鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗治疗上颌窦囊肿的临床研究

Clinical study of endoscopic middle and accurate inferior meatal antrostomy with modified mucoperiosteal flap for maxillary sinus mucosal cyst

目的探讨鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗治疗上颌窦囊肿的临床疗效。方法选择2016年1月-2019年12月该院收治的上颌窦囊肿患者57例,根据手术方式不同分为对照组(n=26)和研究组(n=31)。两组患者均行鼻内镜下上颌窦自然开口入路手术,对照组同时予常规下鼻道开窗术,研究组同时予改良黏骨膜翻瓣精准下鼻道开窗术。比较两组患者的手术相关指标、临床疗效及并发症发生情况。结果两组患者手术时间、术中出血量和住院时间比较,差异均无统计学意义(P>0.05);研究组下鼻道骨窗口及骨窗两侧切除的黏膜面积均小于对照组(P<0.05);两组患者临床疗效比较,差异无统计学意义(P>0.05);研究组上颌窦黏液纤毛传输时间(MTT)较对照组短(P<0.05);研究组术中并发症总发生率较对照组低(P<0.05)。结论鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗术治疗上颌窦囊肿具有较好的临床疗效,对患者创伤小、上颌窦功能影响小,且术中并发症发生率低,值得临床推广应用。

Objective To investigate the clinical effect of endoscopic middle and accurate inferior meatal antrostomy with modified mucoperiosteal flap in the treatment of maxillary sinus mucosal cyst.Methods 57 patients with maxillary sinus mucosal cyst from January 2016 to December 2019 were divided into 26 cases in control group and 31 cases in study group according to different surgical methods.The control group was treated with endoscopic surgical operation through maxillary sinus natural ostium combined with conventional inferior meatal antrostomy.The study group was treated with endoscopic surgical operation through maxillary sinus natural ostium combined with accurate inferior meatal antrostomy with modified mucoperiosteal flap.The operation related indexes,clinical efficacy and complications between the two groups were compared.Results There was no significant difference between the two groups in operation time,intraoperative blood loss and hospitalization time(P>0.05).The bone window in the lower nasal canal and the mucosal area of both sides of the bone window in the study group was smaller than that in the control group(P<0.05).There was no statistically significant difference in clinical efficacy between the two groups(P>0.05).The mucociliary transmission time of maxillary sinus of maxillary sinus in the study group was shorter than that in the control group(P<0.05).The incidence of total intraoperative complications in the study group was lower than that in the control group(P<0.05).Conclusion Endoscopic middle and accurate inferior meatal antrostomy with modified mucoperiosteal flap has a good effect in treatment of maxillary sinus mucosal cyst.It is worthy of clinical application because of little trauma,little effect on maxillary sinus function,and low incidence of surgical complications.