下鼻道泪后开窗上颌窦手术47例临床分析

目的：探讨经鼻内镜下鼻道泪后开窗处理上颌窦病变的疗效。方法：对47例上颌窦病变的患者，采取在鼻内镜鼻窦手术基础上进行下鼻道泪后开窗，经下鼻道窗和扩大的自然窦口对上颌窦息肉、内翻性乳头状瘤、侵袭性鼻窦真菌病等病变进行清理。结果：47例患者上颌窦腔清洁，上颌窦窦口引流好，黏膜转归良好，中鼻道引流好，无囊泡水肿等黏膜病变。仅2例（4．25％）下鼻道窗口约2个月闭锁，1年后上颌窦腔清洁，无病灶复发。结论：经鼻内镜下鼻道泪后开窗联合扩大的自然窦口完全满足处理上颌窦良性病变的需要，同时保留下鼻道窗可在术后起到机械性重力引流作用，在鼻腔鼻窦黏膜纤毛运输系统功能修复前尤为重要。

The clinic analysis of 47 cases with endoscopic maxillary sinus surgery by lateral wall fenestration of the inferior nasal meatus

Objective：To evaluate the efficacy of the endoscopic maxillary sinus surgery by lateral wall fenestration of the inferior nasal meatus（EMSLWF）. Method：Based on traditional Messerklinger sinus surgery, we treat the 47 eases with maxillary sinus disorder by lateral wall fenestration of the inferior nasal meatus, removing the polyp, hemangioma, inverting papilloma, invasive sinus aspergillosis etc, trans-apertura maxillary and intranasal window. Result：The maxillary sinuses of the 47 cases are clean. Mucosa are well recovered and drained of the mid dle and inferior nasal meatus. We did not find the nasal mucosa pathological changes like the fluid-filled blisters or edema etc. The intranasal windows are closed in only 2 eases（4.250~） after about 2 months. The maxillary sinuses of all cases are still clean with no recurrence of primary diseases. Conclusion： The EMSLWF is well suitable for dealing with the maxillary sinus diseases. Meanwhile, before the function of the nasal mueociliary transportation system recovered in the perioperative period, the gravity drainage effection should be kept by the intranasal window in the inferior nasal meatus. The EMSLWF is worthy of more attention in clinic.