慢性上颌窦炎鼻内镜下开窗方式的选择与疗效观察

Choices of fenestration in endoscopic sinus surgery to treat chronic maxillary sinusitis and their clinical observation

目的观察鼻内镜下上颌窦开放术治疗慢性上颌窦炎,不同开窗方式的选择与疗效分析。方法 56例单侧慢性筛、上颌窦炎伴鼻息肉患者,术前Lund-Mackay CT评分,CT评分=2者纳入研究对象,术中随机分为A组28例、B组28例,分别行中鼻道开窗和中下鼻道联合开窗,以鼻腔鼻窦结局测试-20(sino-nasal outcome test-20,SNOT-20)量表中文版、Lund-Kennedy评分及糖精试验黏液纤毛传输时间(mucociliary transport time,MTT)对比术后疗效,另外,用亚甲蓝染色观察黏液纤毛传输途径。结果术后6个月时,A、B两组SNOT评分、Lund-Kennedy评分及MTT值差异均有统计学意义(P<0.05);50例亚甲蓝从上颌窦口下缘流出,5例亚甲蓝从上颌窦口前缘流出。结论①对于慢性上颌窦炎Lund-Mackay CT评分=2的病例,行中、下鼻道联合开窗可取得更好的疗效;②上颌窦口下缘黏膜是黏液纤毛传输的重要途径,对上颌窦的引流起着极为重要的作用。

OBJECTIVE To observe the therapeutic effect of different fenestration of chronic maxillary sinus under nasal endoscopy.METHODS Fifty-six patients （56 sides） which were diagnosed unilateral chronic ethmomaxillary sinusitis with polyps were observed. According to Lund-Mackay CT score,the patients whose CT score before operation equaled 2 were enrolled as research subjects.All the cases were randomly divided into A and B.Fenestration of middle nasal meatus were done in the group A patients,while fenestration of both middle nasal meatus and inferior nasal meatus were done in the group B patients.SNOT-20 score,Lund-Kennedy score and MTT were adopted to observe therapeutic effect.In addition,methylene blue-stained was used to observe mucociliary transmission path.RESULTS Six months after the operation,The SNOT-20 score,Lund-Kennedy score and MTT of group A and B were statistically different （P0.05）.Methylene blue were drained out from opening of maxillary sinus,by inferior edge in 50 cases,and by front edge in the other 5 cases.CONCLUSION 1.For patients with chronic maxillary sinusitis whose CT score is 2 before operation,simultaneous inferior and middle nasal meatus fenestration could obtain a better effect.2.The inferior edge of aperture maxillaris is an important path for mucociliary transmission,which is extremely important for the drainage of maxillary sinus.