内窥镜鼻窦手术保留中鼻甲的可能性及其临床意义

Possibility and clinical significance of reservation middle turbinate in endoscopic sinus surgery

目的探讨鼻窦炎和／或鼻息肉内窥镜鼻窦手术中保留中鼻甲的可能性及其临床意义。方法①应用鼻内窥镜和扫描电镜分别观察２０例手术前、后中鼻甲形态和粘膜表面超微结构；②应用鼻内窥镜观察中鼻甲保留组和中鼻甲切除组各６０例的术后中隔鼻甲和筛窦术腔闭塞的发生率。结果①肿胀型、息肉样变型和息肉形成型的中鼻甲形态和粘膜表面超微结构术后呈良性转归；②中鼻甲保留组和中鼻甲切除组中隔鼻甲出现率分别为１３．３％和５８．３％，筛窦术腔闭塞率分别为１８．３％和５１．７％（Ｐ＜０．０１）。结论内窥镜鼻窦手术中经适当处理保留的中鼻甲有恢复正常的趋向，并对术后术腔恢复和提高临床治愈率有积极作用。

Objective To study the possibility and significance of reservation of the middle turbinate in endoscopic sinus surgery for sinusitis and/or nasal polyps. Methods (1)The morphology and mucosal ultrastructure of middle turbinate were observed preoperatively and postoperatively by nasal endoscopy and scanning electron microscopy in 20 cases; (2)The proportions of the septal turbinate formation and the closure of ethmoid sinus cavity were investigated postoperatively by nasal endoscopy in 60 cases with middle turbinate reserved and 60 cases with middle turbinate resected. Results (1)The morphology and mucosal ultrastructures of reserved middle turbinate were observed to have recovered postoperatively; (2)The proportions of the septal formation and the closure of ethmoid sinus cavity in the groups with middle turbinates reserved and resected were 13.3%, 18.3% and 58.3%, 51.7% , respectively ( P <0.01). Conclusion It is possible that the structure of reserved middle turbinate may return to normal and it is important to save the middle turbinates to improve clinical cure rate.