Ishibashi T, Ishio K, Ichimura K, Mizuno M, Fukaya T
Department of Otolaryngology, Tokyo University Branch Hospital.
Nihon Jibiinkoka Gakkai Kaiho. 1999 Jul;102(7):871-7. doi: 10.3950/jibiinkoka.102.871.
Functional endoscopic sinus surgery has become an increasingly popular treatment for chronic sinusitis. This approach is aimed at re-establishment of ventilation and mucociliary clearance of the sinuses. However, some otolaryngologists believe that the Caldwell-Luc procedure should be routinely used for unilateral chronic sinusitis, because it is often associated with the maxillary sinus carcinomas. To evaluate the state of endoscopic sinus surgery for the diagnosis and treatment of unilateral chronic sinusitis, we analyzed the cases of 39 patients with unilateral chronic sinusitis who underwent endoscopic sinus procedures. These patients were unresponsive to appropriate antibiotic management for more than 6 months. Generally, endoscopic ethmoidectomy and antrostomy were performed with preservation of the middle turbinate. After the ostium was enlarged, the maxillary sinus was cleaned and carefully inspected for the presence of associated neoplasms using 30 and 70 degree endoscopes. Preoperative computed tomography (CT), postoperatve pathologic diagnosis, fiberscopic findings of the maxillary sinus, and symptomatic improvement were evaluated. Three patients had CT evidence of bone destruction of the lateral nasal wall. Pathological diagnosis demonstrated that three patients had maxillary sinus mycoses caused by Aspergillus species, one patient had inverted papilloma, and the other 35 patients had chronic sinusits. No associated malignancy was found. Eighty-one percent of the patients had almost normal endoscopic findings of the maxillary sinus by postoperative fiberscopic examination 4 to 8 months following surgery. With an average follow-up of 26 months, 88% of the patients were judged as having significantly improved in their presenting complaints of mucopurulent rhinorrhea, nasal obstruction, and facial pain. The results of this series suggest that endoscopic sinus surgery is an effective procedure for the diagnosis and treatment of unilateral chronic sinusitis.
功能性鼻内镜鼻窦手术已成为治疗慢性鼻窦炎越来越常用的方法。这种方法旨在恢复鼻窦的通气和黏液纤毛清除功能。然而，一些耳鼻喉科医生认为，考德威尔-卢氏手术（Caldwell-Luc procedure）应常规用于单侧慢性鼻窦炎，因为它常与上颌窦癌有关。为了评估鼻内镜鼻窦手术在诊断和治疗单侧慢性鼻窦炎方面的情况，我们分析了39例接受鼻内镜鼻窦手术的单侧慢性鼻窦炎患者的病例。这些患者对适当的抗生素治疗6个月以上无反应。一般来说，在内镜下进行筛窦切除术和上颌窦造口术时保留中鼻甲。扩大窦口后，清理上颌窦，并使用30度和70度内镜仔细检查是否存在相关肿瘤。评估术前计算机断层扫描（CT）、术后病理诊断、上颌窦的纤维镜检查结果以及症状改善情况。3例患者有鼻外侧壁骨质破坏的CT证据。病理诊断显示，3例患者有曲霉菌引起的上颌窦真菌病，1例患者有内翻性乳头状瘤，其他35例患者有慢性鼻窦炎。未发现相关恶性肿瘤。术后4至8个月进行纤维镜检查，81%的患者上颌窦内镜检查结果几乎正常。平均随访26个月时，88%的患者在黏液脓性鼻漏、鼻塞和面部疼痛等主要症状方面有明显改善。该系列研究结果表明，鼻内镜鼻窦手术是诊断和治疗单侧慢性鼻窦炎的有效方法。
