鼻窦CT和功能性鼻内窥镜手术

观察３０具成人尸头和８０例患者鼻窦ＣＴ，重点注意中鼻道解剖变异及窦口复合体阻塞同鼻窦炎的关系，结染发现：鼻丘气房、中鼻甲气化和曲线反常、钩突偏曲是最常见的中鼻道解剖变异，且鼻窦度同筛漏斗阻塞有密切关系。认为鼻窦ＣＴ能清晰显示鼻窦和中鼻道解剖及变异，因此，鼻窦ＣＴ应作为鼻内窥镜手术前的常规检查。     

鼻窦CT和功能性鼻内窥镜手术

观察３０具成人尸头和８０例患者鼻窦ＣＴ，重点注意中鼻道解剖变异及窦口复合体阻塞同鼻窦炎的关系。结果发现：鼻丘气房、中鼻甲气化和曲线反常、钩常偏曲是最常见的中鼻道解剖变异，且鼻窦密度同筛漏斗阻塞有密切关系。认为鼻窦ＣＴ能清晰显示鼻窦和中鼻道解剖及变异，因此，鼻窦ＣＴ应作为鼻内窥镜手术前的常规检查。     

鼻内窥镜鼻窦手术前CT检查与术中所见的比较

将３０例（５８侧）慢性鼻窦炎鼻息肉患者行内窥镜鼻窦手术前的ＣＴ检查结果和术中所见进行比较，结果表明，ＣＴ检查能良好地显示鼻腔鼻窦的病变范围和程度，与术中所见的符合率高。根据ＣＴ所示筛房骨化情况可将筛窦分为空泡型、骨质增生型和蜂窝型，并以此作为麻醉方式选择，估计术中难度等的参考依据，可见，ＣＴ是内窥镜鼻窦手术前必不可少的检查手段。     

筛窦及其邻近结构CT影像学研究

为内窥镜鼻窦手术提供影像学资料，观察了筛窦及其邻近结构的关系。对９名健康人筛窦进行了横断层面连续ＣＴ扫描，对２０名健康人进行了横断加冠状层面扫描，每人平均扫描２２次，发现个体间筛窦及其与邻近组织的解剖结构存在着很大的变异。横断扫描可清晰地显示出后组筛窦或蝶窦与视神经管的解剖关系和颈内动脉与蝶窦的解剖关系。冠状扫描可详细地观察到窦口鼻道复合体和筛窦与眼眶、前颅底的解剖关系。鼻窦ＣＴ扫描对鼻窦炎病因学分析、鼻内窥镜手术设计和术中防止并发症的发生均具有重要意义。     

内窥镜鼻窦手术中CT冠状位影像的应用

本文通过对７１例慢性鼻窦炎ＣＴ冠状位扫描的诊断和手术中所见，认为冠状位ＣＴ扫描病变发现率高，鼻窦的精细结构、病变范围和程度能清楚地显示出来，有指导鼻内窥镜手术的作用，应做为鼻内窥镜手术前必要的检查方法。     

CT扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义

目的探讨窦口鼻道复合体（ｏｓｔｉｏｍｅａｔａｌｃｏｍｐｌｅｘ,ＯＭＣ）解剖变异与慢性鼻窦炎的关系,分析其在内窥镜鼻窦手术中的重要性。方法以２９７例（５９４侧）冠状位鼻窦ＣＴ片为材料研究中鼻甲、钩突、筛泡和鼻丘的解剖变异及Ｈａｌｅｒ气房的影像特点,结合病史分析解剖变异与慢性鼻窦炎的关系,用ＳＰＳＳ５．０作统计分析。结果ＯＭＣ解剖变异包括中鼻甲反向弯曲（１３．９７％）、气化（３４．８５％）,钩突肥大（１９．３６％）、偏移（４５．２７％）,筛泡过度气化（３０．３０％）,鼻丘过度气化（０．７０％）,Ｈａｌｅｒ气房（１．００％）。ＯＭＣ解剖变异总出现率为８１．１４％;钩突、中鼻甲和筛泡的变异与慢性鼻窦炎的发病呈正相关（Ｐ＜０．０１）。结论ＯＭＣ解剖变异常见,且与慢性鼻窦炎密切相关,处理ＯＭＣ解剖变异是内窥镜鼻窦手术的一项重要内容。     

