Robinson Simon, Der-Haroutian Vanik, Grove David, Rees Guy, Wormald Peter John
Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, South Australia.
Otolaryngol Head Neck Surg. 2005 Aug;133(2):181-4. doi: 10.1016/j.otohns.2005.04.019.
To establish the prevalence of pus in radiologically diseased sinuses in patients undergoing sinus surgery and to correlate this with the bacterial load in the sinuses.
A prospective study performed on adult patients with the diagnosis of chronic sinusitis undergoing endoscopic sinus surgery at an Adelaide group of academic hospitals. In 45 consecutive and unselected patients, a radiologically diseased sinus was surgically opened, and a specially designed suction aspirator was placed into the sinus under endoscopic control. These aspirates were Gram stained and cultured to quantify the polymorphonuclear neutrophil count, bacterial flora, and bacterial colony count. The CT scans of all patients were graded by using the Lund-Mackay scoring system.
A variety of bacteria, most commonly staphylococci, were cultured from a radiologically diseased sinus in 88% of patients. There was no correlation between the bacterial colony count and presence of pus, and only 11% of patients had microscopic evidence of inflammation in sinus aspirates. There was no correlation between the Lund-Mackay CT score and the presence of pus in the sinus.
The majority of patients undergoing surgery for chronic sinusitis did not have a purulent exudate, and there was no correlation with the bacterial load. The usefulness of antibiotics in the treatment of chronic rhinosinusitis, in the absence of macroscopic pus, is questionable.
确定接受鼻窦手术患者放射学诊断为病变鼻窦中脓液的患病率，并将其与鼻窦中的细菌载量相关联。
对阿德莱德一组学术医院中诊断为慢性鼻窦炎并接受鼻内镜鼻窦手术的成年患者进行一项前瞻性研究。在45例连续且未经筛选的患者中，手术打开放射学诊断为病变的鼻窦，并在内镜控制下将特制的吸引器放入鼻窦。对这些吸出物进行革兰氏染色和培养，以量化多形核中性粒细胞计数、细菌菌群和细菌菌落计数。所有患者的CT扫描均采用Lund-Mackay评分系统进行分级。
88%的患者在放射学诊断为病变的鼻窦中培养出多种细菌，最常见的是葡萄球菌。细菌菌落计数与脓液的存在之间无相关性，只有11%的患者鼻窦吸出物中有炎症的微观证据。Lund-Mackay CT评分与鼻窦中脓液的存在之间无相关性。
大多数接受慢性鼻窦炎手术的患者没有脓性渗出物，且与细菌载量无关。在没有肉眼可见脓液的情况下，抗生素在慢性鼻-鼻窦炎治疗中的作用值得怀疑。
