成形术

目的探讨鼻内窥镜下下鼻甲缩小成形术治疗慢性肥厚性鼻炎的疗效和方法.方法鼻内窥镜下行保留下鼻甲内侧黏膜部分鼻甲切除术.结果术后出血少,反应轻,创面位于下鼻甲外侧.短期与长期观察,下鼻甲与中隔及鼻底距离增宽,通气改善,无结痂与干燥感.结论鼻内窥镜下功能性下鼻甲缩小成形术是治疗肥厚性鼻炎的理想功能性术式.     

鼻内窥镜鼻窦手术中中鼻甲的处理方法和意义

中鼻甲在鼻腔生理功能方面发挥重要作用，又是鼻内窥镜鼻窦手术中极重要的解剖参考标志，所以强调术中保留中鼻甲。但中鼻甲自身解剖结构异常或存有病变，却可导致鼻腔鼻窦功能障碍，并有可能成为鼻窦炎的发源地。本文综合了１２１３例接受鼻内窥镜鼻窦手术的慢性鼻窦炎、鼻息肉患者中９７５例ＣＴ扫描和鼻内窥镜检查结果，并总结了鼻内窥镜鼻窦手术中和术后随访的体会，归纳提出中鼻甲与上颌骨额突（钩突附着缘）及鼻中镉的解剖结构     

鼻内窥镜下中鼻甲处理

在145例鼻内窥镜手术中行中鼻甲重建术45例，术后随访5个月～3年，40例临床效果优良，重建后的中鼻甲恢复至正常形态。将手术方式分为Ⅰ、Ⅱ两型，介绍了手术方法，并对中鼻甲的生理学意义和手术适应证进行了讨论。     

Investigation of training needs for functional endoscopic sinus surgery (FESS)

The use of simulators for training FESS may in the future offer substantial advantages like increased exposure to difficult scenarios, reduced learning curves, and reduced costs. Training simulators may range from very simple, involving only visual simulation, to more complex, involving haptic simulation or force feedback. To effectively employ these training means, insight is needed into the training needs for FESS procedure. A study was carried out to investigate which subtasks of FESS are hardest to perform and have the longest learning curve. A questionnaire was distributed among two groups of Ear, Nose and Throat (ENT) surgeons participating in a basic, as well as in an advanced sinus surgery course. Results showed that tasks related to spatial orientation are judged as hardest, whereas manual tasks are considered less difficult. These results suggest that simulators will not necessarily need haptic feedback to train the most important knowledge and skills needed for FESS.     

功能性内窥镜鼻窦手术出血的预防

目的探讨功能性内窥镜鼻窦手术(FESS)出血的相关因素及预防措施。方法对144例实施 FESS,对患者术中出血量及相关因素进行统计学分析。结果144例中出血量为20～700ml,其中20m1～2例 (14.6％),50ml～47例(32.6％),100ml～54例(37.5％)200ml～18例(12.5％),500ml～4例(2.8％)。术中易 损伤的血管是筛前动脉及筛后动脉,蝶腭动脉和鼻后中隔动脉,颈内动脉。多次手术的患者因瘢痕组织中血 管失去弹性和病变处血管异常增生是术中出血的重要因素。手术全麻和手术时间长可增加出血。结论为 减少FESS术中出血,术者须熟悉鼻窦解剂学,术前仔细阅读CT片,了解病变范周及解剖学变异。术中要清 楚每一步操作处的解剖位置,仔细辩认术区的重要血管并加以保护,术前常规使用1％肾上腺素收敛鼻黏膜 血管可减少术中出血。     

Pupil size and reaction during functional endoscopic sinus surgery (FESS)

This aim of this study was to evaluate the size and light reflex of the pupils during endoscopic sinus surgery (FESS). Pupil size and light reflexes were recorded prospectively in 20 patients undergoing FESS under general anaesthesia. Nasal mucosal vasoconstriction was induced by Moffett's solution. A control group of 20 patients underwent other standard ENT operations under general anaesthesia. Myosis occurred in all 40 patients after induction of general anaesthesia. During surgery, the light reflex was negative for all 40 patients. However, the light reflex became positive in 22 patients within 5 min of surgery, and in all patients after 20 min. Monitoring pupillary size and reflexes during FESS as a means of assessing trauma to the orbital structures is difficult because of the presence of myosis induced by anaesthetic agents. Moffett's solution did not have a mydriatic effect from the systemic absorption of cocaine during the operative period.     

