鼻内镜下额窦开放术并置双管引流治疗慢性额窦炎

A clinic study on treatment of chronic frontal sinusitis with endoscopic surgery and permanent implantation of a place holder

目的：探讨鼻内镜下额窦开放并置管引流术疗效，以期找到一种提高慢性额窦炎治愈率的有效方法。方法：68例（130侧）慢性额窦炎行功能性鼻内镜额窦手术患者，随机分为3组，A组：鼻内镜下额窦开放术并置双管引流术；B组：鼻内镜下额窦开放术并置管引流、倍氯米松滴注；C组：鼻内镜下单纯额窦开放术。结果：3组患者平均随访18个月，鼻内镜下评价3组患者治愈率，A组为93％，B组为93％，C组为71％。B组与C组疗效比较，差异有统计学意义。未见严重手术并发症。结论：慢性额窦炎手术成功与否与术后额窦开口是否再次狭窄或者闭锁密切相关，鼻内镜下额窦开放术后持续6个月以上置双管引流可降低额窦口再次狭窄或者闭锁概率，而且置管保留6～12个月比较合适。我们建议这种方法应用于病情复杂的成人患者或者任何儿童患者。

Objective：To investigate the characteristics of chronic frontal sinusitis and to improve the clinical therapeutic efficacy. Method： Sixty-eight patients （130 sides） who underwent endoscopic frontal sinus surgery in our department were randomly divided into three groups： Group 1 included 23 patients （43 operations） underwent endonasal sinus surgery with the frontal sinus opened and drained by two pipes of silicone for 6 months. Group 2 included 24 patients （45 operations） treated as group 1 but added injection of beclomethasone （approximately 1 cc, 84 mcg/100 microliters）. Group 3 included 21 patients （42 operations） with only frontal sinus opened. Result：After an average follow-up of 18 months, the cute rate in group 1, group 2 and group 3 was 93%, 93% and 71% respectively. Conclusion：The ultimate success or failure of frontal sinus surgical procedures, whether they are endonasal or external, depends on the restenosis of the frontal sinus outflow tract or neo-ostium postoperatively. Long-term stenting for a period of several months will significantly reduce the possibility of restenosis. We recommend that this type of management be considered in difficult revision cases and before performing an external operation.