鼻窦炎伴巨大筛上颌窦气房患者临床分析

Clinical analysis of patients with rhinosinusitis concurrent with large ethmomaxillary sinus underwent endoscopic surgery

目的探讨鼻窦炎伴巨大筛上颌窦(ethmomaxillary sinus,EMS)气房的临床特征和治疗效果。方法收集15例(18侧)EMS气房患者的病例资料,记录术侧EMS气房的影像和内镜特点以及手术、随访结果。结果诊断慢性鼻窦炎不伴鼻息肉9例,慢性鼻窦炎伴鼻息肉3例,真菌球3例。EMS气房左侧7例,右侧3例,双侧4例。EMS气房最大上下径、内外径和前后径分别为(14.6±5.0)mm、(14.9±3.2)mm和(11.8±2.2)mm。患侧上颌窦Lund-Mackey评分为1.4±0.5,EMS气房为0.6±0.5,两者有统计学差异(P=0.006)。内镜下开放同侧上颌窦和EMS气房、去除气房间隔,术后随访3~28个月(平均16个月)所有患者主观症状均明显改善,内镜下窦腔通气引流良好。结论巨大EMS气房内镜手术难度大,彻底开放上颌窦和EMS气房形成共同窦腔效果良好。

OBJECTIVE To investigate the clinical characteristics and surgical results of patients with rhinosinusitis concurrent with large ethmomaxillary sinus(EMS).METHODS Fifteen patients(18 sides of EMS)were reviewed who underwent endoscopic sinus surgery.The computed tomography(CT)imaging and endoscopic characteristics of the EMS as well as the operation and outcomes were recorded.RESULTS There were 9 cases of chronic rhinosinusitis without nasal polyp,3 cases of chronic rhinosinusitis with nasal polyp,and 3 cases of fungus ball of the maxillary sinus(MS).EMSs were found in 7 cases on the left side,3 cases on the right side,and 4 cases on both sides.The maximal diameters of superior-inferior,medial-lateral,and anterior-posterior of EMSs were(14.6±5.0)mm,(14.9±3.2)mm,and(11.8±2.2)mm,respectively.The Lund-Mackey score of the surgery sided MSs were 1.4±0.5,and that of the EMSs were 0.6±0.5(P=0.006).By widening the antrum of MS and EMS and taking down the septum in endoscopic endonasal surgery,a common sinus cavity could be created.After followed up for 3-28 months(average 16 months),the symptoms of all patients were significantly improved with adequate sinus ventilation and drainage.CONCLUSION Large EMS may block the ipsilateral MS and increase the difficulty level of endoscopic surgery.An extensive combined MS and EMS antrostomy to form an integrated cavity could achieve good results.