鼻窦胆固醇肉芽肿24例

Twenty four cases of cholesterol granuloma of the paranasal sinuses

目的探讨鼻窦胆固醇肉芽肿患者的病因、发病机理以及治疗方法。方法回顾性总结分析1996年3月至2003年3月经手术和病理证实的24例鼻窦胆固醇肉芽肿患者的临床资料。结果24例患者中,术前诊断为慢性鼻窦炎10例,鼻窦黏液囊肿8例,鼻息肉或出血坏死性鼻息肉5例,考虑可能为胆固醇肉芽肿者仅1例。主要症状有鼻塞(20/24)、鼻漏(18/24)、嗅觉减退(10/24)、头痛(7/24)、眼眶痛(5/24)、复视(2/24)等。鼻窦CT及MRI提示为慢性鼻窦炎、鼻窦囊肿以及鼻息肉和(或)黏膜息肉样变。所有病例均因保守治疗无效而采取外科手术治疗,即鼻内镜术或CaldwellLuc术,仅1例行鼻侧切开术。23例手术效果良好,随访1年以上无复发;仅1例CaldwellLuc术后2年复发,再次行鼻内镜术,术后3年未复发。结论鼻窦胆固醇肉芽肿的病因主要有三:含气腔通气受阻、引流障碍、含气腔出血。鼻窦胆固醇肉芽肿似乎与鼻窦慢性炎性疾病关系密切,尤其是鼻窦黏液囊肿。术式的选择应根据病变范围和程度来决定,其原则是彻底清除病变,保持鼻窦通畅引流。

Objective To investigate the etiololgy and pathogenesis of cholesterol granuloma of the paranasal sinuses and the treatment for the disease. Methods Twenty four cases of cholesterol granuloma of the paranasal sinuses treated in our hospital during the period from March 1996 to March 2003 were restrospectively analysed. All cases were verified by surgery and pathology. Results Of all cases, 10 cases were diagnosed as chronic sinusitis, 8 cases as nasal sinus cyst, and 5 cases as nasal polyp before operation, only 1 case was considered as cholesterol granuloma. The main symptoms were nasal obstruction (20/24),rhinorrhea (18/24),dysosmia (10/24), headache(7/24), pain around the eye(5/24),double vision(2/24),et al . Different surgical approaches were selected depending upon different pathological changes. Good results were obtained in 23 cases and postoperative follow-up for at least one year showed no recurrence. Only one case received revision nasal endoscopic surgery two years after Caldwell-Luc operation because of recurrence, and remained symptom-free for three years. Conclusions The pathogenesis of cholesterol granuloma includes obstruction of ventilation and drainage and blooding in sinuses. Cholesterol granuloma of the paranasal sinuses seems to have a close relation with chronic sinusitis, especially sinus mucocele. The surgical approach depends upon the location, extension, and severity of the lesion. The principle of surgery is to eliminate the pathological focus and create an adequate drainage.