CAJ | 학술논문

目的对比全面开放和保留上颌窦下缘两种上颌窦自然开口开放方式对手术后上颌窦纤毛传输途径的影响,探讨内镜鼻窦手术(endoscopic sinus surgery,ESS)中开放上颌窦自然开口的恰当位置.方法设立3个观察组,观察示踪剂从上颌窦内向鼻腔的传出途径的差别.①正常对照组30例;②实验A组30例:ESS手术中全面开放和扩大上颌窦自然开口;③实验B组30例:ESS手术中采用上颌窦自然开口前缘和(或)后缘扩大、完整保留下缘.两个实验组均为慢性鼻-鼻窦炎经鼻内镜手术后12个月以上、窦口开放良好的病例.结果 ①正常对照组上颌窦内示踪剂均从自然开口下缘引流出,并直接进入中鼻道,其中下缘后份是核心区域;②全面扩大上颌窦自然开口组(实验A组)30例中,从下缘引流者4例(13.3%),从后缘和(或)上缘弥散进入筛窦者17例(56.7%),示踪剂堆积于上颌窦内和(或)在窦内呈旋转性传输运动,但不能引流出上颌窦者9例(30.0%);③保留上领窦自然开口下缘组(实验B组),全部通过下缘直接进入中鼻道(30/30,100%),无改变引流途径的病例.结论 ①上颌窦自然开口下缘是上颌窦纤毛传输的主要途径;②保留下缘的上颌窦自然开口扩大术后,上颌窦纤毛传输途径与正常人无差别;③全面开放上颌窦自然开口后,上颌窦纤毛传输途径发生改变,只有少数从自然开口下缘直接进入中鼻道,多数从上缘和(或)后缘弥散进入筛窦,部分积滞于上颌窦内难以排出.
목적 대비전면개방화보류상합두하연량충상합두자연개구개방방식대수술후상합두섬모전수도경적영향,탐토내경비두수술(endoscopic sinus surgery,ESS)중개방상합두자연개구적흡당위치.방법설립3개관찰조,관찰시종제종상합두내향비강적전출도경적차별.①정상대조조30례;②실험A조30례:ESS수술중전면개방화확대상합두자연개구;③실험B조30례:ESS수술중채용상합두자연개구전연화(혹)후연확대、완정보류하연.량개실험조균위만성비-비두염경비내경수술후12개월이상、두구개방량호적병례.결과 ①정상대조조상합두내시종제균종자연개구하연인류출,병직접진입중비도,기중하연후빈시핵심구역;②전면확대상합두자연개구조(실험A조)30례중,종하연인류자4례(13.3%),종후연화(혹)상연미산진입사두자17례(56.7%),시종제퇴적우상합두내화(혹)재두내정선전성전수운동,단불능인류출상합두자9례(30.0%);③보류상령두자연개구하연조(실험B조),전부통과하연직접진입중비도(30/30,100%),무개변인류도경적병례.결론 ①상합두자연개구하연시상합두섬모전수적주요도경;②보류하연적상합두자연개구확대술후,상합두섬모전수도경여정상인무차별;③전면개방상합두자연개구후,상합두섬모전수도경발생개변,지유소수종자연개구하연직접진입중비도,다수종상연화(혹)후연미산진입사두,부분적체우상합두내난이배출.
Objective The purpose of this study was to investigate the proper site for enlarging maxillary natural ostium during ESS,and to compare the draining mode of mucociliary trasportation system.Methods Three groups were designed to observe the differences of tracer agent transported from maxillary sinus to nasal cavity.Normal control group:30 cases;Trial group A:30 cases,the maxillary natural ostium were radically enlarged by all sides:Trial group B:30 cases,the maxillary natural ostiums were enlarged by reservation of whole inferior edge and cut away anterior and/or posterior edge.The patients in two trial groups were after nasal endoscopic sinus surgery for more than 12 monthes and the maxillary ostiums were well open.Results Tracer agent was drained from maxillary sinus to nasal cavity by inferior edge(s) of natural ostium in control group.The core area was posterior part of inferior edge.In trial group A,tracer agent was drained out by inferior edge in 4 cases (13.3%),tracer agent drained out by posterior and/or superior edge(s) and then dispersed to ethmoid sinus in 17 cases (56.7%),tracer agent stacked and/or circularlly flowed in the maxillary sinus,and could not be transported out in 9 cases (30.0%).In trial group B,tracer agent drained out by inferior edge to middle meatal in all subjects (30/30,100%),and there was no redirection of the mucociliary transportation.Conclusions The inferior edge of natural ostium is the main passage of mucociliary transportation system of maxillary sinus.If the inferior edge of maxillary natural ostium reserved,the post-operative drainage of maxillary sinus would be the same as normal ones. Radical removal of all edges of maxillary natural ostium could lead to redirection of mucociliary transportation,only few cases could drain out by inferior edge,most cases drained out by posterior and/or superior edge and then dispersed to ethmoid sinus.In some cases,tracer agent often stacked in the maxillary sinus and could not be drained out.When there was a need to enlarge the maxillary natural ostium in ESS, it should be done in the anterior and/or posterior edge of natural ostium,the inferior edge should not be damaged so as not to interfere the passage of mucociliary trasportaion system of the maxillary sinus.