后鼻孔息肉的临床类型和诊断及鼻内镜手术

目的探讨后鼻孔息肉的临床类型、诊断及鼻内镜手术的方法和效果。方法总结1998年1月至2005年12月收治的34例后鼻孔息肉患者的临床资料，分析其发病方式、来源、临床表现、与鼻窦的关系以及鼻内镜手术技巧和疗效。结果①18例发病源于鼻窦囊肿或息肉，其中上颌窦17例，后筛窦1例；②5例发病分别源于鼻囟门或蝶筛隐窝、蝶窦口黏膜，同侧上颌窦或蝶窦积脓或黏膜水肿；③11例发病分别源于中鼻甲、钩突、嗅沟鼻中隔和筛泡前壁黏膜，邻近的鼻窦正常；④全部病例均行鼻内镜手术切除后鼻孔息肉及相应鼻窦开放，术后无复发。结论①建议诊断后鼻孔息肉应分为窦内型、鼻窦阻塞型和单纯型三种临床类型，遵循以临床类型为依据的手术原则，选择合理的术式和范围；②鼻内镜和鼻一鼻窦CT检查可以在术前明确后鼻孔息肉的诊断和临床类型；③鼻内镜手术治疗后鼻孔息肉准确、微创，彻底切除息肉蒂基部，防止复发。

Clinical types, diagnosis and endoscopic surgery of choanal polyps

OBJECTIVE: To investigate the clinical type, diagnosis and prognosis of endoscopic surgery of choanal polyp (CP). METHODS: Thirty four cases of CP treated between January 1998 to December 2005 were retrospectively reviewed. Pathogenesis, original sites, clinical manifestation, its relationship with paranasal sinuses, methods and effects of endoscopic surgery on CP were analysed. RESULTS: (1) In this study, 18 cases originated from the cyst or polyp in sinus (among them, 17 from maxillary sinus, 1 from posterior ethmoid sinus). (2) Five cases from nasal fontaneles or sphenoethmoidal recess, mucosa of sphenoidal ostium, accompanied with homolateral empyema or mucosal edema of maxillary sinus or sphenoid sinus. (3) Eleven cases from middle turbinate, uncinate process, olfactory cleft, nasal septum and anterior wall mucosa of ethmoidal sinus with normal adjacent sinus. (4) All cases were treated by complete excision of the CP and open sinus procedures of the affected ones with intranasal endoscopic approach. No recurrence was observed during the follow-up. CONCLUSIONS: (1) We propose to divide the CP into three clinical types: intrasinus, sinus obstruction and simple ones. We also suggest to abide by the operation principal based on clinical types and to select rational methods and extent of operation. (2) Definite diagnosis and clinical type can be obtained by endoscopic examination and CT scan of sinus before operation. (3) Endoscopic surgery is precise and mini-invasive in treatment of CP and complete removal of CP root can effectively reduces the recurrence.