鼻窦解剖及其变异与鼻窦炎和手术的关系

目的 探讨鼻窦解剖及其变异对鼻窦炎和手术的治疗。方法 观察１００具颅骨、１０个尸头,复习７５０例鼻窦炎鼻窦冠状ＣＴ和１０００例内窥镜鼻窦手术记录,研究中鼻甲、钩突、上颌窦自然口和鼻囟门（含上颌窦骨性裂口）、前鼻颅底、筛蝶区域和鼻中隔的解剖学和影像解剖学,分析解剖、变异与鼻窦炎和手术的关系。结果 ①中鼻甲、钩突、前鼻颅底、筛蝶区域和鼻中隔均存在解剖变异;②中鼻甲、钩突和鼻中隔的变异在有鼻窦炎侧明显多     

筛窦及其邻近结构CT影像学研究

为内窥镜鼻窦手术提供影像学资料，观察了筛窥及其邻近结构的关系，对９名健康人筛窦进行了横断民支面连续ＣＴ扫描，对２０名观察人进行了横断加冠状层面扫描，每人平均扫描２２次，发现个体间筛窦及其与邻近组织的解剖结构存在着很大的变异，横断扫描可清晰地显示出后级筛窦或蝶窦与视神经管的解剖关系和颈内动脉与蝶窦的解剖关系。冠状扫描可详细地观察到窦口鼻道复合体的筛窦与眼眶，前颅底的解剖关系，鼻窦ＣＴ扫描对鼻窦炎病因     

CT扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义

目的 探讨窦口鼻道复合体解剖变异与慢性鼻窦炎的关系。分析其在内窥镜鼻窦手术中的重要性。方法 以２９７例（５９４例）冠状位鼻窦ＣＴ片材料研究中鼻甲、钩突、筛泡和处 的解剖变异及Ｈａｌｌｅｒ气房的影像特点,结合病史分析解剖变异与慢性鼻窦炎的关系,用ＳＰＳＳ５．０作统计分析。结果 ＯＭＣ解剖变异包括中鼻甲反向（１３．９７％）、气化（３４．８５％）,钩突肥大（１９．３６％）、移（４５．２７％）筛泡过度气化     

钩突增生肥大与前组鼻-鼻窦炎的关系探讨

目的　探讨钩突异常增生肥大与局限于前组的鼻-鼻窦炎的关系。方法　回顾分析5例有钩突增生伴慢性鼻-鼻窦炎的患者资料（2015～2018年），所有患者均有鼻 堵和脓涕症状，术前行相关检查以明确诊断。其中1例患者在3年前曾行CT扫描，显示钩突增生伴有鼻-鼻窦炎。患者均接受手术治疗，术后常规处理。结果　鼻内镜和CT扫描确定患者存在钩突向内下方倾斜、增生及鼻-鼻窦炎征象。排除手术禁忌后，全麻鼻内镜下切除钩突，3例症状重的患者同时开放鼻窦，而另外2例患者仅仅切除钩突并且扩大上颌窦口，保留筛漏斗后壁。随访3～32个月，所有患者恢复良好。结论　钩突角度改变及增生可以堵塞鼻窦引流引发范围局限的慢性鼻-鼻窦炎，鼻内镜手术是首选治疗。     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见，ＣＴ扫描的病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变，肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的     

Bony abnormalities of the paranasal sinuses in patients with Wegener's granulomatosis

