外周球囊导管鼻窦扩张术治疗上颌窦炎的疗效分析

Effect of peripheral balloon catheter dilatation on maxillary sinusitis

目的评估外周球囊导管鼻窦扩张术治疗慢性上颌窦炎的可行性及术后近期疗效。方法回顾性分析2018年1~12月徐州医科大学附属医院耳鼻喉头颈外科收治的45例(69侧)慢性上颌窦炎患者的临床资料,根据治疗方式将其分为外周球囊组和常规组,外周球囊组行外周球囊导管鼻窦扩张术,常规组行常规鼻内镜上颌窦自然开口扩大术。术后随访12周,采用Lund-Kennedy(LK)评分和Lund-Mackay(LM)评分系统评估手术效果,采用视觉模拟量表(VAS)评估术后第1天疼痛程度,比较2组患者各项评分差异。结果术后6周LK评分中,外周球囊组患者水肿、瘢痕、结痂及总评分显著优于常规组,差异有统计学意义(P<0.05),2组患者息肉和鼻漏比较差异无统计学意义(P>0.05);术后12周,外周球囊组患者瘢痕及总评分仍优于常规组,差异有统计学意义(P<0.05),2组患者息肉、水肿、鼻漏及结痂比较差异无统计学意义(P>0.05)。术后12周,2组患者LM评分比较差异无统计学意义(P>0.05)。术后第1天,2组患者疼痛程度比较,差异有极显著性统计学意义(P<0.01)。术后12周,45例患者的症状较术前均有不同程度的改善,窦口开放良好,均无眼部及颅底并发症。结论外周球囊导管鼻窦扩张术治疗上颌窦炎具有创伤小、术后痛苦小、恢复快等优点,可有效保护鼻腔黏膜功能,适合在基层医院进行推广应用。

Objective To evaluate the feasibility and short-term postoperative efficacy of peripheral balloon catheter dilation for chronic maxillary sinusitis.Methods The clinical data of 45 patients(69 sides)with maxillary sinusitis in the Otolaryngology Head and Neck Surgery Department of Affiliated Hospital of Xuzhou Medical University from January to December 2018 were retrospectively analyzed.According to the treatment,they were divided into the peripheral balloon group and the conventional group.The peripheral balloon group underwent peripheral balloon catheter dilatation,and the conventional group underwent conventional endoscopic sinus surgery for maxillary sinus.After 12 weeks of follow-up,Lund-Kennedy(LK)endoscopy staging system and Lund-Mackay(LM)CT scoring system were used to evaluate the surgical effect,and visual analog scale(VAS)was used to assess the degree of pain on the first postoperative day.Differences in the scores between the two groups were compared.Results In the 6-week postoperative LK score,edema,scar,scab and total score of patients in the peripheral balloon group were significantly better than those in the conventional group,the differences were statistically significant(P<0.05),there was no statistically significant difference between the two groups in polyps and rhinorrhea(P>0.05).The scars and total score in the peripheral balloon group 12 weeks after surgery were still better than those in the conventional group,the differences were statistically significant(P<0.05),and there was no statistically significant difference in polyps,edema,rhinorrhea and scab between the two groups(P>0.05).There was no significant difference in LM score between the two groups 12 weeks after surgery(P>0.05).On the first day after operation,the pain degrees of the two groups were compared,and the difference was statistically significant(P<0.01).The symptoms of 45 patients were improved to different degrees 12 weeks after the operation compared with those before the operation,and the ostiums opertures opening well,no ocular or skull base complications occurred.Conclusion Peripheral balloon catheter dilation for maxillary sinusitis has the advantages of less trauma,less postoperative pain,and faster recovery,which can effectively protect the nasal mucosa and is suitable for popularization and application in primary hospitals.