飞行人员鼻窦囊肿的诊治和医学鉴定

Diagnosis,treatment and medical evaluation of cyst in nasal sinus of pilots

目的探讨飞行人员鼻窦囊肿(CNS)的发生机制、临床诊治和医学鉴定原则。方法总结飞行人员CNS资料46份,对其进行分类。结果黏膜囊肿44例,黏液囊肿和含牙囊肿各1例。上颌窦囊肿39例,蝶窦囊肿3例,筛窦囊肿、额窦囊肿、上颌窦+额窦囊肿、上颌窦+蝶窦囊肿各1例。I类(地面有症状或体检时发现)37例,II类(地面无症状,飞行中有继发性气压伤表现)9例。手术治疗16例,观察30例。飞行合格41例,永久停飞5例。结论飞行中气压变化的反复刺激可能是飞行人员CNS的发生机制之一,II类CNS是医学停飞的重要原因。

Objective To sum up the principles of diagnosis, treatment and medical evaluation of cyst in nasal sinus （CNS） of pilots and its mechanism. Methods Data about CNS obtained from 46 pilots were summarized and classified. Results Mucosa cyst, mucous cyst, and dentigerous cyst were found in 44, 1, and 1 pilots, respectively. Maxillary sinus cyst, sphenoid sinus cyst, ethmoid sinus cyst, frontal sinus cyst, and sphenoid sinus cyst were found in 39, 3, 1, 1, 1 and 1 pilots, respectively. Class Ⅰ of CNS with symptoms on ground or detected at health examination was found in 37 pilots, and class Ⅱ of CNS with no symptoms on ground but with symptoms of secondary barotraumas in flying was found in 9 pilots. Sixteen pilots underwent surgery and 30 were observed with no treatment. Forty-one pilots were qualified to continue their flying and 5 were permanently grounded （4 had class Ⅱ of CNS）. Conclusion Barotrauma due to repeated rising and falling during flying may be one of the mechanisms underlying CNS in pilots. Class Ⅱ of CNS is an important cause of medical ground.