上颌窦保存性手术术后窦黏膜腔体积变化的定量测量

Quantitative measurements of the volume changes of maxillary sinus mucous cavity after conservative surgery

目的:对上颌窦保存性手术前、后窦黏膜腔体积进行定量测量,探讨保存上颌窦黏膜及骨壁完整的重要性。方法:对2011年12月-2014年12月行上颌窦保存性手术且术后影像学随访期至少3个月的19例患者,经Mimics计算健侧上颌窦和患侧上颌窦术后窦黏膜腔体积,应用SPSS17.0软件包统计健侧(V_0)、患侧术前(V_1)、患侧术后(V_2)上颌窦黏膜腔体积,健、患侧术前体积差值(△V)、患侧手术前、后体积差值(△V_1)和健患侧术后体积差值(△V_2)的均值、标准差。对V_1、V_2以及V_0、V_2分别进行配对t检验,分析患侧窦黏膜腔体积是否比术前明显增大,是否可恢复到正常水平。根据△V_1大小分为低、中、高3级,通过χ~2检验或Spearman秩相关分析,比较△V_1分级与性别、年龄、病种、V_1、△V的相关性,Logistic回归分析方程分析影响△V_1分级的因素。结果:随访期为3~31个月(平均14.4月)。V_0为(15752.65±7735.62)mm^3,V_1为(8888.57±8557.76)mm^3,V_2为(12950.32±8847.97)mm^3,△V为(6864.08±4419.37)mm^3,△V_1为(4061.74±4303.71)mm^3。V_2比V_1显著增加,但与V_0仍有显著差异。△V_1分级与性别和年龄无关,与病种和△V有关。结论:保存上颌窦黏膜及骨壁有利于上颌窦黏膜腔体积的恢复。术前病变突入上颌窦体积越大,术后患侧体积增加越大:牙源性角化囊性瘤和根尖囊肿术后体积增加程度较含牙囊肿大。

PURPOSE：To make a quantitative analysis of the volume changes of maxillary sinus mucous cavity and explore the importance of sinus mucosa and bony wall preservation.METHODS：Patients who underwent conservative sinus surgery and had at least 3 months of follow-up were collected from 2011.12 to 2014.12.With the assistance of Mimics,the preoperative and postoperative volume of ipsilateral maxillary sinus and volume of contralateral sinus were measured.SPSS 17.0 software package was applied to calculate mean value and standard deviation of volume of contralateral sinus cavity（V_0）,preoperative ipsilateral sinus cavity（V_1）,postoperative ipsilateral sinus cavity（V_2）,and difference value of contralateral and preoperative ipsilateral sinus cavity（△V）,preoperative and postoperative ipsilateral sinus cavity（△V_1）,and contralateral and postoperative ipsilateral sinus cavity（△V_2）.Paired t test was performed between V_1,V_2 and V_0,V_2.According to the size,△V_1 was divided into low,medium and high grades,and correlation between △V_1grading and gender,age,disease entity,V_1 and △V were evaluated by Chi square test or Spearman rank correlation.Logistic regression equation was used to analyze the influential factors of △V_1 grading.RESULTS：A total of 19 cases were enrolled in the study and the follow-up period was 3-31 months（mean 14.4 months）.V_2 was significantly increased than V_1 but there was still significant difference between V_2 and V_0.△V_1 grading was related to disease entity and △V.CONCLUSIONS：Preservation of maxillary sinus mucosa and bony wall can facilitate sinus mucosa cavity volume recovery.The larger size of volume of preoperative lesions intruding into the sinus,the more postoperative sinus volume increased.The volume increased more in patients with odontogenic keratocyst and radicular cyst compared with dentigerous cyst.