鼻内镜下不同方法处理上颌窦自然口疗效观察

Efficacy of different treatment methods under endoscope for the ostium of maxillary sinus

目的探讨经鼻内镜手术中不同方法处理上颌窦自然口对术后窦口开放及纤毛功能的影响。方法采用自身配对80例双侧上颌窦病变相近,术中见双上颌窦均有病变的Ⅰ型2期或3期慢性鼻窦炎患者进行研究。对比一侧切除钩突后仅处理上颌窦自然口周围病变,不行上颌窦自然口扩大,另一侧常规开放扩大上颌窦自然口。术后观察不同时期窦口开放及纤毛功能情况。结果术后6个月发现对比侧窦口开放率为97.5%,常规侧窦口开放率为77.5%;对比侧蓝染率为87.5%,常规侧蓝染率为62.5%,差异均有统计学意义(P<0.01)。结论鼻窦手术中对于Ⅰ型慢性鼻窦炎患者,术中重点是处理自然口周围病变,尽可能地减少术中损伤,防止术后窦口闭锁,最大限度保留自然口的正常引流。

Objective To evaluate the influence of the nasal endoscopic surgery with different methods for the ostium of the maxillary sinus on postoperative sinus opening and function of cilia. Methods Eighty cases of type Ⅰ in stage two or three bilateral maxillary sinusitis were enrolled in this study. In all patients, only the maxillary sinus lesions around the ostium were removed at one side after the resection of uncinate process, and the ostium of maxillary sinus at eontralateral side was expanded. The sinuses opening and cilia＇ s function were observed in different period after the surgery. Results The opening rate of maxillary sinus was 97.5% at the side without expanding the ostium after 6 months, and 77.5% at the contralateral side. The blue stain rate at the side without expanding the ostium was 87.5 %, and the blue stain rate at the other side was 62.5 %, and there was significant difference （P 〈 0.01 ）. Conclu- sion Endoscopic surgery for the type Ⅰ chronic maxillary sinusitis should focus on dealing with the lesions around the natural ostium, and reduce the injury as much as possible, which is helpful for avoiding the sinus atresia after operation and keeping the normal drain- age of the maxillary sinus.