额窦相关头痛患者额隐窝气房发育的影像学特点分析  

Anatomical variations and it’s imaging characteristics of frontal recess cells in patients with frontal sinus related headache

作　　者：刘承耀[1,2] 王向东[1,2,3] 许庆刚[4] 崔世磊[5] 刘仲燕[1,2] 赵岩[1,2] 张罗 LIU Chengyao;WANG Xiangdong;XU Qinggang;CUI Shilei;LIU Zhongyan;ZHANG Luo(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University),Ministry of Education,Beijing,100730,China;Beijing Institute of Otolaryngology,Beijing Key Laboratory of Nasal Diseases,Beijing,100005,China;Department of Allergy,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Department of Imaging,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈外科学教育部重点实验室(首都医科大学),北京100730 [2]北京市耳鼻咽喉科研究所,鼻病研究北京市重点实验室,北京100005 [3]首都医科大学附属北京同仁医院变态反应科,北京100730 [4]首都医科大学附属北京同仁医院影像科,北京100730 [5]首都医科大学附属北京同仁医院神经内科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2024年第4期242-247,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家重点研发计划(2022YFC2504100);教育部长江学者创新团队(IRT13082);中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-022);首都卫生发展科研专项重点攻关项目(2022-1-1091)。

摘　　要：目的根据国际额窦解剖分类(International Frontal Sinus Anatomy Classification,IFAC)确定额窦相关头痛患者额隐窝气房变异的出现率,探讨额隐窝气房变异在额窦相关头痛发病中的作用。方法回顾46例额窦相关头痛接受鼻内镜手术治疗患者的鼻窦CT,分析其额隐窝引流区域的额隐窝相关气房,并分析中鼻道变异和鼻窦受累情况。观察其在头痛与否之间表达是否有差异。结果92侧鼻窦CT中,鼻丘气房(agger nasi cell,ANC)出现率为100%(92/92),其次筛泡上气房(supra bulla cell,SBC)为78.3%(72/92),鼻丘上气房(supra agger cell,SAC)为67.4%(62/92),筛泡上额气房(supra bulla frontal cell,SBFC)为27.2%(25/92),鼻丘上额气房(supra agger frontal cell,SAFC)为20.7%(19/92),额窦间隔气房(frontal septal cell,FSC)为8.7%(8/92),眶上筛房(supraorbital ethmoid cell,SOEC)为0%(0/92)。在传统的额窦引流区域,IFAC分类中的SBFC(P=0.0108)和SAC(P=0.0104)和SAFC(P=0.0088)与额窦相关头痛的发生有显著相关。中鼻道变异如泡状中鼻甲也表现出和额窦相关头痛的发生明显相关(P=0.0390)。结论在额隐窝引流通道中,SAC、SAFC、SBFC及泡状中鼻甲的发育异常均与额窦相关性头痛具有明显的相关。OBJECTIVE To determine the prevalence of frontal recess cells variations in patients with frontal sinus associated headache according to the International Frontal Sinus Anatomy Classification(IFAC).METHODS A retrospective study was conducted on the CT scans of sinuses in patients with frontal sinus associated headache.We reviewed 46 patients with frontal sinus-related headache who had clinical symptoms and were relieved after nasal endoscopic surgery.The development of frontal recess cells in the frontal recess drainage area was analyzed,and the variation of middle meatus and sinus involvement were analyzed in the same time.The Anatomical variations and imaging characteristics of frontal recess cells development in patients with frontal sinus associated headache were analyzed.RESULTS A total of 92 sinus CT profiles were analyzed in 46 patients.The most common cells were agger nasi cell(ANC)(100%,92/92),followed by supra bulla cell(SBC)(78.3%,72/92),supra agger cell(SAC)(67.4%,62/92),supra bulla frontal cell(SBFC)(27.2%,25/92),supra agger frontal cell(SAFC)(20.7%,19/92),frontal septal cell(FSC)(8.7%,8/92)and supraorbital ethmoid cell(SOEC)(0%,0/92).In the conventional frontal sinus drainage area,SAFC(P=0.0108),SAC(P=0.0104)and SAFC(P=0.0088)in the IFAC classification were significantly associated with the occurrence of frontal sinus associated headache.At the same time,the middle concha bullosa also showed a significant correlation with the occurrence of frontal sinus associated headache in the lower segment of the frontal recess drainage channel(P=0.0390).CONCLUSION In the frontal recess drainage channel,the abnormal development of SAC,SAFC,SBFC and the middle concha bullosa are significantly correlated with frontal sinus associated headache.

关 键 词：额窦 头痛 额隐窝 国际额窦解剖分类 泡状中鼻甲 

分 类 号：R765[医药卫生—耳鼻咽喉科]