鼻内镜下手术治疗慢性上颌窦炎的临床效果及开窗方式的选择分析

摘要

Objective To explore the clinical efficacy and surgical way of nasal endoscopic surgery under different window modes for chronic maxillary sinusitis.Methods Selected 240 patients diagnosed with chronic maxillary sinusitis; and according to different treatment methods,divided them into the inferior meatus fenestration of maxillary sinus treatment group ( group Ⅰ ),the middle nasal meatus fenestration of maxillary sinus treatment group ( Group Ⅱ ),and dual path of maxillary sinus lesion curettage treatment group ( Ⅲ group ).Compared the clinical efficacy and surgical way between these 3 window modes of nasal endoscopic surgery.Results Nasal congestion,runny nose,olfactory decrease,headache and other symptoms almost completely disappeared in all patients.Followed up at regular interval using nasal endoscopy and sinus CT with coronal and horizontal scanning after treatment,46 cases were cured,and 30 cases improved,witha 57.5％ cure rate,among 80 cases of group Ⅰ ; 78 cases cured,and 30 cases improved,with a cure 65％ rate,among 120 cases of group Ⅱ ; 32 cases cured,and 8 cases improved,with a 80％ cure rate,among 40 cases of group Ⅲ.The clinical efficacy was significantly better in group Ⅲ than in groups Ⅰ and Ⅱ ( P＜ 0.05 ).Postoperative nasal cavity and sinuses end test score was significantly better in group Ⅲ than in group Ⅰ and Ⅱ,and was obviously better in all groups before than after the operation ( P＜ 0.05 ).Conclusions Nasal endoscopic surgery for chronic maxillary sinusitis is efficacious,has a good prognosis,and the choice of dual path fenestration of maxillary sinus lesion removal treatment can improve the cure rate and is worth popularizing clinically.%目的 探讨鼻内镜下手术不同开窗方式治疗慢性上颌窦炎的手术途径及临床疗效.方法 选取我院240例已确诊慢性上颌窦炎患者,根据治疗方法的不同将其随机分为经下鼻道上颌窦开窗术治疗组(Ⅰ组)、经中鼻道上颌窦口开窗术治疗组(Ⅱ组)、双径路上颌窦病变清除术治疗组(Ⅲ组).通过术后回访比较鼻内镜下手术3种开窗方式治疗慢性上颌窦炎在各组中的手术途径及临床疗效.结果 3组共240例患者经治疗后鼻塞、流涕、嗅觉减退和头痛等症状均基本消失,术后经鼻内镜和鼻窦CT冠状位加水平位扫描复查,定期随访,其中Ⅰ组80例痊愈46例,好转30例,治愈率为57.5％,Ⅱ组120例痊愈78例,好转30例,治愈率为65％,Ⅲ组40例痊愈32例,好转8例,治愈率为80％,Ⅲ组临床疗效显著优于Ⅰ组、Ⅱ组,各组结果比较差异具有统计学意义(P＜0.05).Ⅲ组术后的鼻腔-鼻窦结局测试评分显著优于Ⅰ组、Ⅱ组,各组手术前后的鼻腔-鼻窦结局测试评分差异均具有显著性(P＜0.05).结论 采用鼻内镜下手术治疗慢性上颌窦炎,疗效确切,患者预后理想,而选择双径路开窗上颌窦病变清除术治疗更能提高治愈率,值得临床推广使用.