伴有骨质破坏的单侧慢性细菌性上颌窦炎的临床研究  

Clinical Study on Unilateral Chronic Bacterial Maxillary Sinusitis Accompanied by Bone Destruction

作　　者：杨敬[1] 邵辉[1] 张丽萍[1] 马政 王浩 李鹏[1] 侯丽[1] YANG Jing;SHAO Hui;ZHANG Liping;MA Zheng;WANG Hao;LI Peng;HOU Li(Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院耳鼻咽喉头颈外科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2024年第9期916-920,共5页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发计划项目(2022BEG3015)。

摘　　要：目的探讨伴有骨质破坏的单侧慢性细菌性上颌窦炎的临床特点及其相关因素。方法对2021年1月至2022年12月宁夏医科大学总医院耳鼻咽喉头颈外科收治的44例伴有骨质破坏的单侧慢性细菌性上颌窦炎患者的电子鼻咽镜下特点、影像学特点、细菌培养结果等进行临床分析。结果44例患者的主要症状与其他鼻窦炎相比无特殊性。镜下所见患侧鼻腔中鼻道向内膨隆、黏膜水肿、大量白色脓涕潴留并脱向鼻咽部。影像学特点,CT表现为单侧上颌窦腔内均匀低密度影填充,上颌窦口周围有骨质破坏,其中钩突尾端破坏最显著;MRI表现为T1窦壁黏膜呈高信号,增强后明显强化,患侧上颌窦腔内呈均匀低信号,增强后无强化,T2患侧上颌窦腔内见囊液性信号填充,中心可见斑片状高信号影,窦壁黏膜呈结节样增厚。在结构上,与健侧相比,患侧筛泡截面积比健侧大(P<0.05),鼻窦炎在鼻中隔偏曲患者的狭窄侧比宽敞侧多(P<0.05);一般细菌培养阳性率为77.27%(34/44)。共分离出9种细菌,排在前3名的菌种依次为凝固酶阴性葡萄球菌40.91%(18/44)、草绿色链球菌31.82%(14/44)和星座链球菌9.09%(4/44)。结论单侧慢性细菌性上颌窦炎的骨质破坏仅限于上颌窦口周围,以钩突尾端破坏为主;患侧筛泡肥大、鼻中隔偏向患侧可能是窦口阻塞的影响因素;葡萄球菌与链球菌可能是此类鼻窦炎的致病菌。Objective To explore the clinical characteristics and related factors of unilateral chronic bacterial maxillary sinusitis accompanied by bone destruction.Methods Clinical analysis was conducted on 44 patients with unilateral chronic bacterial maxillary sinusitis accompanied by bone destruction who were admitted to the Department of Otolaryngology Head and Neck Surgery of General Hospital of Ningxia Medical University from January 2021 to December 2022,including electronic rhinoscopy characteristics,imaging characteristics,and bacterial cultivation results.Results The main symptoms of the 44 patients were not specific compared with other sinusitis.Under the nasal endoscope,the nasal cavity on the affected side showed inward expansion,mucosal edema,large amounts of white purulent mucus retention,and drainage towards the nasopharynx.Imaging characteristics showed that the CT indicated that the unilateral maxillary sinus cavity was filled with uniformly low density shadows,and there was bone destruction around the maxillary sinus opening,especially at the end of the hook.The MRI indicated that the T1 sinus wall mucosa was of high signal,with obvious enhancement after contrast,and the unilateral maxillary sinus cavity was of homogeneous low signal,with no enhancement after contrast,T2 showed a signal filling with liquid in the unilateral maxillary sinus cavity,and scattered high signal shadows were visible in the center,and there was nodular thickening of the sinus wall mucosa.In terms of structure,compared with the healthy side,the sectional area of the affected side's ethmoid sinus was larger,with significant statistical differences(P<0.05),The narrow side of the patients with sinusitis in nasal septum deviation was narrower than the spacious one,with significant statistical differences(P<0.05).The positive rate of general bacterial cultivation was 77.27%(34/44).A total of nine kinds of bacteria were isolated,of which the top three were negative coagulase Staphylococcus aureus 40.91%(18/44),Streptococcus viridans 31

关 键 词：鼻中隔偏曲 鼻窦炎 上颌窦炎 细菌学分析 

分 类 号：R783.6[医药卫生—口腔医学]