中鼻道联合泪前隐窝入路治疗真菌性上颌窦炎17例  

Maxillary sinusotomy through middle meatus combined with anterior lacrimal recess for treatment of 17 patients with fungal maxillary sinusitis

作　　者：胡志孟[1] 张思聪[1] 邹坚定[1] 熊华[1] 孙民[1] 胡博侠 

机构地区：[1]浙江省慈溪市人民医院耳鼻喉科,上海315300

出　　处：《中国眼耳鼻喉科杂志》2016年第3期214-215,共2页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨中鼻道上颌窦开窗术联合泪前隐窝入路治疗真菌性上颌窦炎的可行性及效果。方法选取2012年6月~2014年7月在本科进行治疗的17例非侵袭性真菌性上颌窦炎患者,所有病例均累及上颌窦前、前内下壁及底壁。先在0°鼻内镜下开放并扩大上颌窦自然口,清理窦腔内病变组织。更换70°鼻内镜观察病变组织在上颌窦前、前内下壁及底壁残留。无法彻底清理时,联合泪前隐窝径路继续清理病变组织。术后门诊定期进行鼻内镜复查6个月以上。结果 17例患者术后病理均证实为真菌感染,无一例出现鼻泪管损伤,术后血涕、面部胀痛、头痛、鼻腔异味症状逐步消失。15例（88.2%）获得临床治愈,2例（11.8%）好转。结论上颌窦真菌性病变累及上颌窦前、前内下壁及底壁时,采用中鼻道联合泪前隐窝入路,能安全、有效地清除病变。Objective To investigate the feasibility and effect of maxillary sinusotomy through middle meatus combined with anterior lacrimal recess in the treatment of fungal maxillary sinusitis. Methods Seventeen cases with non-invasive fungal maxillary sinusitis treated from June 2012 to July 2014 were included. The anterior wall,anterior internal wall and proximal wall of maxillary sinus were all involved in these cases. The maxillary sinusotomy was carried out by using 0° nasal endoscope and the lesions in maxillary sinus were cleaned. Any residual lesion on the anterior wall,anterior internal wall and proximal wall of maxillary sinus was examined and cleaned by using 70° nasal endoscope. The way through anterior lacrimal recess was taken to clean the lesion if was difficult to reach through middle nasal meatus.After the operation,all patients were regularly followed up by nasal endoscope for more than six months. Results All the 17 cases were confirmed fungal infection by pathology. None had nasolacrimal duct injury. Postoperative blood nasal discharge,facial pain,headache,nasal odor symptoms gradually disappeared. Fifteen cases（88. 2%） were clinically cured,and 2 cases（11. 8%） were improved. Conclusions Maxillary sinusotomy through middle meatus combined with anterior lacrimal recess is safe and effective for the treatment of fungal maxillary sinusitis involving anterior wall,anterior internal wall and proximal wall.

关 键 词：中鼻道 泪前隐窝 真菌性上颌窦炎 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]