Wegener's granulomatosis is a systemic vasculitis that can affect any organ system, but primarily involves the upper and lower respiratory tracts and the kidneys. Chronic sinusitis is a well-known clinical feature of the disease. Mucosal abnormalities of the nose and paranasal sinuses have been well-characterized and range from granulomatous lesions to diffuse mucosal thickening. In contrast, abnormalities of the underlying bone of the paranasal sinuses in this disease have not been well-described, and reports have been limited. To characterize bony abnormalities of the nose and paranasal sinuses in patients with Wegener's granulomatosis, we performed a retrospective review of all patients with Wegener's granulomatosis who underwent a sinus CT scan at our institution between 1989 and 1999. Nine patients were identified. A total of 22 distinct bony abnormalities were identified in 5 patients. Specific bony findings included bony erosion and destruction of the septum and turbinates; erosion of the ethmoid sinuses; neo-osteogenesis of the maxillary, frontal, and sphenoid sinuses; and complete bony obliteration of the maxillary, frontal, and sphenoid sinuses. Although these findings are suggestive of Wegener's granulomatosis, they are not pathognomonic. Bony changes on sinus CT scan may provide radiologic evidence of underlying Wegener's granulomatosis when clinical suspicion is high.     

Correlation between preoperative computed tomography and operative findings in functional endoscopic sinus surgery

This study investigated the correlation between diagnostic parameters and surgical findings in patients undergoing functional endoscopic sinus surgery (FESS) for chronic sinusitis. The parameters that were reviewed included the radiologist's report on the computed tomographic (CT) scan, the surgeon's reading of the CT scan, the operative findings, and the histopathology report. A retrospective analysis was conducted of 84 patients with chronic maxillary and ethmoid disease who were treated by the senior author (m.f.p.) over a 5-year period. The average concurrent agreement between the radiologist's CT report and the surgeon's CT interpretation was 92.26% for unilateral ethmoid disease, 83.73% for unilateral maxillary disease, 79.50% for bilateral ethmoid disease, and 64.28% for bilateral maxillary disease. The operative findings compared more closely with the surgeon's CT interpretation. The results of this study underscore the importance of clinical correlation in the surgical management of chronic sinus disease.     

单侧上颌窦占位性病变的CT诊断

目的探讨CT扫描对常见的单侧上颌窦占位性病变的诊断意义。方法回顾性总结2006年1月～2008年1月我科治疗的108例单侧上颌窦占位性病变患者的临床及影像学资料,并以组织病理学结果作为对照,对比分析CT扫描在单侧上颌窦占位性病变中的诊断意义。结果108例单侧上颌窦占位性病变中慢性上颌窦炎36例（33．3％）,上颌窦肿瘤32例（29．6％）,真菌性上颌窦炎19例（17．6％）,上颌窦囊肿14例（13．0％）,上颌窦后鼻孔息肉5例（4．6％）,上颌窦出血坏死性息肉及上颌窦嗜酸性肉芽肿各1例（0．9％）。大多数上颌窦占位性病变都具有其特有的临床及影像学表现,鼻窦CT扫描在单侧上颌窦占位性病变的术前诊断总体准确率为79．1％;其中上颌窦囊肿的术前诊断准确率为92．9％,慢性上颌窦炎为90．0％,上颌窦癌为80．0％,真菌性上颌窦炎为86．4％,鼻内翻性乳头瘤为50．0％。结论CT扫描对单侧上颌窦占位性病变的术前诊断有着十分重要的作用,大多数病变通过鼻窦CT检查可以作出初步的定位或定性诊断,并制定出合理的手术方案,最终确诊仍有赖于组织病理学检查。     

48例上颌窦恶性肿瘤的CT影像分析

目的分析总结上颌窦肿瘤性病变的临床症状和CT表现,探讨CT扫描在诊断上颌窦肿瘤中的价值及其与临床表现的关系,以提高对其临床特征的认识和CT的诊断价值。方法回顾性分析48例上颌窦肿瘤患者,全部患者均经CT扫描、鼻内镜检查及手术病理证实。结果临床特征表现为鼻塞98％,鼻分泌物增多72％,鼻出血65％,面部疼痛25％。CT示恶性肿瘤窦壁骨质呈溶骨性或筛孔样骨破坏,窦腔内均见软组织肿块,窦腔轮廓消失,软组织肿块突出腔外;良性肿瘤CT示肿块边界清楚,周围组织受压,呈膨胀性生长,未见明显的骨质破坏。结论上颌窦肿瘤缺乏临床特异性,而CT可以较好的显示病变程度、范围及与邻近结构的关系,可帮助定性,对制定手术方案有一定的价值。     

