山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 92-96.doi: 10.6040/j.issn.1673-3770.0.2019.376

• 论著 • 上一篇    下一篇

鼻腔鼻窦结石临床诊治体会

翟性友1,侯俊胜2,李新建1,王新1,解营利1,王文佳1   

  1. 翟性友1, 侯俊胜2, 李新建1, 王新1, 解营利1, 王文佳11. 解放军总医院海南医院 耳鼻咽喉头颈外科/海南省耳鼻咽喉头颈外科疾病临床医学研究中心, 海南 三亚 572013;
    2. 河南大学第一附属医院 耳鼻咽喉头颈外科, 河南 开封 475001
  • 收稿日期:2019-07-29 出版日期:2020-07-20 发布日期:2019-10-15

Clinical experience in diagnosis and treatment of stone in nasal cavity and sinusZHAI Xingyou1, HOU Junsheng2, LI Xinjian1, WANG Xin1, XIE Yingli1, WANG Wenjia1 1. Department of Otorhinolaryngology Head and Neck Surgery, Hainan Hospital, General Hospital of PLA, Hainan Province Otorhinolaryngology Head and Neck Surgery Clinical Medical Research Center, Sanya 572013, Hainan, China; 2. Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Henan University, Kaifeng 475001, Henan, ChinaAbstract:Objective

To explore the genesis, clinical diagnosis, treatment, and prevention mechanisms of the formation of stones within the nasal cavity and sinus as well as measures toreduce the rate of clinical misdiagnosis. MethodsA comprehensive analysis was conducted on six patients with nasal and sinus calculi who visited the hospital between April 2012 and November 2017. The etiology, pathology, clinical diagnosis, differential diagnosis, treatment, prevention, and complication management of the disease were summarized for each patient. ResultFive patients underwent surgery for the removal of stones from the nasal cavity and sinus under general anesthesia. Nasal endoscopy was also performed for the assessment of the related sinus passages. One patient recovered upon nasal irrigation and anti-inflammation treatment. All the patients were followed up for six months and the mucosal layer within the operation area that was epithelialized, recovered well. The symptoms disappeared without any additional complications. ConclusionNasal endoscopy in combination with the assessment of clinical manifestation and imaging are conducive to the diagnosis of the disease. Together, these could develop into an effective treatment regimen for nasal cavity and sinusoidal lithiasis.   

  1. Key words: Nasal endoscopic examination;
    Rhinolithiasis;
    Diagnosis and treatment;
    Clinical experience 鼻腔鼻窦结石(calculus of nasal cavity and sinuses)又称鼻石(rhinolith)或鼻石病(rhinolithiasis), 是临床相对较为少见的一种疾病[1], 分为鼻腔结石和鼻窦结石, 尤其是鼻窦结石, 因其发生率很低, 在临床诊断上存在一定的困难。随着影像学和鼻内镜的发展, 该病逐渐被充分认识。笔者于2012年4月至2017年11月参与诊治鼻腔鼻窦结石6例, 现从病因病理、临床诊断、鉴别诊断和治疗预防方面阐述如下。
  • Received:2019-07-29 Online:2020-07-20 Published:2019-10-15

摘要: 目的 探讨鼻腔鼻窦结石病的形成机制、临床诊断、治疗和预防的方法,减少临床误诊率。 方法 对2012年4月至2017年11月就诊的6例鼻腔鼻窦结石患者进行特征性综合分析,总结该病的病因病理、临床诊断、鉴别诊断和治疗预防及并发症处理。 结果 5例患者均在全身麻醉鼻内镜下鼻腔鼻窦结石取出及相关鼻窦开放术,1例经过鼻腔冲洗和消炎治疗后治愈。术后所有患者随访半年以上,术区黏膜均上皮化,恢复良好,症状消失,无并发症发生。 结论 鼻内镜结合临床表现和CT,有利于该病的临床诊断,也是鼻腔鼻窦结石病的最有效治疗方法。

关键词: 鼻内镜检查, 鼻石病, 诊治, 临床体会

Abstract: Objective To explore the genesis, clinical diagnosis, treatment, and prevention mechanisms of the formation of stones within the nasal cavity and sinus as well as measures toreduce the rate of clinical misdiagnosis. Methods A comprehensive analysis was conducted on six patients with nasal and sinus calculi who visited the hospital between April 2012 and November 2017. The etiology, pathology, clinical diagnosis, differential diagnosis, treatment, prevention, and complication management of the disease were summarized for each patient. Result Five patients underwent surgery for the removal of stones from the nasal cavity and sinus under general anesthesia. Nasal endoscopy was also performed for the assessment of the related sinus passages. One patient recovered upon nasal irrigation and anti-inflammation treatment. All the patients were followed up for six months and the mucosal layer within the operation area that was epithelialized, recovered well. The symptoms disappeared without any additional complications. Conclusion Nasal endoscopy in combination with the assessment of clinical manifestation and imaging are conducive to the diagnosis of the disease. Together, these could develop into an effective treatment regimen for nasal cavity and sinusoidal lithiasis.