鼻内镜手术中的中鼻甲的处理

目的探讨鼻内镜手术中的中鼻甲处理技巧和意义。方法回顾性分析收治的80例慢性鼻窦炎、鼻息肉患者随机分为观察组32例（39侧）和对照组48例（54侧）,观察组强调中鼻甲的处理上尽可能保障中鼻甲空间结构和形态上的相对正常;对照组采用传统的Messerklinger术或wigand术式。术后6个月对比两组中鼻甲的稳定性,中鼻道狭窄或粘连的发生情况以及按lund—Kennedy内镜黏膜形态评分系统进行评价。结果两组患者的术前lund—Kennedy内镜黏膜形态评分差异无统计学意义（t=1．659,P〉0．05）,观察组术后6个月Lund—Kennedy评分为（1．89±1．31）分,低于对照组（2．48±1．42）分,两组比较差异具有统计学意义（t=8．1,P〈0．01）。术后观察组中鼻甲结构良好稳定,中鼻甲轻度外移、中鼻道狭窄、中鼻甲与鼻腔外侧壁粘连3种情况的发生率分别为83．2％、4．1％、6．7％,对照组的发生率分别为44．9％、21．6％、10．3％,两组比较差异具有统计学意义（r=10．77,P〈0．01）。结论保障中鼻甲空间结构和形态上的相对正常有助于提高鼻内镜手术疗效,减少术后不良并发症。     

Postoperative pain assessment after functional endoscopic sinus surgery (FESS) for chronic pansinusitis

Postoperative pain after functional endoscopic sinus surgery (FESS) and its optimal management has not been described in detail. The objective was to evaluate pain, its influencing factors and its management on the first postoperative day following FESS. In a prospective case study, 101 FESS patients were examined after removal of the nasal packing within the Quality Improvement in Postoperative Pain Management (QUIPS) project allowing a standardized assessment of patients’ characteristics, pain parameters, outcome and process parameters. The influence of these parameters on the patients’ postoperative pain was estimated by univariate and multivariate statistic analysis. Pain during the first postoperative day after FESS was moderate. Younger patients reported significantly more pain than did older patients. Specific counseling about the possibilities of postoperative pain management reduced pain intensity highly significantly in univariate and multivariate analysis. Patients demanding for pain relief in the recovery room and on the ward predominantly received acetaminophen as non-opioid and piritramide as opioid. This pain management was obviously insufficient as these patients still reported significantly more from pain on the first postoperative day than patients not demanding for pain relief. We conclude that QUIPS could help to optimize the quality of postoperative pain management following FESS.     

电动微切吸器在功能性鼻窦内窥镜手术中对中鼻甲的处理方式

目的：探讨电动微切吸器在功能性鼻窦内窥镜手术中对中鼻甲的处理方式。方法：介绍电动微切吸器技术在７０例功能性鼻窦内窥镜手术中对病变中鼻甲的处理方式及其优点。结果：术后随访７０例病例６个月以上,７０例（１１８侧）中,治愈１１５侧（９７．５％）;好转２侧（１．７％）;无效１侧（０．８％）。结论：对不同分期的慢性鼻窦炎、鼻息肉患者进行鼻窦内窥镜手术时,尽可能保留中鼻甲或合理地处理中鼻甲是保证手术疗效的重要因素之一。     

Pupil size and reaction during functional endoscopic sinus surgery (FESS)1

Pupil size and reaction during functional endoscopic sinus surgery (FESS) This aim of this study was to evaluate the size and light reflex of the pupils during endoscopic sinus surgery (FESS). Pupil size and light reflexes were recorded prospectively in 20 patients undergoing FESS under general anaesthesia. Nasal mucosal vasoconstriction was induced by Moffett's solution. A control group of 20 patients underwent other standard ENT operations under general anaesthesia. Myosis occurred in all 40 patients after induction of general anaesthesia. During surgery, the light reflex was negative for all 40 patients. However, the light reflex became positive in 22 patients within 5 min of surgery, and in all patients after 20 min. Monitoring pupillary size and reflexes during FESS as a means of assessing trauma to the orbital structures is difficult because of the presence of myosis induced by anaesthetic agents. Moffett's solution did not have a mydriatic effect from the systemic absorption of cocaine during the operative period.     

鼻窦内窥镜手术处理病变中鼻甲的意义

目的：探讨功能性鼻窦内窥镜于术（ＦＥＳＳ）中处理病变中鼻甲的临床意义。方法：按照成人中鼻甲解剖学标准,在３２例鼻窦炎、鼻息肉患者ＦＥＳＳ中,对病变中鼻甲进行适当处理,并于术后对中鼻甲形态恢复、筛窦术腔及上凳窦窦中开放率进行随访观察。结果：术后６个月中鼻甲形态恢复正常２４例（７５％）,发生粘连８例（２５％）,其中术腔闭塞２例（６．３５％）;上颌窦窦口开放良好２５例（７８．１％）,狭窄６例（１８．８％