不同手术入路治疗上颌窦真菌性鼻窦炎94例的临床分析

目的探讨不同手术入路治疗上颌窦真菌性鼻窦炎的临床疗效。方法回顾性分析94例上颌窦真菌性鼻窦炎患者的临床资料，分别采用3种手术径路，即柯一陆手术入路31例、鼻内镜上颌窦窦口开放入路33例、鼻内镜上颌窦窦口开放联合下鼻道开窗入路30例；比较不同术式的临床疗效。结果所有患者术后均随访12个月。其中采用柯-陆手术入路患者治愈率74．2％（23／31），5例出现面部麻木，无溢泪及鼻腔粘连等并发症；采用鼻内镜上颌窦窦口开放人路患者治愈率81．8％（27／33），7例患者出现鼻腔粘连，鼻内镜下直接分开后好转，无溢泪及面部麻木等症状；采用鼻内镜上颌窦窦口开放联合下鼻道开窗入路患者治愈率100％，5例患者出现鼻腔粘连，鼻内镜下直接分开后好转，无溢泪及面部麻木等并发症。结论鼻内镜上颌窦窦口开放联合下鼻道开窗入路是一种微创、安全、有效的治疗上颌窦真菌性鼻窦炎的手术方式。

Different surgical approaches for treatment of fungal maxillary sinusitis in 94 cases

Objective To explore the therapeutic effect of different surgical approaches for the treatment of fungal maxillary sinusitis. Methods Clinical data of 94 patients with fungal maxillary sinusitis was analyzed retrospectively. All patients were treated surgically. Three kinds of surgical approaches were adopted, including Caldwell-Luc surgery （n = 31 ）, endoscopic maxillary ostium surgery （n = 33 ） and endoscopic maxillary ostium surgery combined with inferior meatus fenestration （ n = 30 ）. The therapeutic effect was evaluated. Results All patients were followed up for 12 months postoperatively. The patients＇ curative ratio treated with Caldwell-Luc surgery is 74.2 % （23/31 ） , Five had facial numbness, none got epiphora and nasal adhesion. The patients＇ curative ratio treated with endoscopic maxillary ostium surgery is 81.8% （27/33） , 7 had nasal adhesion, none got epiphora and facial numbness. The patients＇ curative ratio treated with endoscopic maxillary ostium surgery combined with inferior meatus fenestration is 100 % , none recurred, and 5 had nasal adhesion. Conclusion Endoscopic maxillary ostium surgery combined with inferior meatus fenestration is a minimally invasive, safe and effective approach for the surgical treatment of fungal maxillary sinusitis