36例筛前神经综合征病因探究及其治疗对策

A clinical investigation on the etiology and therapeutic procedures of anterior ethmoid nerve syndrome-a report of 54 cases

目的探讨筛前神经综合征病因、临床特征和相应的治疗措施. 方法应用鼻内镜和螺旋CT检查患者,找出病因,明确诊断.根据不同的病因分别采用经鼻内镜行鼻中隔黏膜下矫正术、中鼻甲外移、中鼻甲外侧部分切除、钩突切除术和鼻窦开放术等. 结果鼻内窥镜检查和CT扫描结果显示,36例中鼻中隔高位偏曲19例,合并有鼻窦炎7例,中鼻甲肥大18例,中甲气化10例,下部向内偏移7例,黏膜肥厚和增生8例,未发现明显的解剖学变异及病因的3例.手术后临床效果:显效33例(91.7%),有效3例(8.3%),总有效率100%.术后随访0.5～2年,有3例复发,复发率8.3%,其中2例为术后鼻腔粘连,经松解后症状消失,1例因合并有神经衰弱拒绝再治疗而失败. 结论应用鼻内镜结合CT扫描技术可显著提高筛前神经综合征诊断水平,手术方式根据不同的病因而实施.

Objective To investigate the associated causal abnormal changes in local anatomy of nasal cavity with anterior ethmoid nerve syndrome （AENS）and to expolre effective therapies for this syndrome. Methods Fifty-four cases with clinically diagnosed AENS were included in this study. They were given nasal endoscopy at first to evaluate if there were any causal abnormal changes in anatomy of nasal cavity,and then,CT scanning was made among them to obtain image data of nasal strueture. After these procedures,the findings got in this way were analyzed carefully to determine the causal morphological abnormalities in nasal cavity associated with AENS and specific surgical therapy was taken to correct such abnormalities in nasal cavity based on this analysis. All the cases were followed up for 0.5 to 2 years following the surgical therapy. Results Among thses cases,29 were found with upper septum deviation, 11 with hypertrophic uneinate process accompanying with sinusitis,27 with middle turbinate hypertrophy, 15 with middle turbinate pneumatization, 10 with lower middle turbinate deviation inwards due to ethmoid hyperpneumatization, 12 with proliferated hypertrophic mucosa in middle turbinate,and 6 with membranous atresia in the apcrturs maxillaries. Following the surgical therapy,49 cases （90. 7 %）were shown significantly effective and 5 （9.3 % ）were effective, all with their symptoms much inmproved. During the period of following up, only found were 5 cases （9. 3%）with their condition reoccurred. 4 out of them found with synechia nasal. Conclusions Nasal endoscopy combined with CT scanning can significantly improve thediagnostie efficacy for the causal morphological abnormalities in nasal cavity associated with AENS and to result in better therapeutic effects on this syndrome.