两种不同的手术方式治疗真菌性鼻-鼻窦炎

Two ways of surgery for fungal rhinosinusitis

目的：比较鼻内镜下上颌窦开放术和鼻内镜下上颌窦开放术＋柯-陆（Caldwell—Luc）手术治疗真菌性鼻-鼻窦炎的疗效。方法：将30例随机分成两组，A组15例，采用鼻内镜下上颌窦开放术（简称开放式手术）；B组15例，采用开放术联合柯-陆手术（简称联合式手术），术后用1％H2O2及生理盐水冲洗，不用抗真菌药。结果：随访1～3年，开放式手术组15例中治愈5例，术腔完全上皮化，症状消退；好转4例，局部有迁延性炎症，少量脓性引流，开口缩小；复发6例，窦口闭塞，窦腔内再次出现真菌样沉积物堆积。联合式手术组15例中治愈12例，好转3例，无真菌性炎症复发，两组比较差异有统计学意义（P〈0．01）。两种术式均无并发症发生。结论：本研究结果表明，采用尖牙窝、上颌窦自然开口双径路治疗真菌性上颌窦炎的优势在于清除病变彻底，使鼻窦建立足够的通气引流通道，彻底改变了真菌生存的低氧环境，且能保存上颌窦黏膜的正常生理功能，可避免传统方法引起的狭窄、闭锁、引流不畅以及上颌窦通气不良、功能恢复不佳等缺点。此术式创伤小，能真正达到根治、微创目的。

Objective： To compare the response of endoscopic maxillary sinus surgery and endoscopic maxillary sinus surgery plus Caldwell-Luc surgery for fungal rhinosinusitis. Methods： Thirty patients were divided into two groups at random. Fifteen patients （group A） were applied the endoscopic maxillary sinus surgery, and the other fifteen （group B） were applied endoscopic maxillary sinus surgery plus Caldwell-Luc surgery. After surgery they were rinsed with l%H20z and normal saline and did not take antifungal drugs. Results： During a follow-up of 1-3 years, 5 patients of group A healed, and their surgery antnmas became epithelialized completely and symptoms disappeared; 4 got better, and there was inflammation and purulence in some part and the hatch became smaller; 6 recrudesced, and the pore of nasal sinuses was obstructed. There was much different sediment again in nasal cavity; 12 patients of group B healed, 3 got better without recrudescence of mycosis inflammation. There were obvious differences between the two groups （ P 〈 0.01）, and no complication occurred in beth of these two groups. Conclusions： This research indicates that applying canine fossa and maxillary sinus can destroy the abnormal tissues completely and make a big enough channel for aeration and drainage. Under this condition, the low oxygen environment is changed and the normal physiological function of maxillary sinus mucosa is ensured, and furthermore, large trauma is avoided.