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目的观察上颌窦自然引流状态及引流的关键部位,探讨鼻内镜术后上颌实的引流与窦腔炎症的关系,为鼻内镜手术上颌窦自然窦口的处理提供参考。方法用美蓝作为示踪剂,观察15例上颌窦无明显炎症或炎症较轻受检者上颌窦自然引流状态及引流的关键部位。另选择89例慢性鼻窦炎不伴鼻息肉患者鼻内镜术后6个月,且上颌窦黏膜恢复良好的患者,观察其上颌窦引流状态及方式,并继续随访至12个月,内镜下评估黏膜的炎症情况,分析鼻内镜术后上颌窦引流方式与黏膜炎症状态的关系。结果上颌窦自然窦口引流的关键部位在自然窦口的后下,近钩突尾端的附着处。引流物出上颌窦向后下走行,最终流向鼻咽部。传统鼻内镜手术后,引流方式相对正常者15例,占16.9%;74例(83.1%)患者上颌窦的引流状态及引流方式发生了明显改变。其中包括反向引流6例、多相引流31例、引流不能20例、“蓄水池”样改变9例以及黏膜失用8例。术后12个月33.7%的患者再次发生炎症反应,以黏膜失用炎症的发生率(100%)最高,其次是引流不能及反向引流(各占50%)。结论上颌窦自然窦口的后下近钩突尾端附着处是上颌窦引流的关键部位;鼻内镜术后,上颌窦自然引流关键部位的损伤甚至搬痕形成,可以导致上颌窦的异常引流,过度开放上颌窦窦口,有可能加重上颌窦黏膜的损伤;上颌窦的异常引流状态及方式与黏膜炎症的发生率密切相关。
Objective To observe the status of natural drainage of maxillary sinus and drainage of the key parts, to explore the relationship between maxillary real drainage and sinus inflammation after endoscopic sinus surgery, to provide reference for the treatment of maxillary sinus natural sinus ostium endoscopic surgery. Methods Methylene blue was used as a tracer to observe the key parts of natural maxillary sinus drainage and drainage in 15 cases of maxillary sinus without obvious inflammation or inflammation. Another 89 cases of patients with chronic sinusitis without nasal polyps after endoscopic sinus surgery in 6 months, and the maxillary sinus mucosa recovered well, observe the maxillary sinus drainage status and manner, and continue to follow up to 12 months, endoscopic The mucosal inflammation was evaluated, and the relationship between maxillary sinus drainage and mucosal inflammation after endoscopic sinus surgery was analyzed. Results The natural sinus ostium drainage in the maxillary sinus was located at the posterior inferior hilum of the natural ostium and attached to the caudal end of the uncinate process. Drainage out of the maxillary sinus walking under the final flow to the nasopharynx. After conventional endoscopic sinus surgery, drainage was normal in 15 cases, accounting for 16.9%. In 74 cases (83.1%), the drainage status and drainage pattern of maxillary sinus significantly changed. Including the reverse drainage in 6 cases, 31 cases of multi-phase drainage, drainage can not 20 cases, “reservoir ” like change in 9 cases and mucosal failure in 8 cases. Inflammatory reaction occurred again in 33.7% of patients at 12 months after surgery, with the highest incidence of mucosal inflammation (100%), followed by incompetent and reverse drainage (50% each). CONCLUSIONS: The posterior proximal hilum of maxillary sinus is the key part of maxillary sinus drainage. Nasal endoscopic surgery can lead to the abnormal drainage of maxillary sinus , Excessive opening of maxillary sinus ostium, may aggravate the damage of maxillary sinus mucosa; abnormal drainage of maxillary sinus and the way and the incidence of mucosal inflammation are closely related.