保留或重塑与切除钩突对鼻内镜术后鼻窦粘膜转归影响的对比研究

吕凌燕　王玉芝　王兴杰　曲喆

【摘要】 目的：比较鼻内镜手术中保留或重塑钩突与全部切钩突对鼻内镜术后术腔黏膜转归的影响。方法：将46例慢性鼻窦炎患者作为临床观察对象。每例患者左侧鼻腔为实验组，右侧鼻腔为对照组。实验组采用保留或重塑钩突的鼻窦内镜手术，对照组行经典鼻内镜手术。手术后按照主观症状恢复情况和鼻内镜下局部状态评价鼻腔黏膜转归情况进行评定。结果：全部患者均随访1年以上。治愈：试验组40例（86.95%），对照组38例（82.60%）。好转：试验组6例（13.04%），对照组8例（1739%）。两组治愈率无明显统计学差异。术后1年内鼻内镜检查术腔黏膜情况，试验组和对照组筛窦及或中鼻道黏膜囊泡样肉芽生长分别为1例和5例，黏膜息肉样水肿分别为1例和7例，对照组炎症复发1例。实验组和对照组术腔上皮化时间分别为8-10周和10-14周，2组差异有统计学意义（P<0.05）。结论：保留或重塑钩突符合鼻腔生理学特点，减少了术腔粘膜转归阶段发生新生病变可能，对鼻腔、鼻窦黏膜的良性转归有积极的影响，减少了鼻窦黏膜炎症的复发机会。

【关键词】 钩突；重塑；鼻内镜术；粘膜

【Abstract】 Objective： To compare the impact of sinus mucosa outcome by preservation/reconstruction and ablation of uncinate process in endoscopic sinus surgery.Methods： Thirty-six patients with chronic rhinosinusitis（CRS） were selected as clinical subjects.For each patient，the left aide was selected to preserve or reconstruct the shape of uncinate process by nasal sinus opening surgery，the right was received traditional functional endoscopic sinus surgery（FESS） as control， The impact of sinus mucosa outcome after surgery was evaluated according to the restoration of symptoms and local state under endoscope.Results： By the end of one year following treatment，40cases were cured，6 cases were effective in TG，and38 cases were cured，8 cases were effective in CG.12 months after the operation of nasal mucosa endoscopy， the test group and the control group of ethmoid sinus and the middle nasal meatus cystoid edema were 1 case and 5 cases respectively， with a significant difference between 2 groups （P

【Key words】 Uncinate Process； remolding；endoscopic；mucosa

【中图分类号】R765.9 【文献标识码】A 【文章编号】1005-0019（2014）03-0030-01

功能性内窥镜鼻窦手术已成为治疗鼻部疾病的主要手段，目前临床上施行的FESS大多采用Messerklinger术式，主要步骤为切除正常的钩突，钩突切除后窦口充分暴露，解决了窦口鼻道复合体阻塞和各个鼻窦腔的引流问题，但同时也改变了鼻腔气流及鼻窦引流的方向，使各鼻窦天然保护屏障消失，全部窦腔暴露于气流冲击之下，同时增加了逆行感染及鼻腔鼻窦黏膜再次炎性病变的机率。为了对比研究保留或重塑钩突与切除钩突对术后鼻窦黏膜转归的影响，我们对2009年3月至2013年2月收治的46例单纯型慢性鼻窦炎患者施行了左侧鼻腔保留或重塑钩突，右侧鼻腔切除钩突的鼻内镜手术，现总结如下。……