复发性鼻窦炎的原因及修正性鼻内镜手术治疗

Causes and revision endoscopic sinus surgery for recurrent sinusitis

目的:探讨复发性鼻窦炎修正性鼻内镜手术的原因,总结其手术体会。方法:对1 6 8例(2 2 5侧)复发性鼻窦炎患者术前进行鼻内镜和鼻窦CT检查,均实施修正性鼻内镜手术治疗。结果:中鼻甲部分或完全缺失9 5例(1 2 1侧),上颌窦窦口狭窄阻塞5 1例(7 5侧),鼻腔粘连8 5例(1 1 7侧),钩突残留4 8例(5 7侧),筛窦骨质增生3 8例(6 5侧),鼻中隔偏曲2 5例。1 0 6例(1 3 4侧)痊愈,4 0例(5 6侧)好转,2 2例(3 5侧)无效。结论:病变残留、鼻腔粘连、窦口狭窄闭锁、钩突残留、筛窦骨质增生、鼻中隔偏曲是实施修正性手术的主要原因。修正性鼻内镜手术是治疗复发性鼻窦炎的有效方法。术前鼻窦CT检查、选择好具有定向定位作用的解剖参照点是手术成功的关键。

Objective To investigate the causes of revision endoscopic sinus surgery （RESS） , and to evaluate the clinical effect and experience of RESS in the patients with recurrent sinusitis. Methods Before the revision surgery, 168 patients （225 sides） with recurrent sinusitis were examed by CT scans and nasal endoscopy. All patients were operated by revision endoscopic sinus surgery. Results Among the 168 patients, 95 cases （121 sides） had incomplete middle turbinate,51 cases （75 sides ） had maxillary sinus ostium stenosis, 85 cases （117 sides ） had nasal cavity adhesion, 48 cases （57 sides） had uncinate process residual, 38 cases （65 sides） had ethmoid hyperostosis, and 25 cases had nasal septum deviation. One hundred and six patients （ 134 sides ） were cured, 40 patients （56 sides ） were improved, useful 22 patients （35 sides ） were ineffective. Conclusion The most common surgical causes of failures in endoscopic sinus surgery are the disease area remnant, nasal cavity adhesion, maxillary sinus ostium stenosis, uncinate process residual, ethmoid hyperostosis, and nasal septum deviation. Revision endoscopic sinus surgery is a useful way to treat recurrent sinusitis. Preoperative CT scan, correct choice of the anatomic marks of orientation and direction function are the key to operation successful.