慢性鼻窦炎术后复发额窦炎患者额隐窝气房残留情况的影像及再手术结果分析

目的 通过分析鼻内镜手术后复发额窦炎患者的电子计算机断层显像(computed tomography, CT),探究额隐窝气房残留情况以及再次手术后的治疗效果。 方法 回顾性分析2017年1月至2019年12月于北京大学人民医院耳鼻咽喉科住院行手术治疗的慢性鼻窦炎术后复发额窦炎的患者64例,统计患者术前及术后1年的鼻部症状视觉模拟量表(Visual Analog Scales, VAS)评分。根据国际额隐窝气房分型(The International Frontal Sinus Anatomy Classification,IFAC)的标准对患者鼻窦CT进行分析,对各类额隐窝气房的残留情况进行统计,同时统计各额窦的Lund-Mackay评分(LM值),使用SPSS 27.0软件对患者的一般信息及额隐窝气房残留情况与额窦LM值的关系进行统计学分析,分析患者术前和术后VAS评分变化有无统计学意义。 结果 共分析额窦121侧,各种额隐窝气房均有残留,气房残留情况为:鼻丘气房共108侧(89.3%)、鼻丘上气房共11侧(9.1%)、鼻丘上额气房共19侧(15.7%)、筛泡上气房共20侧(16.5%)、筛泡上额气房共13侧(10.7%)、眶上筛房共40侧(33.1%)、额窦间隔气房共49侧(40.5%)、1型额窦间隔气房共15侧(12.4%)、2型额窦间隔气房共34侧(28.1%),其中额窦间隔气房和眶上筛房相对更容易残留。术后1年随访人数为54例,患者术前及术后1年鼻部症状VAS评分平均值分别为6.6±1.4和2.8±1.4。共7例行Draf Ⅲ型手术,术前及术后1年鼻部症状VAS评分平均值分别为7.6±1.1和3.9±0.9。统计学分析显示,先前的手术次数(P=0.016, OR=2.639)与额窦LM值增长相关, 患者术前及术后VAS评分差异有统计学意义(t=19.656, P<0.01)。 结论 复发的鼻窦炎患者中部分额隐窝气房残留比例较高,这可能是导致术后复发的危险因素,在手术中应彻底清除额隐窝气房,通畅引流,预防复发。

Analysis of radiological results of residual frontal recess cells and the efficacy of revision surgery in patients with recurrent frontal sinusitis after sinusotomy

Objective To investigate the situation of residual frontal recess cells and efficacy of revision surgery by analyzing the computed tomographic (CT) results of the patients with recurrent frontal sinusitis after endoscopic sinus surgery. Methods A retrospective analysis of 64 chronic rhinosinusitis patients with recurrent frontal sinusitis after surgery who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People's Hospital from January 2017 to December 2019 was performed. The results of Visual Analog Scales (VAS) of nasal symptoms of the patients before and after surgery were collected. The patients' CT were analyzed according to The International Frontal Sinus Anatomy Classification (IFAC) to record the prevalence of every type of the residual frontal recess cells. The Lund-Mackay (LM) scores of all frontal sinuses were also recorded. The relationship of the patient's general information and the situation of residual frontal recess cells between the frontal sinus LM sores was analyzed statistically by using SPSS 27.0. The VAS scores of patients before and after surgery were analyzed. Results In this study 121 sides frontal sinuses were evolved. All kinds of frontal recess cells were found in the patients: agger nasi cell in 108 sides (89.3%), supra agger cell in 11 sides (9.1%), supra agger cell in 19 sides (15.7%), supra bulla cell in 20 sides (16.5%), supra bulla frontal cell in 13 sides (10.7%), supraorbital ethmoid cell in 40 sides (33.1%), frontal septal cell in 49 sides (40.5%), type 1 frontal septal cell in 15 sides (12.4%), and type 2 frontal septal cell in 34 sided (28.1%). Besides, the frontal septal cells and the supraorbital ethmoid cells were more prone to remaining. There were 54 patients followed up 1 year after surgery. The average VAS scores of the patients before and 1 year after surgery were 6.6±1.4 and 2.8±1.4, respectively. A total of 7 patients underwent Draf Ⅲ surgery. The mean VAS scores of total symptoms before and 1 year after surgery were 7.6±1.1 and 3.9±0.9, respectively. In statistical analysis, t the number of previous surgery (P=0.016, OR=2.639) was correlated with the increase of the frontal sinus LM sores. There were statistical differences between the VAS scores of the patients before and after surgery (t=19.656, P<0.01). Conclusions The proportion of some residual frontal recess cells were high in chronic rhinosinusitis patients after surgery. It may increase the risk of recurrence of frontal sinusitis. For the patients with recurrent frontal sinusitis, appropriate surgical skills should be measured. During the surgery, the frontal recess cells should be completely removed and ensure the drainage pathway smoothly to prevent recurrence.