术前CT扫描对鼻内镜下额窦开放术径路选择的作用  

Effect of preoperative computed tomographic scans on the selection of endoscopic frontal sinus surgery pathways

作　　者：陈泽[1] 梁敏志[1] 钟兆棠[1] 陈声伟[1] 

机构地区：[1]广东省高州市人民医院耳鼻喉科,广东高州525200

出　　处：《中国医药导报》2011年第22期56-58,共3页China Medical Herald

摘　　要：目的：探讨经术前CT扫描后对鼻内镜下额窦开放术径路方式的选择。方法：接受鼻内镜下额窦开放术的52例（94侧）患者,根据术前CT扫描,其中鼻丘气房气化良好、钩突附着处在纸样板或有变异额筛气房的患者为鼻丘径路组,行鼻内镜下鼻丘径路额窦开放术36例（66侧）,开放鼻丘前壁,经鼻丘后内上方开放额窦;鼻丘气房气化不良并钩突附着处在颅底或中鼻甲患者为筛泡基板前径路组,以钩突及筛泡基板前为主要参考标志的鼻内镜下额窦开放术（筛泡基板前径路）16例（28侧）,通过对钩突上端与鼻腔外侧壁附着点的位置判断,在筛泡基板前方开放额窦。结果：①两组术中径路和术前选择后设计的径路符合,不需要改变径路,手术成功率皆为100%。②术后无颅底及眼眶并发症患者。③所有患者随访6~12个月（平均9个月）,术后主观症状均有不同程度的缓解,两组患者的有效率分别为98.48%、96.43%,两组比较,差异无统计学意义（χ2=1.372 4,P〉0.05）。结论：①鼻丘径路和筛泡基板前径路的鼻内镜下额窦开放术皆可有效地治疗慢性额窦炎。②根据术前CT扫描选择不同径路可能更好按术前设计地完成手术,并降低手术并发症,可获得满意疗效。Objective： To evaluate the effect of preoperative computed tomographic（CT） scans on the selection of endoscopic frontal sinus surgery pathways.Methods： Fifty-two patients（94 sides） who underwent endoscopic frontal sinus surgery were randomly divided into two groups according to the preoperative CT scans.In one group,agger nasi cell approach was adopted to treat 36 patients（66 sides） who got good vaporization of the agger nasi cell with uncinate processes attached to papyraceous lamina or had variant fronto-ethmoidal cells.In the other group,the route anterior to basal lamella of bulla were used in 16 patients（28 sides） who got adverse vaporization of the agger nasi cell with uncinate processes attached to basis cranii or suffered from middle nasal concha.Results： ①The achievement ratio of operation was 100% in both groups with the approach applied intraoperatively consistent with the one designed preoperatively.②No basicranial or orbital complication had been noted.③After an average followed-up of 9 months（6-12 months）,65 sides of 66 sides（98.48%） were endoscopically healed by using agger nasi cell approach.And 27 sides of 28 sides（96.43%） were healed by applying the route anterior to basal lamella of bulla.Conclusion： ①The endoscopic frontal sinus surgery by using agger nasi cell approach or by applying the route anterior to basal lamella of bulla is effective for chronic frontal sinusitis.②Surgery pathway according to the preoperative CT scans is the effective and satisfactory to accomplish the designed operation.

关 键 词：鼻窦CT扫描 解剖学 额窦 内镜手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]