保留或重塑钩突的内镜鼻窦手术

Preservation or reconstruction of uncinate process in endoscopic sinus surgery

目的探索新的内镜鼻窦手术方式,使之更加适应鼻腔、鼻窦生理学特征,更加符合结构重建的内镜鼻安手术理论。方法 30例慢性鼻窦炎患者作为临床观察对象,行经鼻内镜鼻窦手术。每例患者的左侧采用保留或重塑钩突形态的鼻窦开放手术作为实验组,右侧用经典鼻内镜手术作为对照,手术后按照主观症状恢复情况和鼻内镜下局部状态综合评价疗效,重点观察保留或重塑钩突之后,上述结构能否恢复正常形态、是否会影响相关鼻窦的引流、以及病变鼻窦是否可以得到与经典鼻内镜手术相同的近期转归。结果患者术后6个月时开始随访,初步结果表明:①保留或重塑的钩突能够维持原有或正常解剖学形态,不影响相关鼻安的引流;②开放的鼻窦和窦口全部隐藏于钩突保护之下不能直视;③各鼻窦引流通畅、双侧鼻窦黏膜恢复的时间与状态一致,未发生因保留钩突而影响局部形态学转归的现象。④手术后6～12个月,患者对双侧症状改善没有自我感觉方面的差异。结论①保留或重塑钩突的鼻窦开放术维护或重建了鼻腔原有结构,可对开放的鼻窦具有保护并防止吸入气流的直接冲击的作用;②实验组的术腔形态可获得与对照组相同的近期转归效果;③该手术方式与手术技术尚处于探索阶段,目前只适合钩突结构和形态基本正常或无明显改变的慢性鼻窦炎病例,其手术适应证的确定还需要技术的不断成熟,手术经验的进一步积累以及远期疗效资料的积累来证实。

Objective To explore a new approach for paranasal sinus by using transnasal endoscope, which would be more coincided with the physiological characteristics of nasal cavity and nasal sinuses, and meet the requirement of structure reconstruction in functional nasal endoscopic surgery. Methods Thirty patients with chronic rhinosinusitis （CRS） were selected as clinical subjects. For each patient, the left side was selected to preserve or reconstruct the shape of uncinate process by nasal sinus opening surgery, the right was received traditional functional endoscopic sinus surgery （FESS） as control. The curative effect after surgery was evaluated according to the restoration of symptoms and local state under endoscope. The most important was to observe whether the above structure could restore to normal after preserving or reconstructing the shape of uncinate process and affect the drainage of related sinuses, and whether diseased sinuses could gain the similar near prognosis to that after FESS. Results The patients were followed up after 6 months since the performance of surgery. （1）Uncinate process maintained original or normal anatomical shape and did not affect the drainage of sinuses.（2）Opened nasal sinuses and orises were covered by uncinate process. （3）All sinuses drained well, and the restoration time and state of beth sides of sinus mucosa were the same, and no local morphology was affected by preserving uncinate process. Conclusions （1）Sinus opening surgery by preserving or reconstructing uncinate process could maintain or reconstruct the original nasal cavity structure, and could protect the opened sinuses and avoid the attack of direct airflow. （2）6-12 months after surgery, no difference was found as to the self sensation about the improvement of symptoms, and the shape of operational cavity in experimental group was similar to that in control group. （3）This surgical approach was under exploration, and it was only suitable for CRS patients with basic normal shape of uncinate process, and the surgical indications would be gained depending on the advancement of technology and accumulation of experience and the data obtained in future curative effect.