【摘要】：目的 采用多層螺旋薄層掃描技術(shù),結(jié)合冠狀位、軸狀位、矢狀位圖像觀察鼻竇炎組患者、正常對照組的鼻中隔及竇口鼻道復(fù)合體(ostiomeatal complex,OMC)的解剖結(jié)構(gòu)變異情況,探討鼻中隔偏曲、OMC解剖變異與慢性鼻竇炎(chronic rhinosinusitis, CRS)發(fā)病之間的關(guān)系。 材料和方法 1.選擇2009年7月至2011年7月間在我院確診為CRS的患者100例及正常對照組(非鼻竇炎組)100例的臨床資料,且兩組均排除鼻中隔呈“S”型偏曲的患者�！� 2.應(yīng)用鼻竇冠狀位、軸狀位、矢狀位CT掃描及鼻內(nèi)窺鏡檢查對鼻竇炎組及正常對照組的鼻中隔偏曲位置、方向、程度及OMC解剖結(jié)構(gòu)變異情況進(jìn)行統(tǒng)計學(xué)分析,并分析其與CRS之間的關(guān)系。 結(jié)果 1.鼻中隔偏曲位置、偏曲程度在鼻竇炎組與正常組之間差異有統(tǒng)計學(xué)意義(P0.05),鼻中隔高位偏曲、重度偏曲與鼻竇炎的發(fā)生關(guān)系密切。 2.額竇炎、前組篩竇炎在鼻中隔高位偏曲和低位偏曲中差異有統(tǒng)計學(xué)意義(P0.05),鼻中隔高位偏曲更易誘發(fā)額竇炎、前組篩竇炎的發(fā)生。 3.鼻中隔偏曲患者兩側(cè)鼻竇炎的發(fā)病率無統(tǒng)計學(xué)意義(P0.05),即鼻中隔偏曲兩側(cè)鼻竇炎的發(fā)病率無顯著性差異。 4.對于鼻中隔高位偏曲,同側(cè)或?qū)?cè)OMC解剖結(jié)構(gòu)變異在鼻竇炎組和對照組中的發(fā)生率均有顯著性差異(P0.05)；對于鼻中隔低位偏曲對側(cè)OMC區(qū)域發(fā)生解剖變異的發(fā)生率在兩組間的分布有顯著性差異(P0.05),而低位偏曲同側(cè)無顯著性差異(P0.05)。鼻中隔偏曲特別是鼻中隔高位偏曲兩側(cè)OMC解剖變異存在差異性,鼻中隔偏曲的對側(cè)更易發(fā)生OMC解剖變異,與CRS的發(fā)生有相關(guān)性。 5.竇口鼻道復(fù)合體中的解剖學(xué)變異：中甲氣化、鉤突偏曲、鉤突肥大、鼻丘氣房和Haller氣房在鼻竇炎患者組與正常對照組中有統(tǒng)計學(xué)差異(P0.05)；而中甲反向偏曲、鉤突氣化、篩泡過度氣化在鼻竇炎患者組與正常對照組之間無統(tǒng)計學(xué)差異(P0.05),竇口鼻道復(fù)合體解剖變異中中甲氣化、鉤突偏曲、鉤突肥大、鼻丘氣房和Haller氣房與CRS的發(fā)生關(guān)系密切。 結(jié)論 1.結(jié)合冠狀位、軸狀位、矢狀位三個方位的圖像,能夠?qū)膊〉牟课�、性質(zhì)、解剖變異、范圍、程度以及手術(shù)中可能出現(xiàn)的各種并發(fā)癥做出正確的評估,尤其能清晰顯示對竇口鼻道復(fù)合體的解剖變異情況,并能夠選擇合理的術(shù)式指導(dǎo)功能性鼻內(nèi)鏡手術(shù)的順利進(jìn)行。 2.鼻中隔偏曲特別是鼻中隔高位偏曲、竇口鼻道復(fù)合體(OMC)的解剖變異在慢性鼻竇炎的發(fā)病中起著重要作用,所以對于慢性鼻竇炎的治療是需要綜合性考慮的,在治療鼻竇炎黏膜炎癥的同時一定要注意解除鼻中隔偏曲及竇口鼻道復(fù)合體等局部解剖變異。
[Abstract]:Objective to observe the anatomic variation of nasal septum and sinus orifice nasal meatus complex (ostiomeatal complex,OMC) in sinusitis group and normal control group by multi-slice spiral thin-layer scanning combined with coronal axial and sagittal images. To explore the relationship between nasal septum deviation, OMC anatomical variation and the pathogenesis of chronic sinusitis (chronic rhinosinusitis, CRS). Materials and methods 1. From July 2009 to July 2011, the clinical data of 100 patients with CRS diagnosed in our hospital and 100 normal controls (non-sinusitis group) were selected, and the patients with "S" deviation of nasal septum were excluded from both groups. The sinus coronal, axial, sagittal CT scan and nasal endoscopy were used to analyze the deviation of nasal septum in sinusitis group and normal control group. The deviation of nasal septum, direction, degree and anatomic structure variation of OMC in sinusitis group and normal control group were analyzed statistically. The relationship between them and CRS was analyzed. Outcome 1. The deviation of nasal septum was significantly different between sinusitis group and normal group (P0.05). The high deviation of nasal septum and severe deviation of nasal septum were closely related to the occurrence of sinusitis. 2. Frontal sinusitis, anterior group ethmoid sinusitis in the nasal septum high deviation and low deviation has statistical significance (P0.05), nasal septum high deviation is more prone to induce frontal sinusitis, the anterior group ethmoid sinusitis occurrence. 3. There was no significant difference in the incidence of bilateral sinusitis in patients with nasal septum deviation (P0.05), that is, there was no significant difference in the incidence of bilateral nasal sinusitis in patients with nasal septum deviation. 4. For the high deviation of nasal septum, the incidence of OMC anatomical structural variation in sinusitis group and control group was significantly different (P0.05). The incidence of anatomical variation in the contralateral OMC region of the nasal septum was significantly different between the two groups (P0.05), but there was no significant difference in the low deviation of the nasal septum on the ipsilateral side (P0.05). There were differences in OMC anatomical variation on both sides of nasal septum deviation, especially in high nasal septum deviation. The contralateral side of nasal septum deviation was more prone to OMC anatomical variation, which was correlated with the occurrence of CRS. 5. Anatomical variation in sinus-orifice-nasomeatus complex: middle turbinate gasification, uncinate process deviation, uncinate process hypertrophy, nasal colliculus air chamber and Haller air chamber in sinusitis patients group and normal control group had statistical difference (P0.05); However, there was no significant difference between the nasal sinusitis group and the normal control group in the reverse deviation of the middle nail, the gasification of the hook process and the over gasification of the ethmoid vesicle between the patients with sinusitis and the normal control group (P0.05). The nasal colliculus chamber and Haller chamber were closely related to the occurrence of CRS. Conclusion 1. Combined with coronal, axial and sagittal images, it is possible to correctly assess the location, nature, anatomical variation, scope, extent, and possible complications of the disease. In particular, it can clearly show the anatomic variation of the sinus-orifice-nasal complex, and can guide the successful operation of functional endoscopic sinus surgery by choosing a reasonable operative method. 2. The deviation of nasal septum, especially the high deviation of nasal septum, and the anatomical variation of (OMC) play an important role in the pathogenesis of chronic sinusitis, so the treatment of chronic sinusitis needs to be considered comprehensively. In the treatment of sinusitis mucosa inflammation, attention must be paid to relieve the deviation of nasal septum and sinus nasal meatus complex and other local anatomical variations.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R765.41

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