上颌窦分隔及其临床意义

Significance of maxillary septa in endoscopic nasal surgery

目的探讨上颌窦分隔对鼻内镜手术的意义。方法2006年5月至12月对592例成年鼻部疾病患者行水平位鼻窦CT扫描，并行冠状位或矢状位重建，在医学数据影像及网络（digital imaging and communication in medicine，DICOM）数据格式下由观察者反复调整窗宽、窗位至达到上颌窦分隔最佳分辨率为准，在计算机上观察分析CT图像。结果592例鼻部疾病患者的影像资料显示，19例（3．2％）存在上颌窦冠状位完全分隔，其中单侧16例（2．7％），双侧3例（0．5％）。在上颌窦冠状位完全分隔变异的19例患者中7例为慢性鼻．鼻窦炎患者，发生率为36．8％。分隔前方的上颌窦腔引流至中鼻道，后方窦腔引流至上鼻道，分隔前后可独立或共同发病。结论观察上颌窦冠状位完全分隔，首选水平位鼻窦CT，鼻内镜手术时宜采取上鼻道径路处理分隔后方窦腔及翼腭窝病变。

Objective To explore the significance of maxillary septa in endoscopic nasal surgery. Methods Five hundred and ninety-two patients （both inpatients and outpatients ） encountered in our hospital during May 2006 and December 2006 were included in this study. Computer tomography images of sinuses from scheduled axial and coronal or saggital scan were analyzed by using digital imaging and communication in medicine. Results The incidence of the coronal complete maxillary septa was 3.2% （19/592） , 16 cases on bilateral sides and 3 cases on unilateral side. The cavity anterior to the coronal complete maxillary septa drainaged into the middle meatus, whereas the antrum posterior drainaged into the superior meatus. The incidence of chronic sinusitis was 36. 8% （7/19） in patients with coronal complete maxillary septa. Conclusions The optimum method to observe maxillary coronal septa was axial CT. The diseases in the cavity posterior to the coronal complete maxillary septa and in pterygopalatine fossa should be operated via the superior meatus.