慢性上颌窦炎鼻内镜下开窗方式的选择与疗效观察

目的观察鼻内镜下上颌窦开放术治疗慢性上颌窦炎,不同开窗方式的选择与疗效分析。方法 56例单侧慢性筛、上颌窦炎伴鼻息肉患者,术前Lund-Mackay CT评分,CT评分=2者纳入研究对象,术中随机分为A组28例、B组28例,分别行中鼻道开窗和中下鼻道联合开窗,以鼻腔鼻窦结局测试-20（sino-nasal outcome test-20,SNOT-20）量表中文版、Lund-Kennedy评分及糖精试验黏液纤毛传输时间（mucociliary transport time,MTT）对比术后疗效,另外,用亚甲蓝染色观察黏液纤毛传输途径。结果术后6个月时,A、B两组SNOT评分、Lund-Kennedy评分及MTT值差异均有统计学意义（P〈0.05）;50例亚甲蓝从上颌窦口下缘流出,5例亚甲蓝从上颌窦口前缘流出。结论①对于慢性上颌窦炎Lund-Mackay CT评分=2的病例,行中、下鼻道联合开窗可取得更好的疗效;②上颌窦口下缘黏膜是黏液纤毛传输的重要途径,对上颌窦的引流起着极为重要的作用。

Choices of fenestration in endoscopic sinus surgery to treat chronic maxillary sinusitis and their clinical observation

OBJECTIVE To observe the therapeutic effect of different fenestration of chronic maxillary sinus under nasal endoscopy.METHODS Fifty-six patients （56 sides） which were diagnosed unilateral chronic ethmomaxillary sinusitis with polyps were observed. According to Lund-Mackay CT score,the patients whose CT score before operation equaled 2 were enrolled as research subjects.All the cases were randomly divided into A and B.Fenestration of middle nasal meatus were done in the group A patients,while fenestration of both middle nasal meatus and inferior nasal meatus were done in the group B patients.SNOT-20 score,Lund-Kennedy score and MTT were adopted to observe therapeutic effect.In addition,methylene blue-stained was used to observe mucociliary transmission path.RESULTS Six months after the operation,The SNOT-20 score,Lund-Kennedy score and MTT of group A and B were statistically different （P0.05）.Methylene blue were drained out from opening of maxillary sinus,by inferior edge in 50 cases,and by front edge in the other 5 cases.CONCLUSION 1.For patients with chronic maxillary sinusitis whose CT score is 2 before operation,simultaneous inferior and middle nasal meatus fenestration could obtain a better effect.2.The inferior edge of aperture maxillaris is an important path for mucociliary transmission,which is extremely important for the drainage of maxillary sinus.