上颌窦冲洗在真菌性上颌窦炎术后的作用观察  

OBSERVATION ON CLINICAL EFFECT OF IRRIGATION OF MAXILLARY SINUS IN ENDOSCOPIC SINUS SURGERY ON FUNGOUS RHINOANTRITIS

作　　者：徐英霞 路虹[2] 于磊 李会英 冯丽梅 于军霞 

机构地区：[1]河北省正定县人民医院耳鼻咽喉科,河北正定050800 [2]河北医科大学第二医院耳鼻咽喉科,河北石家庄050000

出　　处：《河北医科大学学报》2010年第3期298-300,共3页Journal of Hebei Medical University

摘　　要：目的探讨上颌窦冲洗和常规换药在鼻内镜下上颌窦开放术和鼻内镜下上颌窦开放术联合柯-陆(Caldwell-Luc)手术治疗真菌性上颌窦炎的疗效。方法回顾性分析46例真菌性上颌窦炎患者的临床资料及随访结果,Ⅰ组(简称内镜手术组)28例,采用鼻内镜下上颌窦开放术;Ⅱ组(简称联合手术组)18例,采用鼻内镜下上颌窦开放术联合柯-陆手术。3 d后用生理盐水冲洗鼻腔,1个月内每周换药1次,以后6个月视情况每2周或1个月复查1次。据换药时是否行上颌窦冲洗分为2组,A组(上颌窦冲洗组)共29例,其中A I组19例,AⅡ组10例,每次用生理盐水、甲硝唑及氟康唑冲洗上颌窦,分泌物黏稠或有硬块时加用糜蛋白酶;B组(常规换药组)17例,其中B I组9例,BⅡ组8例,鼻内镜下常规清理术腔,未行上颌窦冲洗。结果 A组(上颌窦冲洗组)症状全部消失,无困扰,内镜检查窦口开放良好,无结痂(0分);B组(常规换药组)中BI组9例中6例为0分(66.7%),3例偶有流涕或涕中带血,上颌窦结痂,平均为3分(33.3%);BⅡ组8例中6例为0分(75.0%),2例平均为3分(25.0%)。随访1～2年,复发2例,B Ⅰ、BⅡ各1例。上颌窦冲洗组(A组)较常规换药组(B组)疗效好,差异有统计学意义(P<0.01);2种术式比较差异无统计学意义(P>0.05)。结论鼻内镜手术清除病灶是治疗真菌性鼻窦炎的最有效方法,定期上颌窦冲洗可以明显提高疗效,减少复发。Objective To investigate the effect of irrigation of maxillary sinus in two ways of surgery for fungal rhinosinusitis（endoscopic maxillary sinus surgery and endoscopic maxillary sinus surgery plus Caldwell-Luc surgery） compared with the usual treatment. Methods The clinical and follow-up data of 46 patients with fungal rhinoantritis were retrospectively analyzed. Group I （endoscopic surgery group） had 28 cases,who were applied the endoscopic maxillary sinus surgery. Group II （allied surgery group） had 28 cases, who were applied the endoscopic maxillary sinus surgery plus Caldwell-Luc surgery. Everyone had a regular treatment once a week in 1 month,afterwards rechecked once 2 or 4 weeks until 6 months. They were divided into two groups according to whether having irrigation of maxillary sinus, group A （maxillary sinusirrigated group） with 29 cases,group A I 19 cases,group A II 10 eases,who were given maxillary sinus irrigation with 0.9% salt solution, metronidazole and fluconazole injection, simultaneously used chymotrypsin for injection when the secretion is glutinous or chunky. Group B （usual treatment group） with 17 cases, Group B I 8 cases, Group B II 9 cases, were given the usual treatment, without irrigation of maxillary sinus. Results All symptoms of group A were disappeared, without embarrassment, ostiums were opened, without scab （0 score）. In group B, 6 cases of 9 cases gained 0 score （66.7%） ,3 cases had a running nose or blood stain occasionally, with scab in maxillary sinus,the average score was 3（33.3%）; 6 patients of group B II （total 8 cases） got 0 score （75.0%）,the average score of the other 2 was 3 （25.0%）. After following up for 1 - 2 years, 2 cases were recurred, 1 case was in B I , the other was in B II. There were obvious differences between group A and group B （ P 〈0.01） ,and no obvious differences between group I and group II. Conclusion Clearing up the infected focus by endoscopic sinus surgery is an effective treatment of fungal rhinoantri

关 键 词：上颌窦炎 真菌 灌洗 

分 类 号：R765.42[医药卫生—耳鼻咽喉科]