MSCT评估钩突上附着点分型及引流途径的临床价值

The clinical value of MSCT in evaluating the types of superior attachment of uncinate process and drainage pathways

目的:通过MSCT分析慢性鼻窦炎患者钩突上附着点(Superior attachment of uncinate process,SAUP)的解剖变异及其引流路径改变,并探讨其对额窦炎引流的影响。方法:收集拟行鼻内镜手术并行MSCT扫描的鼻窦炎患者111例222侧。通过MSCT观察确定SAUP各型的发生率,及其与钩突内、外引流的相关性;比较内、外引流组发生额窦炎的差异。结果:222侧SAUP分型中,最常见的分别是Ⅰ型(55%)、Ⅳ型(19.8%)、Ⅴ型(12.6%)。在额窦炎的评估方面,88侧(39.6%)有额窦炎,钩突内引流中57侧(46.7%)有额窦炎,外引流中31侧(31.0%)有额窦炎。慢性鼻窦炎患者中,与外引流相比,额窦炎更常见于SAUP的内引流中(46.7% vs 31.0%,P<0.05)。结论:鼻内镜术前需明确SAUP的解剖变异,SAUP分型所致额窦流出道的位置改变影响额窦炎的发生。慢性鼻窦炎患者中,当额窦引流的区域在内侧时,明显比外侧引流更容易发生额窦炎。

Objective:To analyze the anatomic variations of superior attachment of uncinate process(SAUP)and drainage pathway in patients with chronic sinusitis by MSCT,and to explore the influence on the frontal sinusitis.Methods:Two hundred and twenty-two sides of 111 patients with sinusitis who were candidates for endoscopic sinus surgery and underwent MSCT scanning were collected.The incidence of various types of SAUP,and the correlation between SAUP and internal and external drainage of uncinate process were determined by MSCT.The difference of frontal sinusitis between internal and external drainage groups was analyzed.Results:Among 222 SAUP types,the most common types of SAUP were typeⅠ(55%),typeⅣ(19.8%)and typeⅤ(12.6%).In the evaluation of frontal sinusitis,88(39.6%)had frontal sinusitis,57 internal drainage(46.7%)and external drainage 31(31.0%).In patients with chronic sinusitis,the frontal sinusitis was more common in the internal drainage channels of SAUP than in the external drainage(46.7%vs 31.0%,P<0.05).Conclusions:Before nasal endoscopic surgery,we need to clarify the anatomical variation of SAUP,and the changes in the location of the outflow tract of frontal sinus caused by SAUP typing affect the incidence of the frontal sinusitis.In patients with chronic sinusitis,frontal sinusitis is more likely to occur when the frontal sinus drainage area is internal drainage than external drainage.