上顎竇穿刺術對治療門診鼻竇炎患者之評估

Effect of Maxillary Puncture on Rhinosinusitis Symptoms of Outpatients

馬凱騰(Kai-Teng Ma) ； 曹傑漢(Chien-Han Tsao) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chun-Hsn Hsin) ； 莊俊義(Chun-Yi Chung) ； 李鴻森(Hong-Shen Lee) ； 王雅利(Ya-Li Wang) ； 周明智(Ming-Chih Chou)

《中山醫學雜誌》 17卷1期 (2006/06) Pp. 85-91

https://doi.org/10.30096/CSMJ.200606.0009

摘要

背景：因鼻及鼻竇炎造成的工作時數減少帶來的經濟財產損失已引起廣泛的重視，目前鼻及鼻竇炎的處置方式是先給予口服或局部去鼻充血劑，再加上鼻腔抽吸的局部治療，若10～14天後症狀未改善才依經驗療法給予抗生素，若症狀依然未改善而影像學上出現有膿液積蓄或鼻竇開口阻塞，則施予功能性鼻竇內視鏡手術，治療過程可謂費時。上顎竇穿刺沖洗術兼具採樣，改善鼻竇缺氧環境及快速清除蓄膿的優點。經由鼻竇X光片的影像診斷後實施，對於縮短門診鼻竇炎病患的症狀期是否有幫助，是本研究的目的。
方法：蒐集1999年1月至2001年12月共196名門診病患，以回溯性方式進行研究;患者在症狀上自述臉頰脹痛、鼻塞、鼻涕倒流、喉嚨有異物感等，視診上見鼻口、咽部有膿性分泌物，症狀期一周至兩年。安排鼻竇X光片檢查。如果上顎竇於water's view上呈現黏膜增厚，液氣相面，均勻或不均勻混濁，則施予上顎竇穿刺術。選擇穿刺一週前未服用抗生素者為統計對象，穿刺後給予廣效性抗生素並於3日後依培養結果看是否更動抗生素。將患者分為為急性，亞急性，慢性鼻竇炎及頭頸癌症放療後併發鼻竇炎四組，紀錄實施穿刺術後三週內患者的症狀緩解天數，並統計洗出液量與症狀改善天數之關聯。
結果：本研究結果顯示在鼻竇X光片顯影下，上顎竇呈現不透光的嚴重程度與吸出液的量具有統計上意義。吸出液量與症狀緩解天數具有統計上意義。
結論：上顎竇穿刺既灌洗術可快排除上顎竇內膿性分泌物，改善病患症狀，甚至可避免部分病人的病程進行到非手術不可的地步。鼻竇X光片的嚴重程度有助於預測吸出液的量，而吸出液的量越多則症狀持續的天數越少，有關此項技術執行與否，鼻竇X光片的water's view 提供了重要資訊。

關鍵字

上頷竇穿刺術 ； 鼻及鼻竇炎 ； water's view

並列摘要

Background: Financial losses that have been brought about by a reduction in working hours as a consequence of rhinosinusitis have attracted a great deal of attention. Rhinosinusitis is currently treated by prescribing oral or local nasal decongestants with nasal aspiration that patients can administer themselves. Empirical Antibiotics are prescribed if the symptoms do not improve after 10 to 14 days. When the accumulation of pus or the congestion of the sinus opening is detected by imaging and when symptoms do not improve, a functional endoscopic sinus surgery (FESS) is required, a treatment that is quite time consuming. The maxillary puncture method has the advantages of easier sampling and the ability to rapidly remove accumulated pus, thereby improving the flow of oxygen. The purpose of this research is to establish whether maxillary puncture conducted after diagnosis of sinus using X-ray imaging can help shorten the period of time that outpatients experience rhinosinusitis symptoms.
Methodology: This retrospective study of 196 outpatients was conducted from January 1999 to December 2001. The patients complained of swollen cheeks, stuffy noses, post-nasal drip and drainage in the throat. Mucopurulent discharges were detected in the noses, mouths and pharynxes through visual inspection. Such symptoms had lasted from one week to two years. Sinus X-ray films were taken of the sinus, if the mucous membrane of the maxillary sinus thickened under water's view and the liquid-gas phase was either evenly or unevenly turbid, we would perform a maxillary puncture. Patients refrained from antibiotics for one week leading up to operation. Broad-spectrum antibiotics were given after the operation and the decision to continue using the same antibiotic or to change to another depended on the cultivation results 3 days later. Patients were divided into four groups depending on whether they had acute, subacute, chronic nasosinusitis or complicated sinusitis (head and neck cancer patients after radiation treatment). The number of days of symptom relief after a maxillary puncture was recorded and correlated with the amount of washed liquid.
Result: The results indicated that the relationship between the opaque level of maxillary sinus on the developed X-ray films and the suction/drainage gauges was statistically significant. The amount of washed liquid and the number of days of relieved symptoms were statistically significant as well.
Conclusion: Maxillary puncture can be used for the fast removal of accumulated pus in the maxillary sinus, it can improve the symptoms experienced by sinusitis patients and its use could mean that some patients might not even need an operation. We also found that X-ray films of the sinus can help predict the amount of washed liquid required, an increase in which would lead to a reduction in the number of days the symptoms would last. Finally, we found that X-ray films of the sinus under water's view provide important information on the implementation of this technology.

並列關鍵字

maxillary puncture ； rhinosinusitis ； water's view