Key words: Nasal endoscopic examination, Rhinolithiasis, Diagnosis and treatment, Clinical experience

中图分类号: 

  • R765.2
[1] 卜国铉. 鼻科学[M]. 上海: 上海科学技术出版社, 2000.
[2] Orhan K, Kocyigit D, Kisnisci R, et al. Rhinolithiasis:an uncommon entity of the nasal cavity[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,101(2):e28-e32. doi:10.1016/j.tripleo.2005.07.036.
[3] Nassif C, El Hage RG, Rassi S. Rhinoliths: an unusual diagnosis of nasal obstruction[J]. Le J Meédical Libanais Leban Med J, 2014, 62(2):119-122. doi:10.12816/0004109.
[4] Send T, Jakob M, Eichhorn KW. Multiple causes for rhinolithiasis[J]. Rhinology, 2014, 52(2):183-186. doi:10.4193/Rhin13.153.
[5] Kocasarac HD, Celenk P, Erzurumlu ZU, et al. Clinical and radiological aspects of rhinoliths: report of five cases[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 116(2):232-237. doi:10.1016/j.oooo.2013.05.019.
[6] Hadi U,Ghossaini S,Zaytoun G. Rhinolithiasis:a forgotten entity[J].Otolaryngol Head Neck Surg,2002,126(1):48-51.
[7] 宋科英. 鼻石临床特征分析[J]. 长治医学院学报, 2017,31(2):142-143. doi:10.3969/j.issn.1006-0588.2017.02.018.
[8] 杨本涛, 刘延军, 汪卫中, 等. 鼻石的CT诊断[J]. 中华放射学杂志, 2003, 37(4):341-343. doi:10.3760/j.issn:1005-1201.2003.04.014. YANG Bentao, LIU Yanjun, WANG Weizhong, et al. CT diagnosis of rhinolith[J]. Chinese Journal of Radiology, 2003, 37(4):341-343. doi:10.3760/j.issn:1005-1201.2003.04.014.
[9] Fanchette J, Faucon B, Cartry F, et al. Reconstruction of the anterior wall of the frontal sinus by a custom-made titanium prosthesis after resection of a giant osteoma of the frontal sinus[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2019, 136(1):33-36. doi:10.1016/j.anorl.2018.07.003.
[10] Nguyen S, Nadeau S. Giant frontal sinus osteomas: demographic, clinical presentation, and management of 10 cases[J]. Am J Rhinol Allergy, 2019, 33(1):36-43. doi:10.1177/1945892418804911.
[11] da Costa ED, Peyneau PD, Ferreira LM, et al. Clinical implications, diagnosis and treatment of a giant frontoethmoid osteoma[J]. Gen Dent, 2018, 66(5):e1-e4.
[12] 周立娟, 魏洪政. 真菌球型鼻窦炎的CT及MRI影像特征分析[J]. 中国耳鼻咽喉头颈外科, 2016, 23(12):723-724. doi:10.16066/j.1672-7002.2016.12.012.
[13] 刘金兰, 李杰恩, 陈飚友, 等. CT联合鼻内镜对真菌性上颌窦炎的诊断价值[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(1):60-64. doi:10.11798/j.issn.1007-1520.201901012. LIU Jinlan, LI Jieen, CHEN Biaoyou, et al. Value of computed tomography combined with nasal endoscopy in the diagnosis of fungal maxillary sinusitis[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(1):60-64. doi:10.11798/j.issn.1007-1520.201901012.
[14] Bhattacharya S, Mishra R. Fibrous dysplasia and cherubism[J]. Indian J Plast Surg, 2015, 48(3):236-248. doi: 10.4103/0970-0358.173101.
[15] Atalar MH, Salk I, Savas R, et al. CT and MR imaging in a large series of patientsith carniofacial fibrous dysplasia[J]. Pol J Radiol, 2015,80:232-240. doi: 10.12659/PJR.893425. eCollection 2015.
[16] Kuchler E C,Costa M,DE C,et al.Supernumerary teeth vary depending on gender[J].Braz Oral Res, 2011, 25:76-79.
