鼻窦传统手术的转归

An Endoscopic and Tomographic Evaluation of Patients with Sinusitis after Caldwell-Luc Operation

目的：通过询问病史、ＣＴ扫描及鼻内窥镜检查观察上颌窦根治术后鼻窦炎复发患者的面部症状、鼻窦骨及软组织，从病理生理学角度分析探讨上颌窦根治术后局部组织病理学变化对术后转归的影响，并以此观察分析作为基础，建议合理掌握传统手术及鼻内窥镜手术适应证范围。方法：对２８７例（３８２侧）既往曾行上颌窦根治术（Ｃａｌｄｗｅｌｌ－Ｌｕｃ）后鼻息肉复发患者进行再手术前鼻窦ＣＴ扫描，并观察前期手术后患者面部感觉，上颌窦骨质增生及窦腔容积缩小程度及中鼻道或下鼻道自然口或人工开窗口情况。结果：术后出现慢性鼻窦炎症状的全部被观察患者，２７．５％出现面部症状，４３．６％出现骨质增生引起窦腔容积变小甚至消失。此外还出现上颌窦自然口或下鼻道开窗口完全瘢痕闭锁。结论：有必要重新对各种传统鼻窦手术的适应证重新定义，对手术适应证的概念进行调整修正，以达到在彻底清除病变的基础上减低并发症、控制复发率。

To evaluate the outcome of surgery using objective methods in patients with sinusitis after Caldwell-Luc (CWL) operation and advocate the necessities of limiting the scope of indications for CWL operation while enlarging that of endoscopic sinus sugery (ESS). Methods: Strengthening on postoperative complaining, the shrinkage of the sinus cavity owning to the metaplastic ossification and the status of both the natural maxilla ostium and antrostomy at inferior meatus, 287 (382 sides) cases of postoperative CWL patients were boserved on the results of sinus endoscopic examination and CT scan. Results: The series of cases with the typical symptoms coming from the CWL operation, 27. 5% of the cases developed paresthesia, 43. 6% different degree of shrinkage or even completely closure of the mxillary cavity by CT scan. Conclusion:The indications of traditional and modern technique of nasal surgery should be changed from development of theory.