鼻内窥镜术上颌窦自然开口的处理

目的探讨内窥镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法配对研究５６例双侧鼻窦炎、鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分别为９２．９％和８０．４％（随访６个月时）。回顾性观察５１例施ＣａｌｄｗｅｌＬｕｃ术的患者，下鼻道造口的术后开放率仅为４０．６％。分析３８张单侧鼻窦炎或鼻息肉的鼻窦ＣＴ片，测量对照侧与病变侧的上颌窦口膜样部的上下径和前后径，差异无显著性。病变侧上颌窦口周围的中鼻甲气化、增生及钩突偏曲、筛泡骨性增生等解剖结构异常的发生率明显高于对照侧（Ｐ＜０．０５）。结论鼻内窥镜下处理上颌窦自然开口的关键是窦口周围的解剖异常因素。

Ostium of maxillary sinus in endoscopic sinus surgery

Objective To determine the clinical significance and operative method of maxillary sinus ostium in the treatment of chronic sinusitis and nasal polyps. Methods Fifty six patients (112 sides) undergone endoscopic sinus surgery were studied. Results The patency rates of the maxillary ostia in patients with enlarged and unchanged maxillary ostia were 92.9% and 80.4% respectively. Fifty one patients (64 sides) undergone Caldwell Luc operations were retrospectively studied. The patency rate of inferior antrostomy was 40.6% . CT scans of the sinuses of 38 cases with unilateral sinisitis or nasal polyps were reviewed. The scaled values of the maxillary hiatus on CT images showed no difference between the normal group and the diseased group. Pneumatization and proliferation of middle turbinate and bent uncinate process were the most common anatomic variation in the diseased group. Conclusion The results suggest that management of anatomic variations surrounding the ostia is very important in the treatment of maxillary ostium.