山东大学耳鼻喉眼学报 ›› 2010, Vol. 24 ›› Issue (2): 30-34.

• 论文 • 上一篇    下一篇

不伴有鼻息肉的成人慢性鼻-鼻窦炎的临床评估及鼻内镜手术

袁晓培1,王建英2,邢志敏1,余力生1   

  1. 1. 北京大学人民医院耳鼻咽喉科, 北京  100044;
    2. 武警北京总队一支队卫生队, 北京  100037
  • 收稿日期:2009-10-23 修回日期:2010-01-26 出版日期:2010-04-16 发布日期:2010-04-16
  • 作者简介:袁晓培,男,副主任医师,主要从事鼻科疾病方面的临床研究。 Email:yxiaopei@yahoo.com.cn

Clinical assessment and endoscopic surgery in chronic sinusitis without nasal polyps of adult patients

YUAN  Xiaopei1, WANG  Jianying2, XING Zhimin1, YU Lisheng1   

  1. 1. Department of Otorhinolaryngology, People′s Hospital of Peking University, Beijing 100044, China;
    2. Medical unit of Beijing Armed Police Force Corps Detachment 1. Beijing 100037, China
  • Received:2009-10-23 Revised:2010-01-26 Online:2010-04-16 Published:2010-04-16

摘要:

目的   探讨国内成人不伴鼻息肉的慢性鼻鼻窦炎(CRSsNP)的基本特征和有效的治疗方法。方法  对78例CRSsNP患者进行临床量化评估:鼻窦CT扫描采用LundMackay评分法,计算出病变鼻窦所占百分比;鼻内镜检查采用Lund-Kennedy评分;症状严重度采用视觉类比法评分(VAS法)。结合患者主诉以及客观检查和评分,分析引起病变的解剖异常,制定个性化手术方案,行鼻内镜下鼻腔成型术。术后配合保守治疗和随访,1年后再次进行LundKennedy评分和VAS评分,并进行统计学分析。 结果  所有患者手术均涉及窦口鼻道复合体和上颌窦区域,病理显示以浆细胞和淋巴细胞浸润为主。痊愈53例,有效25例,无效0例,总有效率为100%,术腔上皮化时间平均5周。前组鼻窦出现病变百分比高于后组鼻窦。除0~3分级手术前后VAS症状评分差异无统计学意义,其它患者手术前后VAS症状评分以及Lund-Kennedy评分均有显著性差异。 结论  国内成人CRSsNP有自身特点:局部多解剖异常可能对发病有重要作用,窦口鼻道复合体和上颌窦是病变靶点区;细菌感染因素可能重于变态反应因素,单侧与双侧CRSsNP主要发病机制可能不同;EPOS2007指南中提供的评估方法可较客观全面的反映病变及治疗情况,CRSsNP手术治疗占有重要地位,个体化的鼻内镜鼻腔成型术是有效的手术方法。

关键词: 鼻-鼻窦炎;外科手术;内镜术;评估

Abstract:

Objective  To discuss the basic characteristics and effective treatment of chronic sinusitis without nasal polyps (CRSsNP) of adult patients in China. Methods  78 cases were scored by the quantitative assessment: CT scans by Lund-Mackay scoring system, nasal endoscopy by Lund-Kennedy score, and symptoms severity score by visual analog scale (VAS scale ). Combined with the chief complaint and objective score, we analyzed the abnormal anatomy of the nasal cavity which cause the disease and carried out individual endoscopic surgery. After surgery, patients were followed up for one year, and then were scored again and statistically analyzed. Results  Ostiomeatal complex and maxillary sinus were involved completely. Pathologic examination showed that plasma cells and lymphocytes were the main infiltrating cells. The total response rate was 100%: 53 patients were recovered and 25 patients improved. The average epithelization time was five weeks. The occurrence rate of the lesions was significantly higher in the front sinuses than in the latter sinuses. In patients with0-3 grades, there was no significant difference in the VAS score before and after surgery, while in patients with other grades a significant difference in the VAS score and the Lund-Kennedy score. Conclusion  CRSsNP of adults in China has its own features: multi-local anatomical abnormalities may play an important  role in the pathogenesis, and ostiomeatal complex and the maxillary sinus are the target areas; bacterial infection may be more important than allergy; the pathogenesis of unilateral and bilateral CRSsNP may be different; EPOS2007 guide provide a more objective assessment method which can fully reflect the disease and its treatment; Surgical treatment of CRSsNP plays an important role and endoscopic individual rhinoplasty is an effective method.

Key words: Rhinosinusitis; Surgery; Endoscopy; Assessment

中图分类号: 

  • R765
[1] 姜绍红1,朱宇宏1, 王 强1, 王文一2. 影像导航技术在鼻腔鼻窦内翻性乳头状瘤手术中的应用[J]. 山东大学耳鼻喉眼学报, 2009, 23(6): 15-.
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