Otori N, Fukami M, Yanagi K, Asai K, Iida M, Moriyama H
Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan.
Nihon Jibiinkoka Gakkai Kaiho. 1996 May;99(5):653-60. doi: 10.3950/jibiinkoka.99.653.
We examined the patency of the ostium of the frontal sinus after endoscopic endonasal surgery for chronic sinusitis. This study involved one hundred and seventy-two nasal sides of ninety cases who underwent surgery in this unit in the preceding three-year period by the designated three surgeons. All patients were followed up for more than one year after surgery. We obtained a high postoperative patent rate of 90.1%. However, communication between the frontal and ethmoidal sinus could not be confirmed in 9.9% of the cases due to the presence of polyp or adhesion in the middle meatus. Cases with preoperative severe lesion of the frontal sinus showed significantly lower rates of patent than cases with preoperative mild and/or no lesion. In cases where the opening of the ostium could not be sufficiently widened during surgery because the size around the ostium was already small, lower patent rates resulted. However, even in such cases, scraping or curetting of the surrounding bone should be avoided, because it may cause postoperative narrowing of the ostium due to new bone formation. Cases with unsatisfactory results caused by pathological changes in the middle meatus showed significantly lower patent rates than cases with satisfactory postoperative results. It is recommended that accurate cleaning of the ethmoid sinus and adequate postoperative treatment be considered important. Endoscopic endonasal opening of the ostium of the frontal sinus is shown to be a safe and reliable procedure, which can be performed with clear visualization.
我们对内窥镜下经鼻手术治疗慢性鼻窦炎后额窦开口的通畅情况进行了检查。本研究纳入了此前三年内在本单位由指定的三位外科医生进行手术的90例患者的172个鼻侧。所有患者术后均随访一年以上。我们获得了90.1%的高术后通畅率。然而，由于中鼻道存在息肉或粘连，9.9%的病例无法证实额窦与筛窦之间存在连通。术前额窦病变严重的病例通畅率明显低于术前病变轻微和/或无病变的病例。如果手术期间由于窦口周围尺寸已较小而无法充分扩大窦口开口，则通畅率会降低。然而，即使在这种情况下，也应避免刮除或刮除周围骨质，因为这可能会因新骨形成导致术后窦口狭窄。因中鼻道病理改变导致结果不理想的病例通畅率明显低于术后结果满意的病例。建议重视筛窦的准确清理和充分的术后治疗。内窥镜下经鼻额窦开口术被证明是一种安全可靠的手术，可在清晰视野下进行。
