慢性鼻-鼻窦炎CT筛窦分型组织病理学与预后相关性

Histolopathologic features of CT scan typing of chronic rhinosinusitis and relation with prognosis

目的观察评价慢性鼻-鼻窦炎（chronic rhinosinusitis，CRS）CT筛窦分型的组织病理学特点及其与预后的关系。方法回顾性分析112例CRS患者，按术前轴位鼻窦CT进行筛窦分型；观察筛窦标本骨质病理学改变，并对筛窦骨质重塑活性进行评分；采用Lund和Kennedy鼻内镜评分评价预后；分析不同CT筛窦分型间筛窦骨质组织病理评分和鼻内镜评分的差异以及骨质组织病理评分和鼻内镜评分的相关性。结果Ⅲ型（骨质增生型）25例，占22．3％；Ⅱ型（空泡型）44例，占39．3％；Ⅰ型（蜂窝型）43例，占38．4％。III型骨组织病理改变程度和术后随访鼻内镜评分分别与Ⅰ型和Ⅱ型间差异有统计学意义（P值分别为0．01，0．02）。CRS患者的筛窦骨组织病理评分和术后鼻内镜评分有明显相关性（x2=9．78，P=0．002）。结论CRS的cT筛窦分型具有相应组织病理学基础；新骨形成或重塑是反映鼻窦疾病严重程度的重要指标，筛窦骨组织病变程度能够反映患者术后预后情况；CT筛窦分型对鼻内镜外科手术疗效的预测具有现实应用意义。

Objective To evaluate the histopathologic changes of the ethmoid bone in CT scan typing of chronic rhinosinusitis （ CRS）, and investigate relations with outcomes of endoscopic surgery. Methods One hundred and twelve random CRS patients undergoing endoscopic sinus surgery at Tongren hospital were prospectively evaluated. According to the preoperative CT scan, these patients were divided into three groups of CT scan typing. The bony changes and bone remodeling of ethmoid bone were graded and relations with outcomes of endoscopic surgery were investigated. Results The CT scan typing results of ethmoid sinus of CRS were as followed： 22. 3% （ typeⅢ ）, 39. 3% （ type Ⅱ ）, and 38.4% （ type Ⅰ ）. Comparison of bone remodeling and postoperative endoscopic scores between the three groups revealed a significant difference （ P = 0. 01, P = 0. 02 ）. A trend toward more advanced bone remodeling grade in association with a higher postoperative endoscopic scores was identified, with a statistically significant correlation. Conclusion The Chinese CT scan typing of CRS has its pathological basis and can a useful method to predict the surgical outcomes of CRS. The new bone formation or bony tissue remodeling of sinus often represents pathogenesis of CRS and implicates the prognosis of sinus surgery.