经鼻内镜中下鼻道联合扩大入路治疗上颌窦后鼻孔息肉

Clinical experience on the treatment of antrochoanal polyp under nasal endoscopy by expand road of the combined middle-inferior meatus

目的探讨经鼻内镜中下鼻道联合扩大入路治疗上颌窦后鼻孔息肉(ACP)的临床疗效。方法回顾性分析山东省枣庄矿业集团中心医院耳鼻咽喉科自2011年12月至2014年11月收治的31例上颌窦后鼻孔息肉患者的临床资料,根据手术方式分为A组、B组。A组14例经鼻内镜常规开放上颌窦口和息肉切除,在角度镜下手术;B组17例在A组的基础上骨折内移下鼻甲,联合下鼻道开窗扩大入路内镜直视下切除息肉和上颌窦病变。结果所有患者鼻塞、打鼾、鼻出血、头痛及耳闷症状消失。A组术后病情部分控制4例(28.6%),随访中复发病情未控制5例(35.7%)后纳入B组;B组术后病情部分控制2例(11.8%),随访中未见复发病例,病情控制率为88.2%(15/17)。病情控制率组间差异均有统计学意义(P<0.05)。结论两组方法治疗ACP均有良好临床效果,B组因视野更清晰、操作更方便、术后利于引流和复查、病情控制率高、术后复发率低,更具优势。

Objective To explore the clinical effect of treating antrochoanalpolyp（ ACP） under nasal endoscopy by expand road of the combined middle-inferior meatus. Methods The clinical data of 31 patients with ACP treated at department of otorhinolaryngology of the central hospital of Zaozhuang Mining Group Co. Ltd. from December 2011 to November 2014 were retrospectively analyzed. They were divided into tw o groups（ labelled as group A and B）,14 in group A were resected through the classical wide middle meatalantrostomy by angle nasal endoscopy and 17 in group B were treated by the same method except that fractured and displacement of the inferior turbinate and combined with broadening inferior meatus and excised polyp and maxillary sinus disease under the nasal endoscope view. Results The follow ing symptoms,such as rhinobyon,snoring,epistaxis,headache,ear stuffy disappeared in all patients. Four patients in group A were controlled portionly（ 28. 6%）,five had recurrence（ 35. 7%） and then were included in group B.Tw o patients in group B controlled portionly（ 11. 8%） and no relapse were found in group B. The control ratio was88. 2%（ 15/17）. Conclusion The therapeutic methods used in group A and B both featured good clinical effects. The method used in group B is more advantageous with clearer view,more convenient operation,easier drainage and reexamination after surgery,better control ratio and low er recurrence rate.