摘要
目的通过CT分析筛上颌窦(ethmomaxillary sinus,EMS)气房在慢性鼻窦炎(chronic rhinosinusitis,CRS)患者中的出现率及影像学特点,并探讨其在内镜上颌窦手术中的意义。方法回顾性分析2017年2—12月于北京大学人民医院耳鼻咽喉科住院行手术的CRS患者111例,其中双侧病变79例,单侧病变32例。根据有无手术史分为两组,仅对CRS的患侧进行分析,无手术史组98例(167侧),有手术史组13例(23侧)。观察患者鼻窦CT,统计两组CRS患侧的EMS气房发生率,并对无手术史组中CRS患侧与EMS气房相关的影像学特点及相关解剖变异进行分析。采用SPSS 22.0进行统计学分析。结果在CRS患侧EMS气房的发生率有手术史组为21.7%(5/23),无手术史组为12.0%(20/167),两组之间差异无统计学意义(χ2=0.940,P>0.05)。EMS气房的内外径范围为8.50~14.10 mm,平均(10.38±1.69)mm(均值±标准差,下同)。按EMS气房与上颌窦间隔突起方向分为突向EMS气房(2侧)、突向上颌窦(5侧)和平直(13侧)共3种类型。有EMS气房和无EMS气房的病例的上颌窦Lund-Mackay评分(LM值)的差异无统计学意义[(1.60±0.50)分比(1.40±0.62)分,Z=1.285,P>0.05]。EMS气房从后、上、内侧挤压上颌窦口引流,所有患者的EMS气房均经鼻内镜手术开放以改善引流。无手术史组中EMS气房合并出现的解剖变异包括Onodi气房(7/20)、Haller气房(3/20)、泡样中鼻甲(6/20)及上颌窦发育不全(3/20)。结论EMS气房在CRS患者中并不少见,其毗邻眼眶,向外过度气化,影响上颌窦的引流,手术中去除上颌窦与EMS气房的间隔可以改善上颌窦引流。
Objective To investigate the prevalence and radiographic characteristics of ethmomaxillary sinus(EMS)in chronic rhinosinusitis(CRS)patients by CT scan,as well as their endoscopic surgical significance in antrostomy.Methods A retrospective analysis of 111 CRS patients who were prepared for surgery in Department of Otorhinolaryngology Head and Neck Surgery of Peking University People′s Hospital from February to December of 2017 was performed.In all CRS patients,79 patients were bilateral CRS and 32 were unilateral.The patients were divided into two groups according to whether they had history of surgery.Only the sides with CRS were analyzed.There were 98 patients(167 sides)in the non-surgical history group and 13 patients(23 sides)in the surgical history group.The prevalence of EMS in CRS sides in the two groups was counted by analyzing the CT images.The CT image features and anatomical variations associated with EMS in CRS sides in the non-surgical history group were also analyzed.SPSS 22.0 software was used for statistic analysis.Results The prevalence of EMS in CRS sides was 21.7%(5/23)in the surgical history group and 12.0%(20/167)in the non-surgical history group.No statistically significant difference in the prevalence of EMS was found between the two groups(χ2=0.940,P>0.05).The medial-lateral diameters of the EMS ranged from 8.50 to 14.10 mm with an average of(10.38±1.69)mm(Mean±SD).The shape of the bony septum between the EMS and maxillary sinus was divided into three types:convex toward to the EMS(2 sides),convex toward to maxillary sinus(5 sides)and flat(13 sides).The Lund-Mackay(LM)scores of the maxillary sinuses in patients with and without EMS showed no statistically significant difference(1.60±0.50 vs 1.40±0.62,Z=1.285,P>0.05).The EMS obstructed the drainage of maxillary sinus posteriorly,medially and superiorly.All the EMS in diseased sides were dissected endoscopicly to improve drainage.In the non-surgical history group,the EMS coexisting anatomic variations were the Onodi cell(7/20),Haller c
作者
史慕寒
王旻
李辉
吴雨潇
Shi Muhan;Wang Min;Li Hui;Wu Yuxiao(Department of Otorhinolaryngology Head and Neck Surgery,Peking University People′s Hospital,Beijing 100044,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2019年第11期813-818,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
首都卫生发展科研专项基金(2016-1-2052)
北京大学人民医院研究发展基金(RDB-2015-03)。
