鼻内镜下经前囟钩突切除术治疗慢性鼻-鼻窦炎疗效观察

Therapeutic effect of uncinectomy through the anterior nasal fontanelle in endoscopic sinus surgery

目的观察经前囟钩突切除术治疗慢性鼻-鼻窦炎的疗效及术后上颌窦黏液纤毛传输功能的恢复情况。方法收集2012年5月至9月行手术治疗的慢性鼻-鼻窦炎不伴鼻息肉患者60例的临床资料,其中研究组31例(52侧),对照组29例(50侧)。采用功能性鼻内镜的常规术式,在切除钩突开放上颌窦口时,研究组采用经前囟钩突切除术,对照组采用Messerklinger术式。根据术后1年时的VAS评分、Lund-Kennedy评分、黏液纤毛传输时间(MTT)评价两组疗效。结果术后1年研究组VAS评分为0.93±0.69,对照组为1.91±0.99(t=-3.21,P<0.01);研究组Lund-Kennedy评分为0.89±0.67,对照组为2.03±0.91(t=-3.76,P<0.01);两组窦口开放良好率差异无统计学意义(研究组为100%,对照组为94%,P>0.05)。研究组52侧(100%)的活性炭均从上颌窦口下缘流出;对照组47侧中,有8侧(17.02%)活性炭颗粒滞留于窦腔,不能从窦口排出,15侧(38.46%)从窦口下缘排出,20侧(51.28%)从后缘和(或)上缘排出,4侧(10.25%)从前缘排出。研究组平均黏液纤毛传输时间为(21.87±4.76)min,对照组为(34.21±3.96)min(P<0.01)。结论采用经前囟钩突切除术治疗慢性鼻-鼻窦炎有利于上颌窦纤毛传输功能的恢复,较传统的M esserklinger术式效果更好。

Objective To observe the therapeutic effect of uncinectomy through the anterior nasal fontanelle in endo-scopic sinus surgery.Methods Sixty patients diagnosed as chronic ethmomaxillary sinusitis were divided into two groups.The research group had 31 patients（52 sides）and the control group had 29 patients（50 sides）.The research group received uncinectomy via the anterior nasal fontanelle while the control group received the traditional uncinectomy by Messerklinger.VAS score,Lund-Kennedy score,mucociliary transport time（MTT）and the activated charcoal powder method were used to observe the therapeutic effects.Results Twelve months after the operation,the VAS score,Lund-Kennedy score and the MTT of the two groups were statistically different （P 〈0.05）.Activated charcoal powder was all drained out from the inferior edge in the research group,while there was powder stacked in the sinuses in 8 sides of the control group.Conclusion Uncinectomy through the anterior nasal fontanelle is a more effective method for chronic si-nusitis and can achieve better recovery of the mucocilliary transport system than the uncinectomy by Messerklinger does.