鼻腔结构与真菌性上颌炎关系的CT影像学研究

Computed tomographic analysis of the relationship between nasal structure and fungal maxillary inflammation

目的探讨真菌性上颌窦炎是否存在鼻腔解剖结构异常。方法分析102例真菌性上颌窦炎患者(单侧患病)的CT图像,观察鼻中隔、中鼻甲、钩突、筛泡的变异情况,有无Haller气房;测量冠状位钩突平面下鼻甲、钩突和中鼻甲所占该平面鼻腔面积比。结果鼻中隔偏曲87例(85.29%),其中51例宽敞侧发病,36例狭窄侧患病(P<0.05)。高位偏曲病例与低位偏曲相近。高位偏曲病例中,宽敞侧患病例数多于狭窄侧(P>0.05),但无统计学差异。低位偏曲病例中,两侧患病例数差异无统计学意义。患侧与健侧中鼻甲、钩突、筛泡变异及Haller气房出现情况患侧反向中鼻甲明显多于健侧,差异有统计学意义。钩突偏曲、Haller气房两侧差异有统计学意义,筛泡过度气化患侧较健侧多,但无统计学意义。冠状位钩突平面下鼻甲、钩突和中鼻甲所占该平面鼻腔面积比,两侧差异无统计学意义。结论鼻中隔偏曲及中鼻甲、钩突变异可能是真菌性上颌窦炎致病因素,真菌性上颌窦炎手术应同时处理相应变异结构。

Objective To investigate whether there is abnormal anatomy of the nasal cavity for fungal maxillary sinusi-tis（FMS）.Methods A total of 102 individuals （204 sides）of unilateral FMS were performed coronal plane CT scan-ning and measured the nasal structure including nasal septum,the middle turbinate,uncinate,ethmoid bulla and Haller cell.The CT images from 89 patients were used for image processing.The percentage of cross sectional area of inferior turbinate,uncinate process and middle turbinate （PCSA）in respective nasal cavity was calculated and compared. Results The percentage of nasal septal deviation（NSD）was 85.29%.In these patients with unilateral FMS diseases, 51 had wide side of nasal cavity,36 had narrow side（P 〈0.05）.The number of high NSD and low NSD were similar. In patients with high NSD,the number of FMS of wide side was more than that of narrow side（P 〉0.05）.The ana-tomic variation of ostiomeatal complex （OMC）was as fellows：diseased side was significantly different from the healthy side,with respect to middle concha reverse deviation,uncinate process deviation and Haller cell（P 〈0.05）,in-contrast,diseased side was insignificantly different from the healthy side,with respect to uncinate process hypertrophy, ethmoid bulla.About the PCSA,It had no significant differences between the two sides of the nasal cavity （P 〉0.05）. Conclusion As NSD,and anatomic variation of the middle turbinate and uncinate played an important role pathogene-sis of FMS.Therefore,while treating FMS,NSD,and antatomical variation of the middle turbinate and uncinate should be cleared at the same time.