上颌窦后鼻孔息肉的起源及多种入路处理上颌窦后鼻孔息肉疗效的比较  

Observe the origin of antrochoanal polyp and the comparison of the curative effect of antrochoanal polyp

作　　者：郑文雯[1] 胡国勤[1] 刘斌[1] 刘诗敏[1] 王琴[1] 孙晓飞[1] 周虎军[1] 

机构地区：[1]合肥市第二人民医院耳鼻咽喉头颈外科,合肥230011

出　　处：《临床耳鼻咽喉头颈外科杂志》2016年第3期209-212,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨上颌窦后鼻孔息肉的起源及疗效。方法:对57例上颌窦后鼻孔息肉患者进行术前鼻内镜检查、冠状位和轴位CT扫描;分别采用鼻内镜下中鼻道上颌窦开窗术、联合中鼻道及下鼻道开窗术、联合鼻内镜下鼻腔侧壁切开入路及中鼻道开窗3种手术方式;术中鼻内镜下观察后鼻孔息肉与上颌窦内病变的关系、组织病理学检测结果;术后进行随访。结果:57例上颌窦后鼻孔息肉起源于同侧上颌窦囊肿,22例中鼻道上颌窦开窗术,复发2例;17例联合中鼻道及下鼻道开窗术,复发1例;18例联合鼻内镜下鼻腔侧壁切开入路及中鼻道开窗术,治愈率100%。结论:上颌窦后鼻孔息肉起源于上颌窦内囊肿,囊壁由窦口脱出于中鼻道及鼻咽部形成息肉,常见于单侧,偶发双侧。鼻内镜下中鼻道上颌窦开窗术、联合中鼻道及下鼻道开窗术有很好的疗效,对于上颌窦前壁的囊肿联合鼻内镜下鼻腔侧壁切开入路可获得较好的视野,有利于病变的完整切除。Objective：To explore the curative effect and origin of antrochoanal polyp（ACP）with various approaches.Method：Fifty-seven patients with ACP were included in the study.All the ACP patients were examined by preoperative endoscopy and computer tomographic（CT）scans.The patients were treated by various endoscopic approaches including endoscopic middle meatus antrostomy,inferior meatus antrostomy combined with endoscopic middle meatus antrostomy or endoscopic medial maxillectomy combined with endoscopic middle meatus antrostomy respectively.The relationship between polyp location in middle meatus and lesions in the antrum was explored during the surgery.Pathological examination was carried out and patients were regularly followed up after operation.Result：Fifty-seven ACP develops from antral cyst.In 22 cases of endoscopic middle meatus antrostomy,two patients relapsed.In 17 cases of inferior meatus antrostomy combined with endoscopic middle meatus antrostomy,one patients relapsed.In 18 cases of endoscopic medial maxillectomy combined with endoscopic middle meatus antrostomy,no one relapsed.Conclusion：Our data indicated that the ACP mainly originates in antral cyst,and capsule wall herniates to middle meatus through the antral ostium.ACP are common in unilateral,rare in both sides.The endoscopic approaches of middle meatus antrostomy and inferior meatus antrostomy combined with endoscopic middle meatus antrostomy might guarantee good prognosis.If the cyst is on the anterior wall of maxillary sinus,the approach of endoscopic medial maxillectomy can obtain a better vision and completely remove the lesions.

关 键 词：鼻息肉 上颌窦 囊肿 内镜检查 外科手术 

分 类 号：R765.25[医药卫生—耳鼻咽喉科]