鼻内镜下真菌性上颌窦炎的术式选择及疗效评估

目的鼻内镜下采用3种不同入路手术治疗真菌性上颌窦炎并对其临床疗效进行观察,为临床个体化治疗真菌性上颌窦炎提供参考。方法以该院2016年1月-2017年12月收治的84例非侵袭性真菌性上颌窦炎的手术患者作为研究对象,术前常规行鼻内镜检查和鼻窦CT检查,根据病变的部位范围选择手术方式,将患者分为3组:A组30例,行鼻腔外侧壁保留黏膜瓣的下鼻道入路;B组20例,行上颌窦自然口入路手术;C组34例,行联合入路手术。结果 84例患者均治愈,血涕、面部胀痛、头痛或鼻腔异味症状逐步消失,鼻内镜复查见术腔愈合好,上皮化良好,各鼻道无异常分泌物,术腔病变无残留,无鼻腔粘连、前鼻孔狭窄、鼻泪管损伤或其他并发症。术后6个月复查鼻窦CT无病变残留,下鼻道黏膜瓣愈合良好。结论术前根据病变部位及范围选择手术方式个体化治疗真菌性上颌窦炎,能充分暴露上颌窦窦腔,有效清除病变,避免损伤鼻腔鼻窦的正常结构,达到既微创又能彻底清除病灶的目的。

Clinical evaluation of curative effect and selection of surgical methods for fungal maxillary sinusitis with endoscope

Abstract: Objective To investigate the clinical efficacy of three different approaches of endoscopic sinus surgery for fungal maxillary sinusitis, and then provide reference for the clinical individualized treatment of fungal maxillary sinusitis. Methods 84 patients with non-invasive fungal maxillary sinusitis from January 2016 to December 2017 were enrolled in the study. Routine nasal endoscopy and sinus CT scanning were performed before surgery, the patients were divided into three groups according to the location of the lesion. Group A: 30 cases were treated with inferior meatus pathways which left the lateral wall of nasal cacavity mucosal flap. Group B: 30 cases cases of nasal endoscopy combined with opening maxillary sinus orifice. Group C: 34 cases were treated with the above two ways. Results 84 cases were cured, all of the patients were free from disease postoperatively. All the patients were followed up for more than half a year. Bloody snot, facial pain, headache and ozena gradually disappeared. Nasal endoscopy showed that cavity and epithelialization are recovered well, no abnormal secretions in the nasal tract or residual lesions in the surgical cavity, no nasal adhesion or anterior nasal stenosis, nasolacrimal duct injury or other complications. Nasal endoscopy and sinus CT scanning was performed after surgery to evaluate cavity condition, there is residual disease. Conclusions Preoperative treatment of fungal maxillary sinusitis according to the location and extent of the lesion can fully expose the maxillary sinus cavity, effectively remove the lesions, ensure the normal physiological function of maxillary sinus mucosa, and avoid the normal injury of the nasal cavity and sinus to really achieve radical minimally invasive purpose.