真菌球型上颌窦炎鼻内镜下两种手术路径的临床研究

目的:比较鼻内镜下中鼻道联合下鼻道小视窗双路径术和单独下中鼻道开窗术治疗真菌球型上颌窦炎的临床疗效。方法:采用前瞻性随机对照试验,将2013年8月~2015年5月在我院择期行手术治疗的50例真菌球型上颌窦炎患者分为观察组与对照组,每组25例,对照组行鼻内镜单独下中鼻道开窗术,观察组在对照组的基础上联合下鼻道小视窗术。术前及术后6个月采用鼻腔鼻窦结局测试20条量表(SNOT-20)对两组患者进行评分,术后6个月对鼻黏膜纤毛清除功能及疗效进行评估,比较两组手术时间及术中出血量。结果:术后6个月两组SNOT-20量表评分显著低于术前,且观察组显著低于对照组(P0.05)。术后6个月观察组粘膜纤毛传输时间(MTT)显著低于对照组(P0.05)。两组总有效率、手术时间及术中出血量比较,差异均无统计学意义(P0.05)。结论:鼻内镜下以上两种手术路径治疗真菌球型上颌窦炎的疗效相近,但鼻内镜下中鼻道联合下鼻道小视窗双路径术更有利于减轻患者症状及促进鼻黏膜纤毛清除功能恢复。

Clinical Study of Nasal Endoscopic Surgery with Two Surgical Approachs for Fungus Ball Maxillary Sinusitis

Objective:To Compare the clinical effect between dual approach surgery of middle and inferior meatus combined with small window in inferior meatus with single approach surgery of middle and inferior meatus under nasal endoscopy in treatment of fungus ball maxillary sinusitis.Methods:Used the prospective randomized controlled trial, 50 patients with fungus ball maxillary sinusitis underwent selective operation in our hospital from August 2013 to May 2015, who were divided into observation group and control group, with 25 cases in each group, the control group was treated with single approach surgery of middle and inferior meatus under nasal endoscopy, and the observation group was combined with small window in inferior meatus on the basis of the control group, the patients of two groups were scored by the sino-nasal outcome test-20 (SNOT-20)scale before and 6 months after operation, and the function of nasal mucosal cilia clearance and efficacy were evaluated at 6 months after operation,then compared the operation time and blood loss during operation in two groups.Results:The SNOT-20 scale scores of two groups 6 months after operation were significantly lower than before operation, and which of the observation group was significantly lower than the control group (P<0.05); The mucociliary transport time(MTT)of the observation group was significantly lower than control group(P<0.05); Compared the total effective rate, operation time and blood loss during operation in the two groups, the difference was not statistically significant (P<0.05).Conclusion:The effect of above two surgical approachs under nasal endoscopy is similar in the treatment of patients with fungus ball maxillary sinusitis, but the dual approach surgery of middle and inferior meatus combined with small window in inferior meatus under nasal endoscopy is more conducive to reducing the symptoms and promoting the recovery of the function of nasal mucosa cilia clearance.