黏膜下钩突骨质切除治疗单纯型慢性鼻窦炎疗效观察

The clinical effect of submucous resection of uncinate bone in the simple type chronic sinusitis patients

目的观察黏膜下钩突骨质切除治疗单纯型慢性鼻窦炎的疗效。方法将2009年5月～2010年4月该科住院具有行FESS手术指征的单纯性鼻窦炎患者,通过评估,筛选出可以行黏膜下钩突骨质切除的患者,按照随机的方法分为两组,试验组采用黏膜下钩突骨质切除手术方式,对照组采用传统的钩突切除术,随诊至术后6个月,观察术后患者症状缓解程度、术腔上皮化情况,进行组间比较。结果两组患者有效率均为100%;试验组治愈率为96%,对照组为91.3%,两组患者治愈率差异无显著性(P=0.478);试验组手术方式可以加快术腔上皮化的进程(P=0.026),并且随着时间的推移,鼻腔黏膜的上皮化时间趋于一致。试验组上皮化时间为(5.96±0.87)周,对照组上皮化时间为(6.75±1.21)周,两组患者上皮化时间差异无显著性(P=0.423);术后两组评分总分分别为(4.30±0.67)、(5.70±0.96)分,试验组较对照组较症状缓解明显(P=0.023)。结论钩突骨质切除治疗单纯型慢性鼻窦炎,在去除钩突对中鼻道的阻塞因素的同时充分保留了钩突黏膜,缩短了上皮化的时间,缓解患者症状更明显,更符合功能性手术理念,值得在临床推广应用。

[Objective] To observe and evaluate the clinical effect of submucous resection of uncinate bone in the simple type chronic sinusitis patients.[Methods] The simple type chronic sinusitis patients with FESS operation indications were collected and evaluated,the patients that could undergo the submucous resection of uncinate bone were selected from May.2009~Apr.2010,then were divided randomly into two groups,the treatment group were treated with the submucous resection of uncinate bone,while the control group were treated with the traditional uncinatectomy.After surgery,these patients were followed up 6 months with endoscopy,and then evaluated the situation of clinical symptoms improvement and the procession recovery of postoperative mucous,and the topical situation of operative cavity.Comparisons were taken between the situations before and after surgery.[Results] The two groups effective rate were 100.0%.The cure rate of treatment group was 96%,otherwise the cure rate of control group was 91.3%,there was no significant difference（P =0.478）.The total process of epithelization of treatment group was faster than control group（P =0.026）,The epithelization time of two groups were（5.96±0.87） weeks and（5.96±0.87） weeks respectively,there was no significant difference（P =0.026）,the post-operative VAS score of two groups were（4.30±0.67） and（5.70±0.96） respectively,the score of the treatment group decreased than the control group.[Conclusion] The submucous resection of uncinate bone could remove the blocking factor of the middle nasal meatusm,fully retained uncinate process mucosa,and be more functional.This surgery could relief the symptom,shorten the time of epithelium,and is more in line with the concept of functional surgery.