林浩然+袁先平+杨田福+杨丽+梁华锋+李锐锋

    [摘要] 目的 研究不同度数鼻内镜(包括0°、30°、70°镜)在鼻咽癌放疗后并发上颌窦炎手术治疗中的观察应用价值。 方法 选择2012年5月~2013年11月佛山市顺德区桂洲医院鼻咽癌放疗后确诊并发上颌窦炎患者33例，经保守治疗效果不佳，予鼻内镜下行中鼻道入路手术治疗上颌窦炎，用不同度数鼻内镜进行观察。术前观察指标包括：钩突、筛泡、中鼻甲、上颌窦自然开口；术中观察上颌窦指标包括：前壁、后外壁、内侧壁、上壁、底壁、窦内脓性分泌物；术后上颌窦炎治疗效果观察指标包括：上颌窦开口、出血、水肿、坏死、脓性分泌物、结痂、瘢痕。对镜像评分资料进行研究、分析。 结果 术前指标观察：70°镜在术前观察平均得分最高，为(7.0±0.2)分，存在的死角或盲点最少，不同角度镜头存在的死角或盲点集中在上颌窦自然开口。术中指标观察：70°镜在术中观察平均得分最高，为(7.7±0.2)分，存在的死角或盲点最少。术后上颌窦炎治疗效果指标观察：70°镜术后观察上颌窦炎治疗效果指标平均得分最高，为(9.8±0.2)分。不同度数鼻内镜在鼻咽癌放疗后上颌窦炎手术治疗中观察效果：70°镜对鼻咽癌放疗后上颌窦炎手术治疗观察效果最好。 结论 不同度数鼻内镜在鼻咽癌放疗后并发上颌窦炎手术治疗观察效果存在差异性，70°镜观察效果最佳，结果可供镜头选择参考。

    [关键词] 鼻咽癌；上颌窦炎；鼻内镜；放疗

    [中图分类号] R765[文献标识码] A[文章编号] 1673-7210(2014)05(a)-0019-04

    Effect observation of maxillary sinusitis surgery after nasopharyngeal carcinoma radiotherapy with different degrees of nasal endoscopic

    LIN Haoran YUAN Xianping▲ YANG Tianfu YANG Li LIANG Huafeng LI Ruifeng

    Department of ENT, Guizhou Hospital of Shunde District in Foshan City, Guangdong Province, Foshan 528305, China

    [Abstract] Objective To study the value of different degrees of nasal endoscopy (0°, 30°, 70°) for nasopharyngeal structure observation of maxillary sinusitis surgery after nasopharyngeal carcinoma radiotherapy. Methods 33 cases with maxillary sinusitis after nasopharyngeal carcinoma radiotherapy in Guizhou Hospital of Shunde District in Foshan City from May 2012 to November 2013 were selected. The conservative treatment effect of patients was bad, and given surgery in the nasal passages under nasal endoscopic for maxillary sinusitis treatment. Different degrees of nasal endoscopy was used for observation. Preoperative observation indexes included processus uncinatus, ethmoidal bulb, concha nasalis media and maxillary sinus natural openings. Intraoperative maxillary sinus observation indexes included antetheca, ektexine, medial wall, superior wall, footwall, purulent secretion in the sinus. Postoperative maxillary sinusitis treatment effect observation indexes included maxillary sinus openings, bleeding, edema, necrosis, purulent secretion, escharosis, scar. The nasal endoscopy score data were analyzed. Results Preoperative indexes observation: preoperative observation average score of 70° mirror was the highest of (7.0±0.2) scores, had less dead ends or blind spot. Lens dead ends or blind spots of different degrees of nasal endoscopy focused on maxillary sinus natural openings. Intraoperative indexes observation: 70° mirror had highest score of (7.7±0.2) scores in intraoperative observation, which had less dead ends or blind spot. Postoperative maxillary sinusitis treatment effect observation: 70° mirror had highest score of (9.8±0.2) scores in postoperative observation of maxillary sinusitis treatment effect. Effect for nasopharyngeal structure observation of maxillary sinusitis surgery after nasopharyngeal carcinoma radiotherapy with different degrees of nasal endoscopic: 70° mirror had the best effect for nasopharyngeal structure observation of maxillary sinusitis surgery after nasopharyngeal carcinoma radiotherapy. Conclusion Different degrees of nasal endoscopy have different treatment observation effects for patients with maxillary sinusitis after nasopharyngeal carcinoma radiotherapy, 70° microscope is best, the results can be used for reference for the selection of lens. ......