多螺旋 CT检测在窦口-鼻道复合体解剖变异与慢性鼻窦炎中的应用

摘要

Objective To study the incidence of anomaly of ostiomeatal complex ( OMC) and its relation to chronic sinusi-tis.Methods CT images of 933 cases who received health examination were retrospectively analyzed .The anatomical variants of OMC were clearly displayed by MPR .Variants of middle turbinate recurvation/gasification , ethmoidal bulla excessive gasi-fication,uncinate process diviation/hypertrophy/gasification,agger excessive gasification,and Haller cell were observed and compared in order to search the relation between anomaly and sinusitis .Results In the 933 cases,the incidence of chronic si-nusitis was 30.12%,with chronic genyantritis being the highest .The incidences of OMC anomaly were 1.7%,13.8%,5.8%, 6.8%,5.1%,1.1%,0.4%,and 2.7%respectively.OMC anomaly in chronic genyantritis ,ethmoidal sinusitis and frontal si-nusitis showed significant differences (P<0.01).The incidence of nasosinusitis in the mixed anomaly group was remarkably higher than the single anomaly group .In 457 cases of non-smokers,OMC anomaly was significantly related to the incidence differences of chronic genyantritis ,ethmoidal sinusitis and frontal sinusitis (P<0.05).In terms of single anomaly factors,mid-dle turbinate recurvation ,uncinate process gasification/diviation/hypertrophy were closely related to the incidence of chronic genyantritis;ethmoidal bulla excessive gasification was closely related to chronic ethmoidal sinusitis ;uncinate process diviation was closely related to chronic frontal sinusitis .Conclusion 1.Multi-slice CT can clearly show the anomaly of OMC .2.Differ-ent anomalies of OMC play different roles in the development of chronic sinusitis .%目的：应用多螺旋CT检测窦口-鼻道复合体（ OMC）解剖变异发生率及探讨其与慢性鼻窦炎发生的关系。方法回顾性分析本院933例健康查体者鼻窦扫描图像，薄层横断图像重建冠状面图像，观察OMC解剖变异情况：中鼻甲（反曲、气化）、筛泡过度气化、钩突（偏曲、肥大、气化）、鼻丘过度气化、Haller气房，并比较解剖变异发生差异。结果933例查体者中慢性鼻窦炎发生率为30．1％，发生率最高为慢性上颌窦炎，在OMC变异中，中鼻甲反曲、气化、筛泡过度气化、钩突偏曲、肥大、气化、鼻丘过度气化、Haller 气房发生率为分别为1．7％、13．8％、5．8％、6．8％、5．1％、1．1％、0．4％、2．7％。 OMC变异分别在慢性上颌窦、筛窦炎及额窦炎的发生差异均有显著性（P＜0．01）。混合变异组鼻窦炎发生率明显高于单一变异组。在剔除吸烟因素的457例非吸烟者中，OMC变异与慢性上颌窦、筛窦炎、额窦炎的发生差异有显著性（ P＜0．05）。单一变异因素中，中鼻甲偏曲、钩突气化、钩突偏曲、钩突肥大与慢性上颌窦炎发生关系密切；筛泡过度气化与慢性筛窦炎关系密切；钩突偏曲与慢性额窦炎关系密切。结论（1）多螺旋CT能清楚地显示OMC的解剖变异，在鼻窦炎患者病因探究及手术治疗方案制定前螺旋CT扫描具有明显的临床意义，应作为鼻窦炎常规的检查手段。（2） OMC单一变异和混合变异均与慢性上颌窦、筛窦炎的发生具有相关性，各种变异在慢性鼻窦炎发生中作用不一致。