上頜竇根治術併篩竇功能性內視鏡手術應用在廣泛性息肉樣鼻竇炎

Caldwell-Luc Operation and Functional Endoscopic Ethmoid Surgery for Diffuse Polypoid Sinusitis

袁本治(Ben-Chih Yuan)

《中華民國耳鼻喉科醫學會雜誌》 30卷5期 (1995/10) Pp. 456-462

https://doi.org/10.6286/1995.30.5.456

摘要

鼻竇功能性內視鏡手術已被鼻科醫師廣泛應用在治療慢性或復發性鼻竇炎。但有些病例，如廣泛性息肉樣鼻竇炎，在多次鼻竇功能性內視鏡手術後，效果仍不甚滿意。因此我們在廣泛性息肉樣鼻竇炎的病人使用傳統上頜竇根治術併篩竇功能性內視鏡手術，來觀察並評估其療效。自1994年1月至10月，共有13名診斷廣泛性息肉樣鼻竇炎之病人，一側接受鼻竇功能性內視鏡手術，而另一側接受上頜竇根治術併篩竇功能性內視鏡手術。所有病人均符合術前電腦斷層掃描之上頜竇完全混濁的診斷，並於手術中用內視鏡證實上頜竇黏膜有廣泛息肉樣變化。所有病人於術後約一個月追蹤一次，以內視鏡觀察並比較鼻竇兩邊黏膜變化之差異及改善程度。結果，在單純鼻竇功能性內視鏡手術有4例 (30%) 可確定為手術治癒。在合併內視鏡及上頜竇切開術則有9例 (69%) 可確定為手術治癒。

關鍵字

鼻竇功能性內視鏡手術，上頜竇根治術，廣泛性息肉樣鼻竇炎

並列摘要

Functional endoscopic sinus surgery (FESS) is now accepted as the standard surgical therapy for chronic sinusitis. Long term clinical result of this surgery appear to be better than that of the traditional Caldwell-Luc operation (TCLO) and intranasal ethmoidectomy. Various studies have quoted success rate of FESS from 76% to 97%. But in some cases, FESS didn’t get much success rate. The purpose of this study is trying to increase the success rate in treating severe rhinosinopathy such as diffuse ploypoid sinusitis.
From January to October 1994, 13 patients underwent FESS in one side and FESS for treatment of ostiomeatal unit with Caldwell-Luc operation for the maxillary sinus in the other side, under the diagnosis of diffuse polypoid sinusitis. All patients received coronal CT scan of the sinuses and sinus endoscopies before and after operation. The time of follow-up was at least 4 months.
On FESS side, 4 patients (30%) were evaluated to be successful, whereas 5 (39%) with persistent polyposis of the maxillary mucosa, 3 (23%) with recurrent polyps in the middle meatus, 1 (8%) with visible pus secretion. On fuctional endoscopic ethmoid surgery and Caldwell-Luc operation side, 9 patients (69%) were successful, whereas 2 (10%) with persistent polyposis of the maxillary mucosa, 1 (8%) with granulation tissue formation and 1 (8%) with significant crusting and pus secretion.
In view of facilities available today, FESS leads to excellent result in chronic or recurrent sinusitis. But it is not satisfactory for diffuse polypoid sinusitis. However, comparison between these two methods, combined operation of FESS with TCLO achieves better results than standard FESS in diffuse polypoid sinusitis.

並列關鍵字

functional endoscopic sinus surgery, Caldwell-Luc operation, diffuse polypoid sunusitis