Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.
Rhinology. 2011 Oct;49(4):438-44. doi: 10.4193/Rhino10.111.
Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.
内窥镜鼻窦手术 (ESS) 是治疗药物治疗失败后的慢性鼻鼻窦炎 (CRS) 的主要手术方法。ESS 基于上颌窦口阻塞是 CRS 发病机制的主要原因的理论。关于扩大上颌窦自然窦口仍存在争议。本研究旨在比较保留或扩大上颌窦口后的 CT 表现。30 例非息肉性 CRS 患者随机接受单侧钩突切除术和对侧中鼻道造口术的内窥镜鼻窦手术。在术前和术后 9 个月，对 CT 扫描进行 Lund-Mackay (LM) 评分和窦口直径分析，并对两种手术技术进行比较。此外，还研究了 CT 表现与主观结果之间的相关性。对术前和术后 CT 扫描的比较表明，无论采用哪种手术方式，两侧的 LM 评分均显著降低。与钩突切除术相比，中鼻道造口术侧的窦口面积明显更大。较大的上颌窦口似乎与较低的术后 LM 评分相关，但似乎并不能提供更好的症状缓解。
