新疆医科大学学报

目的探讨鼻内镜手术治疗慢性鼻-鼻窦炎术后复发病例的手术操作因素和病变主要集中的部位。方法回顾性分析2007年4月-2012年4月在新疆医科大学第二附属医院耳鼻咽喉科就诊的51例复发的慢性鼻-鼻窦炎患者的临床资料,并对其中资料完整的46例复发患者的随访结果进行分析,统计致复发的手术操作因素和病变主要集中的部位。结果 46例患者中引起复发的手术操作因素按从高到低的顺序依次为中鼻甲处理不当(32.6%)、筛窦病变清除不彻底(23.9%)、鼻丘气房与额隐窝病变清除不彻底(15.2%)、上颌窦处理不当(10.9%)、高位鼻中隔偏曲未矫正(8.7%)、钩突尾端残留(6.5%)、其他因素(2.2%);复发病变主要集中的部位按从高到低的顺序依次为中鼻甲、筛窦、额窦、上颌窦、鼻中隔、钩突。结论在引起慢性鼻-鼻窦炎术后复发的手术操作因素中,中鼻甲处理不当居于首位,其次是筛窦病变清除不彻底、鼻丘气房与额隐窝病变清除不彻底等;复发病例病变主要集中的部位也以中鼻甲为首,其次是筛窦、额窦等。

Objective To evaluate the surgery causes and the main damage parts of the recurrent chronic rhinosinusitis after nasal endoscopic surgery.Methods A retrospective analysis was adopted in the clinical data of 51cases of patients with recurrent chronic rhinosinusitis in the Second Affiliated Hospital of Xinjiang Medical University from April 2007to April 2012and a continuing analysis in follow-up survey of 46 cases among them,in which the cases of the surgery causes and main damage parts of the recurrent patients were collected and analysed.Results The surgery causes inducing 46cases recurrent chronic rhinosinusitis included improper handling of the middle turbinate,with percentage of 32.6%,incomplete removal of the ethmoid sinus,with percentage of 23.9%,incomplete removal of the agger nasi air cells and the frontal recess,with percentage of 15.2%,improper handling of the maxillary sinus,with percentage of 10.9%,the deviation of the upper nasal septum,with percentage of 8.7%,incomplete removal of the uncinate process end,with percentage of 6.5%,and unknown,with percentage of 2.2%;the main damaged parts were the middle turbinate,the ethmoid sinus,the agger nasi air cells and the frontal recess,the maxillary sinus,the upper nasal septum,the uncinate process end.Conclusion Improper handling of the middle turbinate,which is one of the surgery causes of the recurrent chronic rhinosinusitis after nasal endoscopic surgery,is the most common,then incomplete removal of the ethmoid sinus,incomplete removal of the agger nasi air cells and the frontal recess and so on.The main damaged part of the recurrent chronic rhinosinusitis is located most often in he middle turbinate.