鼻中隔偏曲与慢性鼻—鼻窦炎关系的探讨

发布时间：2019-01-15 07:54

【摘要】：目的通过对鼻窦CT分析探讨鼻中隔偏曲与慢性鼻-鼻窦炎不伴鼻息肉(chronic rhinosinusitis without nasal polyps,CRSs NP)发病的相关性。方法对185例鼻中隔偏曲患者行鼻内镜、鼻窦轴位和/或冠位CT扫描观察,所有鼻窦CT均采用Lund-Machay CT评分系统评估鼻窦炎发病情况。分析并统计鼻中隔偏曲方向、程度、鼻中隔偏曲位置在鼻窦炎组和正常对照组中的发病率。与鼻中隔偏曲方向一致的一侧鼻腔称为窄侧,反之为宽侧,分析宽窄两侧鼻窦炎发病率;根据张剑宁分组方法将鼻中隔偏曲合并慢性鼻-鼻窦炎不伴鼻息肉分为A、B、C、D、E、F六组,分析并统计各偏曲组慢性鼻-鼻窦炎不伴鼻息肉发病率;通过鼻内镜观察鼻中隔偏曲两侧鼻腔结构改变情况。结果185例鼻中隔偏曲患者中,并发CRSs NP的有129例,发病率为69.73%,其中鼻中隔偏曲宽侧并发CRSs NP的有87例,发病率较高,为67.44%;鼻中隔偏曲窄侧并发CRSs NP的有42例,发病率为32.56%;1、鼻窦炎组与对照组中鼻中隔偏曲方向比较差异无统计学意义;鼻中隔偏曲程度在鼻窦炎组和正常组之间比较,鼻中隔偏曲程度与慢性鼻窦炎之间有统计学差异,中重度鼻中隔偏曲与CRSs NP有相关性;鼻中隔偏曲位置组之间比较,鼻中隔偏曲位置在鼻窦炎组与正常对照组之间有统计学意义,鼻中隔高位偏曲与CRSs NP有相关性。2、根据Lund-Mackay鼻窦CT评估和计分方法,对入组患者鼻窦炎严重程度进行统计后发现,鼻腔宽侧部分鼻窦浑浊居多,其中以上颌窦、前组筛窦较显著。3、根据张剑宁对鼻中隔偏曲分组,185例鼻中隔偏曲患者中,有129例并发CRSs NP,其中A组合并CRSs NP有12例;B组合并CRSs NP有14例;C组合并CRSs NP有15例;D组(高位,筛骨垂直板)合并CRSs NP有56例;E组合并CRSs NP有11例;F组合并CRSs NP有21例。其中高位偏曲组(D、F组)CRSs NP发病率最高,共77例。4、鼻中隔偏曲并发CRSs NP双侧鼻腔检查结果显示:中、下甲及钩突肥大等结构变异更常见于宽侧鼻腔;中甲反向屈曲和中甲受压多见于窄侧鼻腔。结论1、鼻中隔偏曲患者中CRSs NP发病率较高,鼻中隔中重度偏曲及鼻中隔高位偏曲与CRSs NP的发生有相关性。2、鼻中隔偏曲宽侧CRSs NP发病率高于窄侧,鼻中隔偏曲宽侧上颌窦、前组筛窦发病率较显著。3、鼻中隔偏曲各分组中D、F组CRSs NP发病率较高。4、鼻中隔偏曲宽侧中鼻甲、下鼻甲及钩突肥大;中甲反向屈曲和中甲受压则常见于窄侧鼻腔。
[Abstract]:Objective to investigate the relationship between nasal septum deviation and chronic rhinosinusitis without nasal polyp (chronic rhinosinusitis without nasal polyps,CRSs NP) by CT analysis of paranasal sinuses. Methods CT scanning was performed in 185 patients with nasal septum deviation. The incidence of sinusitis was evaluated by Lund-Machay CT scoring system in all cases. The incidence of nasal septum deviation in sinusitis group and normal control group was analyzed and analyzed. The side of nasal cavity which is consistent with the direction of deviation of nasal septum is called narrow side and vice versa. The incidence of sinusitis on both sides of nasal septum is analyzed. According to Zhang Jianning's grouping method, the nasal septum deviation combined with chronic rhinosinusitis without nasal polyps was divided into six groups. The incidence of chronic rhinosinusitis without nasal polyps was analyzed and counted. The changes of nasal cavity structure on both sides of nasal septum deviation were observed by nasal endoscopy. Results among the 185 patients with nasal septum deviation, 129 cases were complicated with CRSs NP, the incidence rate was 69.73 and 87 cases were complicated with CRSs NP in the wide side of nasal septum deviation, the incidence rate was higher (67.4444). There were 42 cases of nasal septum deviation and narrow side complicated with CRSs NP, the incidence rate was 32.566.There was no significant difference between the sinusitis group and the control group in the direction of nasal septum deviation. The degree of nasal septum deviation was significantly different between sinusitis group and normal group. There was statistical difference between the degree of nasal septum deviation and chronic sinusitis. There was a correlation between moderate and severe nasal septum deviation and CRSs NP. The position of nasal septum deviation was statistically significant between sinusitis group and normal control group, and the high deviation of nasal septum was correlated with CRSs NP. 2. According to Lund-Mackay sinus CT evaluation and scoring method, According to the statistics of the severity of sinusitis in the patients, it was found that most of the nasal sinuses were turbidity in the broad side of nasal cavity, including maxillary sinus and anterior ethmoid sinus. 3. According to Zhang Jianning's classification of nasal septum deviation, 185 patients had nasal septum deviation. There were 129 cases of CRSs NP, of which 12 cases were complicated with CRSs NP in group A; There were 14 cases with CRSs NP in group B, 15 cases with CRSs NP in group C, 56 cases with CRSs NP in group D (high position, vertical plate of ethmoid bone), 11 cases with CRSs NP in group E and 21 cases with CRSs NP in group F. The incidence of) CRSs NP was the highest in group D F (77 cases). The results of nasal cavity examination of nasal septum deviation and CRSs NP showed that middle, inferior thyroid and uncinate process hypertrophy were more common in broad nasal cavity. Contralateral flexion and compression of middle thyroid were more common in narrow nasal cavity. Conclusion 1. The incidence of CRSs NP in patients with nasal septum deviation is higher. The incidence of CRSs NP in the wide side of nasal septum deviation is higher than that in narrow side, and the incidence of maxillary sinus in wide side of nasal septum deviation is higher than that in the wide side of nasal septum deviation, and the incidence of high deviation of nasal septum and high deviation of nasal septum is related to the occurrence of CRSs NP. The incidence of ethmoid sinus in the former group was significant. 3. The incidence of CRSs NP in the DUF group was higher. 4. The middle turbinate, inferior turbinate and uncinate process were hypertrophic in the wide side of nasal septum deviation. Contralateral flexion and compression of middle thyroid were common in narrow nasal cavity.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765

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