Miłoński Jarosław, Olszewski Jurek
Klinika Otolaryngologii i Onkologii Laryngologicznej, II Katedry Otolaryngologii UM w Łodzi.
Otolaryngol Pol. 2009 Sep;63(7):16-9. doi: 10.1016/S0030-6657(09)70182-9.
The aim of the study was to evaluate the frequency of co-occurrence of anatomic disorders within the nasal area in patients suffering from chronic paranasal sinusitis.
Between 2006-2008 there were 446 endoscopic operations performed on patients with chronic paranasal sinusitis. Apart from paranasal sinuses surgeries, 172 patients underwent an additional operation on anatomic deviations within the nasal area. The study group included 98 women and 74 men. First, the nasal septoplasty was performed in a typical way according to the Cottle's principles with the use of endoscope, which was followed by functional endoscopic operations on paranasal sinuses. The middle concha bullosa operations were performed by opening the pneumatisized bony part and removing the lateral part.
Among 446 patients who underwent endoscopic treatment due to chronic paranasal sinusitis substantial anatomic disorders were found in 38.6% of the cases qualifying the patients for further surgical procedures. Simultaneously, bilateral plasties of the middle concha bullosa were conducted in 25.1% of the cases whereas 10.3% of the patients underwent lateral operations on the middle concha bullosa. In the studied group the septoplasty was performed in 37.4% of the cases. Rarely unilaterally, with the use of endoscope, we removed spines or ledges from the nasal septum in 19.5% and 7.7% of the cases respectively. Moreover, 14 patients underwent operations on the nasal septum and middle concha bullosa at the same time. The co-occurrence of the spine in the nasal septum and middle concha bullosa was found in 6 operated patients. Bilateral middle concha bullosa and nasal septum ledge were operated three times.
The anatomic causes of disorders in nasal patency were frequently found in the studied material. Thus, it proves their substantial part in patomechanism of paranasal sinusitis. Correcting anatomical anomalies ought to be performed simultenously with the operation within the paranasal sinuses. Endoscopically controlled limited septoplasty is a crucial element of complex surgical approach in the paranasal sinusitis.
本研究的目的是评估慢性鼻旁窦炎患者鼻腔区域解剖结构紊乱的并发频率。
2006年至2008年间，对慢性鼻旁窦炎患者进行了446例内窥镜手术。除鼻旁窦手术外，172例患者还接受了鼻腔区域解剖结构异常的额外手术。研究组包括98名女性和74名男性。首先，按照科特尔原则，使用内窥镜以典型方式进行鼻中隔成形术，随后进行鼻旁窦功能性内窥镜手术。中鼻甲气化手术通过打开气化的骨质部分并切除外侧部分来进行。
在因慢性鼻旁窦炎接受内窥镜治疗的446例患者中，38.6%的病例发现存在严重解剖结构紊乱，这些患者需要进一步的手术治疗。同时，25.1%的病例进行了双侧中鼻甲气化手术，而10.3%的患者接受了中鼻甲气化的外侧手术。在研究组中，37.4%的病例进行了鼻中隔成形术。在内窥镜辅助下，我们很少分别在19.5%和7.7%的病例中单侧切除鼻中隔棘突或嵴。此外，14例患者同时进行了鼻中隔和中鼻甲气化手术。在6例手术患者中发现鼻中隔棘突与中鼻甲气化并存。双侧中鼻甲气化和鼻中隔嵴进行了3次手术。
在所研究的材料中经常发现鼻腔通畅障碍的解剖学原因。因此，这证明了它们在鼻旁窦炎发病机制中的重要作用。在进行鼻旁窦手术的同时应纠正解剖学异常。内窥镜控制下的有限鼻中隔成形术是鼻旁窦炎综合手术方法的关键要素。
