上颌窦后鼻孔息肉起源临床观察  

Clinical observation on the origin of antrochoanal polyp

作　　者：李树华[1] 石洪金[1] 吴大海[1] 史春海[1] 

机构地区：[1]沈阳军区总医院耳鼻咽喉科110016

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第9期764-766,共3页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的通过对临床病例的系统研究，探讨上颌窦后鼻孔息肉的起源。方法对26例上颌窦后鼻孔息肉患者进行系统临床研究，包括术前鼻内镜检查、冠状位和轴位CT扫描观察、术中鼻内镜下观察后鼻孔息肉与上颌窦内病变的关系、切除标本的大体观察和组织病理学检查等，综合分析所有资料，讨论上颌窦后鼻孔息肉的起源及形成机制。结果术前鼻内镜检查中17例可以明确观察到息肉根蒂部出自上颌窦口或副口，CT扫描中19例可以明确观察到中鼻道后鼻孔软组织影与上颌窦内软组织影联系密切。术中追踪息肉起源发现23例患者上颌窦内病变为囊肿，后鼻孔息肉根蒂部与上颌窦囊肿关系密切，一般为根蒂经上颌窦口与囊肿相连，将息肉连同囊肿一并切除后，发现息肉表面黏膜与囊肿的囊壁相延续，息肉本身成为囊壁增生肥厚的一部分。结论上颌窦后鼻孔息肉多起源于同侧上颌窦囊肿，其发病机制推测为上颌窦内逐渐增大的上颌窦囊肿最终自上颌窦口膨出到中鼻道并逐渐增大，并逐渐突向后鼻孔，最终形成上颌窦后鼻孔息肉。Objective To explore the origin and etiopathogenesis of antroehoanal polyp （ACP） based on the clinical data. Methods Twenty-six patients with ACP were included in the study. All the ACP patients were documented by preoperative endoscopy and computer tomographic （CT） scans. All patients were treated under endonasal endoscopic surgery. The relationship between polyp in middle meatus and lesions in the antrum was observed during the surgery. Following surgical removal, the polyps and lesions in the antrum were studied under maeroscopy and microscopy. Results Among 26 cases with ACP, 17 cases were confirmed by preoperative endoscopic examination that polyp originating from antrum ostium, 19 cases showed intimate relationship between the polyp and antrum lesions in CT scan, and 23 cases were found that the polyp originating from the antrum cyst. The pedicle of polyp connected the cyst through autrum ostium, and the polyp existed as a part of capsule wall. Conclusion Based on the data obtained, it is tempting to suggest that the ACP mainly develops from antral cyst, an increase in pressure in cyst forced capsule wall to herniate to middle meatus through the antral ostium, and the continuous herniation and hyperplasy leading to the formation of ACP.

关 键 词：鼻息肉 上颌窦 囊肿 内窥镜检查 耳鼻喉外科手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]