鼻道-窦口复合体CT三维重建在鼻窦内镜术中的应用价值

Application Value of CT 3D Reconstruction of Nasal-Sinus Complex in Endoscopic Sinus Surgery

目的探究鼻道-窦口复合体CT三维重建在鼻窦内镜术中的应用价值。方法选取2018年3月至2019年7月我院耳鼻喉科诊治的105例慢性鼻窦炎患者进行研究。其中22例行鼻内镜手术,观察鼻内镜技术在手术中作用,采用CT观察鼻道-窦口复合体解剖变异情况、鼻-鼻窦炎症分布、病变区域和筛泡立体空间关系。结果105慢性鼻窦炎患者,其中22例行功能性内镜鼻窦手术患者病变位置术中内镜下与CT显示相同。105例慢性鼻窦炎有85.71%(90/105)发生鼻道-窦口复合体变异,包括泡状鼻甲30.48%(32/105),反常中鼻甲9.52%(10/105),钩突肥厚13.33%(14/105),钩突内侧偏移11.43%(12/105),钩突外侧偏移3.81%(4/105),钩突气化2.86%(3/105),Haller气房8.57%(9/105),鼻丘气房9.52%(10/105),鼻中隔偏曲24.76%(26/105)。鼻-鼻窦炎症分布:前组筛窦87.62%(92/105),后组筛窦37.14%(39/105),上颌窦口69.52%(73/105),上颌窦65.71%(69/105),额隐窝20.00%(21/105),额窦14.29%(15/105),蝶窦8.57%(9/105)。鼻道-窦口复合体变异合并鼻窦炎共90例。结论慢性鼻窦炎患者采用CT可有效观察鼻道-窦口复合体解剖变异情况及炎症分布情况,有效提高鼻窦内镜术成功率,并可以更详细说明手术操作空间、病变范围及结构变异情况。

Objective To explore the application value of CT three-dimensional reconstruction of the nasal canalsinus complex in endoscopic sinus surgery.Methods A total of 105 patients with chronic sinusitis diagnosed and treated in our ENT department from March 2018 to July 2019 were enrolled,of which 22 cases underwent nasal endoscopic surgery.The role of the endoscopic technique in operation was observed.CT was used to observe the anatomical variation of the nasal-sinus complex and the distribution of nasal-sinus inflammation,three-dimensional relationship between lesion area and cribriform vesicles.Results Of the 105 patients with chronic sinusitis,22 of them underwent functional endoscopic sinus surgery,and the lesion location under endoscopy was the same as that of CT.Nasalsinus complex variation occurred in 85.71%(90/105)of 105 cases of chronic sinusitis,including 30.48%(32/105)of the vesicular turbinate,9.52%(10/105)of abnormal middle turbinate,and 13.33%(14/105)of unciform process hypertrophy,11.43%(12/105)of inside uniform process offset,3.81%(4/105)of outside uniform processoffset,2.86%(3/105)of unciform process vaporization,8.57%of Haller air cells(9/105),9.52%(10/105)of agger nasi air cells,and 24.76%(26/105)of the deviated nasal septum.Nasal-sinus inflammation distribution:87.62%(92/105)in the anterior ethmoid sinus,37.14%(39/105)in the posterior ethmoid sinus,69.52%(73/105)in the maxillary sinus opening,65.71%(69/105)in the maxillary sinus,20.00%(21/105)in the frontal recess,14.29%(15/105)in the frontal sinus,and 8.57%(9/105)in the sphenoid sinus.There were 90 cases of nasal-sinus complex variation with sinusitis in total.Conclusion CT can effectively depict the anatomical variation and inflammation distribution of the nasal canal-sinus complex in patients with chronic sinusitis and effectively improve sinus endoscopy success rate of sinus endoscopy,the operation space,pathological range,and structural variation in detail.