不同手术路径治疗非侵袭性真菌性上颌窦炎的临床疗效研究

摘要

Objective:To investigate the clinical effects of different surgical methods on non-invasive fungal maxillary sinusitis, and then to guide the surgical operation.Methods: Sixty-six patients with non-invasive fungal maxillary sinusitis underwent endoscopic sinus surgery (ESS) were divided into three groups: 25 cases were treated with endoscopic maxillary sinus windowing (EMSS) ,simple endoscopic maxillary sinus open-(EMIF group), 22 cases of nasal endoscopy combined with inferior meatus pathways group (EMIF group) , opening combined with glottic sulcus approach group (ESSL group) in 19 cases under nasal endoscopic nasal.The clinical symptoms, the situation of nasal cavity and paranasal sinus lesions were compared between the three groups.Results: The therapeutic effect was evaluated by the standard of Haikou.The effective rates of EMSS, EMIF and ESSL were 80.0%, 94.7% and 100%, respectively.Compared with EMIF group and ESSL group, EMSS had significant difference (P<0.05).There was no significant difference between EMIF group and ESSL group (P>0.05).There were no significant differences in the VAS score, Lund-Kennedy endoscopic score and Lund-Mackay CT score between the three groups before operation (P>0.05).There were significant differences between EMSS group and EMIF group and ESSL group before and after operation (P <0.05).There were significant differences between EMSS group and EMIF group and ESSL group after operation (P<0.05).There was no significant difference between EMIF group and ESSL group (P> 0.05).The VAS score, Lund-Kennedy endoscopic score and Lund-Mackay CT score were highest in the EMSS group at 6 months postoperatively.Conclusions: The combined approach has better therapeutic effect on non-invasive fungal maxillary sinusitis than EMIF and ESSL.However, the effect of EMIF and ESSL is not different.However, Trauma of the inferior meatus window is less, less blood and more convenient operation.It is an ideal method In clinical treatment of Non-invasive fungal maxillary sinusitis and worthy of promotion.%目的:探讨不同手术方式治疗非侵袭性真菌性上颌窦炎的临床疗效,进而指导外科手术.方法:对我院收治的66例确诊为非侵袭性真菌性上颌窦炎并行鼻内镜手术 (ESS)治疗的患者根据不同术式分为3组:单纯鼻内镜下上颌窦开窗径路组(EMSS组)25例;鼻内镜下中鼻道联合下鼻道开窗径路组(EMIF组)22例;鼻内镜下中鼻道开窗联合唇龈沟径路组(ESSL组)19例,比较3组患者术后临床症状、鼻腔及鼻窦病变的改善情况.结果:采用海口标准对手术疗效进行评估,EMSS、EMIF、ESSL组的有效率分别是80.0%、94.7%和 100%.采用Memenyi法比较:EMSS与EMIF组、ESSL组比较,差异有统计学意义(P<0.05);EMIF与ESSL组比较,差异无统计学意义(P>0.05).术前3组间的VAS 评分、Lund-Kennedy内镜评分及Lund-Mackay CT 评分差异无统计学意义(P>0.05);术后与术前相比差异有统计学意义(P<0.05);术后组间相比:EMSS组与EMIF组、ESSL组相比差异有统计学意义(P<0.05),EMIF与ESSL组相比差异无统计学意义(P>0.05).并且术后6个月EMSS组的VAS评分、Lund-Kennedy鼻内镜评分和Lund-Mackay CT评分最高.结论:联合径路对非侵袭性真菌性上颌窦炎的治疗效果较单径路好;EMIF及ESSL术后疗效无差别,但下鼻道开窗径路创伤小,术中出血少,操作更便捷,是治疗非侵袭性真菌性上颌窦炎较为理想的方法,临床上值得推广.