1000例鼻窦内窥镜手术疗效分析

Treatmentoutcomeof1000casesofendoscopicsinussurgery

为了评价鼻内窥镜鼻窦手术的疗效，对１９９１年１１月～１９９５年１月间实施鼻内窥镜手术并完成术后随访的１０００例慢性鼻窦炎、鼻息肉患者进行了疗效分析。１０００例有前期手术史７５４例（６４．８％），最多２５次，平均３．７次。术前ＣＴ检查采用冠状位及水平位骨窗扫描。治愈率为８４．０％。其中Ｉ期治愈５５７例（５５．７％）；延期治愈２８３例（２８．３％）；迁延炎症１６０例（１６．０％）。临床分期Ⅰ～Ⅳ期分别为９．９％、２１．０％、１５．０％，和５４．１％。手术并发症１８例。全部病例中一次接受双侧鼻窦开放手术者占９５０例。同期行鼻中隔矫正术者２７６例。术中采用中鼻道上颌窦开窗术者７８５例（１２５６侧）。术中出血量１０～１８００ｍｌ，平均１８０ｍｌ。同时对中鼻甲和鼻中隔偏曲的处理，术前病情评估，术中出血控制，手术并发症、影响治愈率因素等问题进行了讨论。

Toassessthetreatmentoutcomeofendoscopicsinussurgery(ESS),1000patientswithchronicsinusitisandnasalpolyptreatedbetweenNovember1991andJanuary1995wereinclud-edinthisstudy.Amongthem,754patients(64.8%)hadpreviousoperationsfrom1to25timeswithanaverageof3.7.BeforeESS,axialandcoronalCTscanswereobtained(windowwidth:1000HU,windowlevel:+90HU;sectionthickness:2mmwith12to16sections).PatientswithclinicalstagesfromItoIVwere9.9%,21.0%,15.0%and54.1%respectively.BilateralESSwasperformedin95%patients,septoplastyin27.6%,middlemeatalantrostomyin78.5%.Theclinicalcureratewas84.0%.557patientswereconsideredasprimaryhealing,283patientsdelayedhealingand160pa-tientshadpersistentinflammation.Complicationswerenotedin18patients.BleedingduringESSvariedfrom10to1800ml(average180ml).Theindications,preoperativeevaluation,controlofbleeding,preventionofcomplicationsandprognosiswerediscussedindetail.Thearticleindicatedthattheimportantfactorstoincreasethecureratearepostoperativefolow-upandsystematictreat-ment.