鼻内镜下泪前隐窝入路联合上颌窦开放治疗非侵袭性真菌性上颌窦炎的临床研究

Clinical study on combining the approach of frontal recess of tears and the patency of maxillary sinus under nasal endoscope in treatment of non-invasive fungal maxillary sinusitis

目的研究鼻内镜下泪前隐窝入路联合上颌窦开放治疗非侵袭性真菌性上颌窦炎的临床疗效。方法选择2011年4月-2015年4月在我院接受手术治疗的非侵袭性真菌性上颌炎患者60例,所有患者窦腔内均存在密度较高软组织影或斑片状钙化影或密度不均点状影。将上述患者依据随机数字表法分为实验组（n=30）与对照组（n=30）,两组一般资料差异无统计学意义（P〉0.05）。实验组患者均行鼻内镜下泪前隐窝入路联合上颌窦开放治疗,对照组所有患者均行上颌窦根治术。术后两组患者均以生理盐水反复冲洗窦腔。观察统计所有患者临床疗效及术后病理检查结果。结果经治疗,实验组治疗总有效率（93.33%）高于对照组（70.00%）,差异有统计学意义（P〈0.05）。经术后病理检查,实验组曲霉菌感染率（83.33%）,毛霉菌感染率（10.00%）,假丝酵母菌感染率（6.67%）与对照组曲霉菌感染率（90.00%）,毛霉菌感染率（3.33%）,假丝酵母菌感染率（6.67%）差异无统计学意义（P〉0.05）。结论鼻内镜下泪前隐窝入路联合上颌窦开放治疗治疗非侵袭性真菌性上颌窦炎具有疗效显著、创伤小、无显著手术后遗症等优点,值得应用于临床。

Objective To study the clinical therapeutic efficacy of combining the approach of frontal recess of tears and the patency of maxillary sinus under nasal endoscope in treatment of non-invasive fungal maxillary sinusitis. Methods 60 patients with non-invasive fungal maxillary sinusitis receiving surgical treatment in our hospital during the period from April 2011 to April 2015 were selected as the study objects. Among all patients, high-density soft tissue shadow or patch-like calcification shadow or uneven-density spot shadow were found in the sinus cavity. The patients were divided into experimental group and control group according to random digital method with 30 cases in each. There was no significant difference between the two groups（P〉0.05）. Patients in experimental group were treated with combining the approach of frontal recess of tears and the patency of maxillary sinus under nasal endoscope. Patients in control group were treated with radical maxillary sinus surgery. After operation, all the patients in the two groups were treated with physiological saline repeatedly flushed sinus. The clinical therapeutic efficacy of all patients and post-operative pathological examination results of the two groups were oberved and summed up. Results After treatment, the total effective rate of the experimental group（93.33%） was higher than that of the control group（70.00%）, and the difference was statistically significant（P〈0.05）. After postoperative pathological examination, fungal infection rate test suite（83.33%）, mucor infection rate（10.00%）, candida infection rate（6.67%） had no statistically significant difference on fungal infection rate（90.00%）, fungal infection rate（3.33%）, Candida infection rate（6.67%） of control group（P〉0.05）. Conclusion Combining the approach of frontal recess of tears and the patency of maxillary sinus under nasal endoscope in treatment of non-invasive fungal maxillary sinusitis has the advantages of obvious curative effect, small trauma, no significant sequelae, etc. It is worthy of clinical application.