[17] 喻佳,叶礼新,姜叶芳.CT诊断鼻腔额外牙1例[J].中国医学影像学杂志,2013,21(9):701. YU Jia, YE Lixin, JIANG Yefang. CT diagnosis of extra teeth in nasal cavity:1 case[J].Chinese Journal of Medical Imaging, 2013, 21(9):701.
[18] 郭光良,胡丽敏,路远.鼻腔额外牙并同侧上颌窦炎1例[J].临床耳鼻咽喉头颈外科杂志,2015, 29(16):1494-1495. GUO Guangliang, HU Limin, LU Yuan. One case of additional in nasal cavity combined with ipsilateral maxillary sinusitis[J].Journal of Clinical Otolaryngology Head and Neck Surgery, 2015, 29(16):1494-1495.
[19] 王秀启,李希华,吉登云,等. 鼻石1例[J]. 山东大学耳鼻喉眼学报,2012,26(02):91.
[1] 李勇. 儿童鼻窦炎的诊治——困难、挑战与对策[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 1-7.
[2] 张剑伟,王国庆,倪泽. 颅咽管瘤误诊为蝶窦囊肿1例[J]. 山东大学耳鼻喉眼学报, 2016, 30(3): 109-110.
[3] 李厚杰,渠倩,徐世才,刘领兵,张永超,王绪增,刘磊. 经鼻内镜中下鼻道联合扩大入路治疗上颌窦后鼻孔息肉[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 62-64.
[4] 孟庆国, 卢永田, 伍小六, 李建兴, 孙焕吉, 张宝莹, 谢畅. 腭鞘管后部的浅沟:定位腭鞘管的解剖标记[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 55-61.
[5] 余鹏举1,许风雷2,江满杰2. 鼻内镜治疗难治性鼻出血121例疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(4): 4-5.
[6] 缪建良, 郭建林, 吴剑, 虞洪雷, 陆佳, 霍志强, 王晨旭. 237例鼻出血住院患者临床分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(1): 43-44.
[7] 王海英1,杨美艳2. 鼻窦CT在鼻内镜手术中的重要意义[J]. 山东大学耳鼻喉眼学报, 2013, 27(1): 91-92.
[8] 尤建强,巢长江,王凯,王晓晔,邱建鹤. 经鼻内镜两种径路额窦手术的临床分析[J]. 山东大学耳鼻喉眼学报, 2012, 26(5): 43-46.
[9] 高水超,李仕晟,唐青来. 输血吸引器联合电刀在鼻内镜手术中的应用[J]. 山东大学耳鼻喉眼学报, 2012, 26(2): 64-65.
[10] 李建房. 吊瓶式鼻内镜冲洗器[J]. 山东大学耳鼻喉眼学报, 2012, 26(1): 92-92.
[11] 梁辉,王启荣,韩飞,崔朝阳,古林涛. 30°鼻内镜下腺样体肥大分度对鼻塞症状评估的意义[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 62-.
[12] 于海洋, 孙丰林, 张增,王卫国. 鼻内镜下经咽鼓管鼓室内置管注药治疗梅尼埃病[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 64-.
[13] 史余勇,刘定荣. 鼻内镜下治疗顽固性鼻出血448例[J]. 山东大学耳鼻喉眼学报, 2011, 25(4): 62-.
[14] 马俊伟, 刘婷婷,张念凯. 鼻内镜下鼻中隔正中入路治疗额窦病变的应用解剖[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 54-56.
[15] 韩飞, 王启荣, 崔朝阳. 吸凝器在治疗难治性自发性鼻出血中的应用[J]. 山东大学耳鼻喉眼学报, 2010, 24(5): 34-.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 马宝峰,党光福 . 折叠式人工晶状体经巩膜缝线固定术16例[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 376 -378 .
[2] 封新荣,张红霞,许贞姬,曲君君 . 射频消融术治疗慢性肥厚性鼻炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(3): 225 -226 .
[3] 张秋贵,何海燕 . 青岛地区变应性鼻炎常见变应原调查分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 520 -521 .
[4] 李海燕,赵秋良,韩晓攀,于丽 . 阻塞性睡眠呼吸暂停综合征患者自由基损伤与高血压的关系[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 527 -529 .
[5] 宋西成,张华,张庆泉 . 血循环DNA的检测与头颈部肿瘤的诊断[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 385 -387 .
[6] 詹善强,孔凡俐,操文娟,汤杰,沈菊,詹文波 . 电刀切除扁桃体236例[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 559 -560 .
[7] 陈 俊,傅爱清,朱秋萍,楼正才 . 慢性鼻窦炎耐甲氧西林葡萄球菌对抗生素的耐药分析[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 130 -132 .
[8] 张 虎,艾 琴 . 甲状腺癌再手术15例[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 166 -167 .
[9] 胡 明,李招娜,李云杰,陶祥臣 . 硬性透气性角膜接触镜对圆锥角膜的塑形作用[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 171 -173 .
[10] 娄 锋 . 喉上神经阻滞预防喉显微手术心血管反应[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 173 -175 .