鼻内窥镜术后鼻腔粘连对疗效的影响

目的 :探讨鼻腔粘连对鼻窦内窥镜手术疗效的影响。方法 :应用Storz硬性鼻内窥镜 ,根据不同的病变部位 ,参照Messerklinger鼻内窥镜手术方法 ,行鼻内窥镜手术 84 5例 (15 5 8侧 ) ,术后定期随访 1年以上。结果 :治愈 12 80侧 ,总治愈率为 82 .2 %。其中Ⅰ型病例治愈率达 91%以上 ;Ⅱ型 1期和 2期分别为 98.9%和82 .8% ,3期为 75 .0 % ;Ⅲ型治愈率为 6 1.2 %。在 2 78侧无效病例中鼻腔粘连 15 1侧 ,占 5 4 .3%。结论 :鼻窦内窥镜术后鼻腔粘连以中鼻甲与其周围结构为主 ,导致鼻窦引流不畅 ,以致影响疗效 ,因此 ,减少术后局部粘连是提高手术疗效的关键。术中对中鼻甲的适当处理有助于减少术后粘连 ,提高手术效果

The effect of postoperative nasal cavity adhesion on the long-term results of endoscopic sinus surgery

OBJECTIVE: To observe the effect of postoperative nasal cavity adhesion on the long-term results of endoscopic sinus surgery. METHOD: From October, 1994 to September 1998, 845 patients with sinusitis and polyps under gone endoscopic sinus surgery in our hospital. There were 132 cases with unilateral lesion and 713 cases with bilateral lesion, total of 1558 lateral lesions. All the lesions were classified according to the Haikou (1997) typing and staging system of sinusitis. All the cases were follow-up over 1 year. RESULT: According to the Haikou cure criterion, 1280 sides were cured one year after operation. The total cure rate was 82.2%. The cure rates of type I, type II stage 1, type II stage 2, type II stage 3 and type III patients were 91%, 98.9%, 82.8%, 75% and 61.2% respectively. Total of 278 sides were failure. 151 sides of them had nasal cavity adhesion (54.3%). The types of the nasal cavity adhesion were middle turbinate adhesion to the lateral wall of the middle meatus, to the inferior turbinate and to the nasal septum. CONCLUSION: The postoperative nasal cavity adhesion was the main factor which can cause the failure of the endoscopic sinus surgery. The middle turbinate played an important role in preventing nasal cavity adhesion.