单侧鼻窦病变的诊断及临床特征分析

A retrospective analysis of clinical characteristics,diagnosis in patients with unilateral sinus disease

目的:通过分析单侧鼻窦病变患者的临床特征,探讨单侧鼻窦病变的发病规律。方法:对2 480例鼻窦病变患者的临床资料进行统计学分析,并针对部分鼻窦病变类型进行讨论。结果:1 350例(54.4%)双侧鼻窦病变患者的术后病理诊断均为普通的慢性鼻窦炎。1 130例(45.6%)单侧鼻窦病变患者中术后病理提示为慢性鼻窦炎者589例(52.1%),其余541例(47.9%)患者中真菌性鼻窦炎312例(27.6%),内翻性乳头状瘤95例(8.4%),鼻窦囊肿78例(6.9%),恶性肿瘤34例(3.0%),骨瘤及骨纤维异常增生症11例(1%),其他11例(1%)。单侧鼻窦病变中真菌性鼻窦炎患者呈现逐年增多趋势,头面部胀痛(46.8%)、涕血及鼻出血(31.1%)为其常见症状(P<0.05)。内翻性乳头状瘤近几年多见,男性好发(77.9%),32.6%的患者存在同侧鼻窦手术史,影像学检查可见窦壁骨质吸收破坏(26.7%)。恶性肿瘤患者约半数为老年人,男性多见(79.4%),涕血及鼻出血(58.8%)为其常见症状(P<0.05),影像学可见窦壁骨质吸收破坏(35.3%)。结论:单侧鼻窦病变患者有近半数为非普通炎症性疾病,其中真菌性鼻窦炎及内翻性乳头状瘤、骨瘤、鳞状细胞癌等各种良恶性肿瘤的发生率较高。因此对于这类患者应进行详尽的病史询问,仔细的内镜检查、影像学检查,以免漏诊、误诊。

Objective：The aim of this study is to investigate the clinical features in patients with unilateral sinus disease.Method：A retrospective review of 2 480 patients who had undergone sinus surgery was performed.The clinical data were gathered and analyzed to investigate the features of the unilateral sinus disease.Descriptive and inferential statistics were computed.Result：1 350 patients（54.4%）who had bilateral sinus disease were all diagnosed as chronic rhinosinusitis pathologically confirmed after surgery.Unilateral sinus disease was identified in 1130patients（45.6%） and the disease entities were categorized as chronic rhinosinusitis（589 patients,52.1%）,fungal rhinosinusitis（312 patients,27.6%）,inverted papilloma（95 patients,8.4%）,sinus cyst（78 patients,6.9%）,malignant tumor（34 patients,3%）,osteoma including osteodysplasia fibrosa（11 patients,1%）and others（11patients,1%）.Among the patients of malignant tumor,there were 13 cases of squamous cell carcinoma,6 cases of malignant lymphoma,4 cases of sarcoma,4 cases of melanoma,3 cases of adenocystic carcinoma,1 case of verrucous carcinoma,1 case of metastases from liver,1 case of plasmacytoma,and 1 case of hemangiopericytoma.The number of fungal rhinosinusitis patient increased year by year.The common major presenting symptom for fungal rhinosinusitis was headache（46.8%） and bloody discharge（31.1%）.Male accounted for a large part of both inverted papilloma and malignant tumor patients,both of which CT findings that correlated with the presence was the absorption and destruction of the sinus wall.Thirty-one cases（32.6%）of inverted papilloma patients recurred.Bloody discharge（58.8%） was major symptom of the malignant tumor.Conclusion：There were almost a half of unilateral sinus diseases that were not common chronic rhinosinusitis,in which the incidence of fungal rhinosinusitis,inverted papilloma,squamous cell carcinoma and other kinds of benign and malignant tumor was high.A careful history taking and endoscopic examination play a key role as well as imaging examination in identifying unilateral sinus disease,which is important for reaching a correct diagnosis and treatment.