真菌性鼻窦炎CT的非特征性表现

目的：回顾分析真菌性鼻窦炎患者术前CT,提出非特征性的临床表现,以提高术前诊断的准确性。方法：术后病理诊断为真菌性鼻窦炎患者CT176例,术前均行鼻窦CT检查及鼻内镜检查。所有患者均经鼻内镜下鼻窦开放术,术中清理窦内病变并经病理检查证实为真菌感染。其中单纯蝶窦35例,单纯上颌窦84例,筛窦上颌窦49例,全组鼻窦3例,筛窦蝶窦5例。观察以上各组术前CT除病变钙化特征以外的非特征性表现。结果：本组患者共176例179侧,其中单侧173例,双侧3例（全组鼻窦感染）。CT的非特征性改变包括：窦内病变密度均匀增高,窦内病变密度不均匀增高,受累鼻窦内侧壁可有骨质吸收。病理证实179侧中,单纯蝶窦组CT病变钙化27侧,CT病变非特征性改变8侧,其中窦内均匀密度增高5侧,不均匀密度增高3侧;单纯上颌窦组病变钙化72侧,病变非特征性改变12侧,其中窦内均匀密度增高8侧,不均匀密度增高4侧,伴有骨质吸收5侧;筛窦上颌窦组病变钙化36侧,病变非特征性改变13侧,其中窦内均匀密度增高9侧,不均匀密度增高4侧,伴有骨质吸收6侧;全组鼻窦组病变钙化6侧;筛窦蝶窦组病变钙化5例。窦内病变钙化达81.56％。结论：窦内病变的钙化被视为真菌性鼻窦炎CT的特征性表现,但在临床工作中可观察到部分真菌性鼻窦炎术前CT的非特征性改变。当缺乏CT的特征性表现时,仅通过CT尚不能作出真菌性鼻窦炎的术前诊断,需其他检查手段来做鉴别诊断,甚至需经手术探查后的病理诊断来确诊。     

应用A型超声鼻窦诊断仪诊断鼻窦疾病

目的：了解Ａ型超声鼻窦诊断仪在鼻窦疾病诊断中的作用,方法：通过临床诊断和使用Ａ型超声鼻窦诊断仪,对１１５例鼻窦疾病患者和２２例正常人进行对比观察。结果：Ａ型超声检测与临床诊断的符合率,正常人为１００％,鼻窦疾病为６２．５％￣９２．０％,结论：Ａ型超声鼻窦诊断仪具有操作简便,价格便宜,可多次重复使用和相对人体无害的优点,能辅助诊断上颌窦,额窦疾病。     

Hipoplasia del seno maxilar

Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见、ＣＴ扫描和病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变、肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的ＴＮＭ分期及划定放疗野，为制定手术方案提供可靠参考。ＣＴ扫描较Ｘ线平片及多轨迹断层摄影具有明显的优越性，但鉴别诊断和定性诊断还应密切结合临床和病理。     

The importance of preoperative nasal endoscopy in patients with sinonasal disease

Functional endoscopic sinus surgery (FESS) has popularized the use of telescopes in sinus surgery and has emphasized the importance of nasal endoscopy and computed tomography (CT) in the evaluation of patients with diseases of the nose and paranasal sinuses. Variations in intranasal and sinus anatomy have been implicated in the etiology of chronic and recurrent sinusitis, and CT imaging has become an important diagnostic tool. Despite this, some patients present with symptoms and telescopic examination suggestive of sinonasal disease, yet demonstrate little abnormality on CT scan. The authors reviewed videoendoscopic and CT examinations of 100 consecutive patients with symptoms of sinus disease and found 9% of patients with abnormal telescopic examination in the context of negative CT findings. In those patients whose CT examinations were positive, telescopic nasal endoscopy was especially useful in delineating the type of soft tissue which obscured the area of the middle meatus. In those patients whose CT examinations were negative, telescopic examination demonstrated septal deflections, mucosal edema involving the middle meatus, as well as turbinate and adenoid hypertrophy. These findings demonstrate that telescopic nasal examination is an important diagnostic modality which often yields important information when evaluating patients with sinonasal disease.