摘要
目的:探讨内镜鼻窦手术中眶上筛房(SOEC)定位额窦口(FO)和筛前动脉(AEA)的作用,以及AEA内镜分型的临床意义。方法:收集116例慢性鼻窦炎患者的临床资料,筛选出伴有SOEC并完成DrafⅡA型手术者36例(47侧),记录SOEC与FO、AEA的影像-解剖关系。根据内镜下AEA隆起范围与筛顶的关系,将其分为1型(隆起向内延伸未超越筛顶外侧1/3)、2型(超出1/3,但未超越2/3)和3型(超越筛顶2/3)。结果:SOEC出现率占同期DrafⅡA型手术侧别的26.1%(47/180)。CT上,7侧FO被鼻丘上额气房或筛泡上额气房占据,其余40侧(85.1%)均紧邻SOEC前方。AEA100%位于SOEC后缘附近,其中6侧(12.8%)贴附于颅底、41侧(87.2%)悬空于筛顶。内镜下,SOEC识别率为89.4%(42/47),5侧(10.6%)因黏膜水肿、出血等因素未能确认。AEA识别率为76.6%(36/47),其中1型、2型和3型分别占41.7%(15/36)、38.9%(14/36)和19.4%(7/36)。去除额筛气房后,所有FO均位于SOEC的前方或前内侧,所有可识别的AEA在筛前孔水平位于SOEC开口的后缘。结论:SOEC是内镜鼻窦手术中定位FO和AEA的可靠标志;AEA内镜分型有利于指导额筛区域的精准手术。
Objective: To investigate the role of the supraorbital ethmoidal cell(SOEC) in identifying the frontal sinus ostium(FO) and the anterior ethmoidal artery(AEA) in endoscopic sinus surgery, and to evaluate the clinical significance of a proposed endoscopic classification of AEA. Methods: The clinical data of 116 patients with chronic rhinosinusitis were collected. Thirty-six patients(47 sides) with SOEC and DraftⅡA frontal sinusotomy were included. The radiological-anatomical relationship between SOECs and FO, AEAs were recorded. Endoscopic classification of AEA was proposed according to the relationship between the AEA and the ethmoidal roof(EF): type 1, the AEA prominence did not extend beyond the lateral one-third of the EF;type 2, that exceed the lateral one-third but not beyond two-thirds of the EF;type 3, that exceed the lateral two-thirds of the EF. Results: The incidence of SOECs was 26.1%(47/180) of the DraftⅡA operating sides. On computed tomography images, seven sides of FO were occupied by supra agger frontal cells or supra bulla frontal cells;the other 40 sides(85.1%) were immediately anterior to the SOECs. The AEAs were 100% located near the posterior margins of SOECs with 6(12.8%) running under the EF and 41(87.2%) low-lying distant from the EF. Under endoscopy, the identification rate of SOECs was 89.4%(42/47), and five(10.6%) SOECs were not confirmed due to edematous mucosa, bleeding, and other reasons. The identification rate of the AEA was 76.6%(36/47), of which type 1, type 2 and type 3 accounted for 41.7%(15/36), 38.9%(14/36) and 19.4%(7/36) respectively. After removing the frontoethmoidal cells, all the FO were located anteriorly or anteromedially to the SOECs. All the identified AEAs were located in the posterior boundary of the SOEC openings at the level of the anterior ethmoidal foramen. Conclusion: The SOEC is a reliable landmark for locating the FO and the AEA in endoscopic sinus surgery. The new endoscopic classification of AEA helps the surgeon dissect the frontoethmoidal region pre
作者
冯燕军
闫素英
王建宏
刘怡
李希平
FENG Yanjun;YAN Suying;WANG jianhong;LIU Yi;LI Xiping(Department of Otolaryngology Head and Neck Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,China)
出处
《临床耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2021年第6期495-500,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
内镜鼻窦手术
鼻窦炎
眶上筛房
筛前动脉
额窦口
endoscopic sinus surgery
sinusitis
supraorbital ethmoid cell
anterior ethmoidal artery
frontal sinus ostium
