下鼻甲翻转在真菌性上颌窦炎鼻内镜手术中的应用

下鼻甲翻转在真菌性上颌窦炎鼻内镜手术中的应用 下鼻甲翻转在真菌性上颌窦炎鼻内镜手术中的应用 【摘要】 目的 探讨真菌性上颌窦炎手术入路和手术。方法 2003 年6月至2006年6月应用下鼻甲翻转治疗真菌性上颌窦炎32例，所 有病例特点为病变占据整个上颌窦腔，单纯经中鼻道或下鼻道无法彻 底处理病变，其中伴有不同程度骨质破坏或吸收19例。全部病例采 用鼻内镜下经鼻手术，自下鼻甲前端距离前缘附着处约0.5?cm切断 下鼻甲，将下鼻甲制作成蒂在后方的条状组织瓣，依据需要将下鼻甲 翻向后方或上方，充分暴露上颌窦腔手术视野。应用0?、30?、70? 鼻内镜可处理上颌窦各个方向病变，对于上颌窦内下角病变可采用内 镜下刮匙刮除。病变清除彻底以后将下鼻甲复位，下鼻甲前端切断处 缝合1 2针或应用耳脑胶粘附。结果 所有病变在鼻内镜下经鼻处理 彻底，随访1 4年，未见复发，5例患者术后感觉干燥，应用鼻腔冲 洗等处理，症状半个月、1个月逐步消失，所有病例3个月后没有鼻 腔干燥、头痛等不适。无鼻腔粘连、狭窄及下鼻甲坏死等。结论 应 用下鼻甲翻转经鼻手术一方面可以减小创伤，避免了唇龈沟切口;另 一方面提供了开阔的手术视野，特别是上颌窦内下角病变的处理，克 服了内镜下单纯经中鼻道无法暴露和处理上颌窦内下角病变的不足; 克服了因纤毛破坏导致术后不能经中鼻道排泄分泌物的缺点，术后可 以从下鼻道引流;同时为术后鼻内镜的复查和复发后的处理提供了充 足的视野;另外，保留了下鼻甲结构和容积，避免了因为鼻腔外侧壁 去除过多而导致的术后干燥、结痂、头痛等后遗症。 【关键词】 真 菌鼻 窦炎 诊断 内窥镜检查 治疗 under a rhino endoscope Abstract: Objective To explore the treatment method for mycotic maxillary sinusitis. Methods 32 patients hospitalized from June 2003 to June 2006 were treated by an inferior nasal concha flipping pathway. All patients are characterized with a fully occupied maxillary antrum cavity, and the pathological tissues could not be completely removed through middle or sub. 19 patients featured bone destruction or absorption to different degrees. All patients underwent rhino endoscope surgeries. The inferior nasal concha was partly cut off 0.5 cm from the anterior adhering point, and the hamular process and the tissues around the opening of maxillary sinus as well as the tissues of the inferior nasal meatus were removed. The inferior nasal concha was made into a banded tissue flap with the pedicle at the rear, and then based on the situation, it was flipped backwards or upwards exposing the fields of view in the operations. Using 0?, 30? and 70? endoscopes, the disordered tissues in the endo inferior part of maxillary cavity were erased using a curette, and the lacrimal canal in the front end and the sphenopalatine artery were well preserved. After complete removal of the disordered tissues, the inferior nasal concha was repositioned, and the anterior incisions were sutured or glued. Results All disordered tissues were completely removed and no recurrence was found after a follow up of 1 to 4 years. 5 patients complained about dry nasal cavities and after a nasal douche their symptoms disappeared in 15 to 30 days. 3 months after the operations no complaints about dry nasal cavities or headache were found. No nasal synechia, angusty or necrosis were found. Conclusions Inferior nasal concha flipping can reduce trauma, avoid labiogingval incisions and provides an expansive field of view. Especially when it comes to the management of the endo inferior part of the maxillary antrum, the pathway can be discharged through the middle meatus. The pathway also provides an expansive field of view for post operative recheck and management for relapse. By preserving the structure and volume of the inferior nasal concha, the sequel of dry nasal cavity, incrustation and headache are decreased. Key words: Fungi; Sinusitis; Diagnosis; Endoscopy; Therapy 随着广谱抗生素和激素在细菌性鼻窦炎治疗中 的长期不当应用，鼻窦的慢性真菌感染明显增加，据国内外文献统计， 上颌窦的发病率最高。对真菌性上颌窦炎的有效治疗措施主要为手术。传统为Caldwell Luc手术，创伤大，并发症多。近年来鼻科学的迅速发展，特别是鼻内镜手术的广泛应用，为慢性真菌性鼻窦炎的治疗提供了新的有效方法，但鼻内镜下无论视野还是操作都存在死角，容易出现病变残留。2003年6月至2006年6月我们应用下鼻甲翻转治疗真菌性上颌窦炎32例，取得了较好的治疗效果。 1 资料与方法 1.1 临床资料 32例中，男19例，女13例，23 67岁，平均41.3岁;单侧病变31例，双侧病变1例;病程3个月 年，平均18个月。 1.2 症状 鼻塞17例，头胀痛13例，流脓涕或血涕例，鼻腔异味27例，面部肿痛9例, 复视1例, 牙痛3例。伴有糖尿病4例。鼻内镜检查:鼻中隔偏曲例，中鼻甲肿大或肥大11例，钩突肥大或息肉样变9例，鼻中隔偏曲例，鼻息肉或中鼻甲息肉样变15例，中鼻道有干酪样块状异物17例，脓性分泌物28例。 1.3 病例特点 所有患者术前均行CT水平位和冠状位扫描，患侧上颌窦均有高密度软组织块影或窦腔中有密度不均匀的点状或斑片状钙化影，其中伴有不同程度骨质破坏或吸收19例，所有病例特点为病变占据整个上颌窦腔，单纯经中鼻道或下鼻道无法彻底处理病变。