鼻内窥镜微创手术治疗牙源性上颌窦炎的临床观察

目的探讨慢性牙源性上颌窦炎应用鼻内窥镜手术的治疗效果。方法回顾性分析41例慢性牙源性上颌窦炎患者的临床资料，其中采用柯-陆氏手术治疗24例，采用鼻内窥镜下联合进路中鼻道上颌窦造口术17例，比较两种方法的治疗效果。结果采用柯一陆氏术式者面颊肿胀、面颊麻木、上牙槽酸痛的发生率分别是100．0％、37．5％、33.3％，鼻内窥镜手术组未见上述表现；柯-陆氏术式第一次手术拔牙率37．5％(9／24)，5例再次手术者均拔除患牙，总拔牙率58．3％(14．／24)，鼻内窥镜手术组拔牙率35．3％(6／17)，11例经根管治疗的牙齿保存良好；柯-陆氏手术组3年内复发率为37．5％(9／24)，而鼻内窥镜手术组术后3～6个月鼻道窦口复合体完全恢复通畅，随访1～3年未见复发。结论鼻内窥镜微创手术能最大限度减少上颌窦粘膜及骨质的损伤，利于术后恢复，在保留鼻窦正常生理功能、保存牙齿及减少复发率等方面明显优于传统的柯一陆氏手术。

The Clinical Observation of Mini-trauma Surgery with Nasendoscopy in Patients with Chronic Odontogenic Maxillary Sinusitis

Objective To explore the therapeutic efficacy of surgery with nasendoscopy on chronic odontogenic maxillary sinuitis compared with Caldwell-Luc operation. Methods The clinical data of 41 surgical patients with chronic odontogenic sinuitis of highmore antrum were retrospectively analysed, including 24 cases undergone Caldwell-Luc operation (Caldwell-Luc group) and 17 cases antrostomy in highmore antrum via middle nasal meatus with nasendoscopy (nasendoscopy group). Results The incidence rates of cheek swelling, cheek numbness, soreness in maxillary teeth were 100%, 37.5%, 33.3% respectively in Caldwell-Luc group, and no symptom above in nasendoscopy group. The incidence rate of exelcymosis in Caldwell-Luc group was 37.5%(9/24), but 5 cases needed re-operation underwent exelcymosis. and the total rate of exelcymosis was 58.3%(14/24); the incidence rate of exelcymosis in nasendoscopy group was 35.3%(6/17), and teeth were preserved well by root canal therapy in 11 cases in the group. The recurrence rate within 3 years was 37.5%(9/24) in Caldwell-Luc group. With the complex of apertures of nasal meatus recovered to be unobstructed after 3 to 6 months, no recurrence was found after 1- to 3-year follow-up visit in nasendoscopy group. Conclusion Mini-trauma surgery with nasendoscopy can utmost reduce trauma to mucous membrane of maxillary sinus. There were more therapeutic advantages in patients with antrostomy in highmore antrum via middle nasal meatus with nasendoscopy than those with Caldwell-Luc operation in the tooth preservation and prevention of recurrence.