经鼻内镜微创手术治疗慢性额窦炎的探讨

目的　慢性额窦炎的鼻内镜术后复发在很大程度上是由于额隐窝和额窦口处理不当所致。本研究的目的在于探讨慢性额窦炎的临床病理解剖特点及其相应的手术处理原则 ,以期提高治疗效果。方法　经鼻内镜微创手术治疗慢性额窦炎 5 8例 (96侧 ) ,根据额窦口和额隐窝的不同病变和解剖特征 ,采用不同的方法处理局部病变。结果　术中可见所有病例均有不同程度的中鼻道阻塞。额窦口和额隐窝情况 :局部没有气房阻塞 ,仅有肿胀黏膜、息肉样变黏膜或者息肉阻塞者 38侧(39 6 % ) ;额隐窝被发育过度的鼻丘气房、筛泡气房或终末气房挤压导致额窦引流通道狭窄者 34侧(35 4 % ) ;额隐窝完全被发育过度、呈蛋壳样气房阻塞者为 15侧 (15 6 % ) ;额窦自然口狭窄者 9侧(9 4 % )。额窦内病变情况 :积脓、黏膜充血肿胀 18侧 ;黏膜肿胀、充血 2 1侧 ,黏膜充血 4 9侧 ;黏膜未见明显病变 8侧。随访 6～ 2 0个月 ,其中治愈 6 9侧 (71 9% ) ,好转 17侧 (17 7% ) ,复发 10侧(10 4 % ) ,未见严重手术并发症。结论　窦口鼻道复合体和额隐窝的阻塞是慢性额窦炎的主要原因 ,额隐窝和额窦口阻塞有 4种病理状态 ,应根据不同的病变采取不同的手术方式 ,手术疗效有待进一步提高

Transnasal endoscopic frontal surgery for chronic frontal sinusitis

Objective The recurrence of chronic frontal sinusitis after endoscopic surgery is mainly due to the mismanagement of frontal recess and frontal sinus orifice The aim of this study is to investigate the characteristics of chronic frontal sinusitis and to advance the clinical therapeutic efficacy Methods Different methods were used to manage different local diseases in frontal sinus orifice or frontal recess in 58 cases ( 96 sides) with chronic frontal sinusitis by nasal endoscopic surgery Results Different degree of middle meatal obstruction was seen in all cases at operation The situation of frontal sinus ostium and frontal recess was as follows: 38 sides obstructed by swollen mucosa, polypoid mucosa or polyps, no cell obstruction at frontal sinus orifice;34 cases constricted by over development of agger nasi cells, ethmoid bulla or terminal cell at frontal recess; 15 cases obstructed completely by over development cells at frontal recess; osteal stenosis at frontal sinus orifice in 9 cases The situation in frontal sinus was as follows: pus accumulation in 18 sides, mucosal swellen in 21 sides, mucosal congestion in 49 sides, no obvious mucosal diseases in 8 cases Follow up for 6 20 months showed that 69 sides (71 9%) were cured, 17 sides (17 7%) better and 10 cases (10 4%) recurrent Conclusion Obstruction of ostiomeatal complex and frontal recess is the main causes of chronic sinusitis There are four pathologic states in obstruction of frontal recess and frontal ostium Different operative methods should be taken according to different pathological changes The operative effects is still needed to improve