球囊导管扩张术治疗慢性鼻-鼻窦炎失败原因分析  

The possible failing reasons of balloon catheter dilation procedure in the management of chronic rhinosinusitis

作　　者：李明仙 张永春[1] 张维天[1] 叶海波[1] 李大伟 苏开明[1] LI Mingxian ZHANG Yongchun ZHANG Weitian YE Haibo LI Dawei SU Kaiming(Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People＇s Hospi tal, Shanghai Jiao Tong University, Shanghai, 200233,Chin)

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉头颈外科,上海200233

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第5期336-341,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨球囊导管扩张术(BCD)治疗慢性鼻-鼻窦炎(CRS)的技术可行性、安全性及临床疗效,分析导致BCD失败的可能因素以及解决措施。方法:对2014-09-2016-12期间行单纯鼻窦BCD、功能性内镜鼻窦手术(FESS)辅助BCD以及完全变更为FESS的32例患者(46个鼻窦)进行回顾性分析。术后随访1、3及6个月,对术中技术操作难点、疗效进行回顾,评估BCD治疗CRS的技术适应性以及局限性。结果:拟行BCD的32例(46个窦口)患者,包括19个上颌窦、22个额窦、5个蝶窦,单纯BCD以及FESS辅助BCD共成功扩张13个上颌窦、19个额窦、4个蝶窦。13个上颌窦中单纯行BCD者有9个,其他4个辅助钩突部分切除或鼻腔息肉切除等术式;22个额窦中19个BCD成功扩张,3个额窦因引流通道曲折,额窦BCD失败后行FESS开放额窦;5个蝶窦中BCD成功扩张4个,1个因蝶筛隐窝息肉,蝶窦内分隔气房致扩张失败。术后随访1、3、6个月,结果显示患者生活质量(SNOT-20)评分中症状明显缓解,鼻腔黏膜状况较术前明显改善,无明显瘢痕形成,扩张窦口持续开放,无明显狭窄,无严重术后并发症发生。结论:BCD治疗CRS安全有效,但BCD依然有其技术局限性。术前需根据患者的病情以及全面的影像学检查进行评估,以提高BCD的成功率。Objective：To investigate the effectiveness of balloon catheter dilation（BCD）in the treatment of chronic rhinosinusitis,and to analyse the possible factors which lead to BCD failure,as well as to provide basic reference for BCD clinical usage.Method：Forty-six sinuses of 32 patients with chronic rhinosinusitis were underwent ＂ Balloon-only＂ BCD or ＂ FESS assisted＂ BCD at our institution between September 2014 and December 2016.By recording details of the operation of all the subjects in this study and following up the clinical symptoms,nasal endoscopy,computed tomography of the sinuses,and postoperative complications six months after operation,to evaluate the difficulty,safety,effectiveness and especially,the failing reasons of BCD.Result：BCD was approached in 46 sinuses（19 maxillary sinus,22 frontal and 5 sphenoid）,and succeeded in 13 maxillary sinuses,19 frontal sinuses,and 4 sphenoid sinuses.Of the 13 maxillary sinuses,there were 9 sinuses underwent ＂ Balloon-only＂ procedure,other 4 cases underwent ＂ FESS assisted＂ procedure.There were 3 cases of frontal sinus failed,because of the frontal recess anatomical complexity and the twisted drainage.Of the 5 sphenoid sinuses,4 cases succeeded,including fungal sphenoiditis cases,in which the mould was completely cleared through the dilated ostia,and 1 case failed.All the patients were followed up for 1,3 and 6 months of patient＇s quality of life,nasal endoscope,computed tomography of the sinuses.The results showed that the SNOT-20 scores of the quality of life in significant relief of symptoms,nasal mucosa status improved significantly compared with the preoperative,dilated ostium remains open,no obvious scar formation,no severe operative complications.Conclusion：Balloon catheter dilation in the treatment of chronic rhinosinusitis is safe and effective.But the operation indications is limited,and many factors influence the success rate of BCD,so,preoperatively gaining the information of nasal cavity and anatomical structure around ostiu

关 键 词：慢性鼻-鼻窦炎 球囊导管扩张术 可行性 成功率 失败率 

分 类 号：R765.41[医药卫生—耳鼻咽喉科]