鼻中隔的解剖变异与慢性鼻窦炎相关性的CT评价

发布时间：2018-01-30 06:33

本文关键词： 慢性鼻窦炎鼻中隔中鼻甲解剖变异 CT　出处：《中国医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的采用多层螺旋薄层CT扫描技术观察正常及鼻窦炎患者的鼻中隔及周围毗邻结构(中鼻甲)的解剖结构及其变异情况,探讨鼻中隔的解剖变异与慢性鼻窦炎(CRS)之间的关系。方法选择我院耳鼻喉科2009年1月至12月于放射线科做螺旋CT鼻窦薄层扫描并经过临床证实为鼻中隔解剖变异的合并CRS和不合并CRS成年人患者各50例为研究对象(排除真菌感染、鼻腔内翻性乳头状瘤及鼻腔各种良恶性肿瘤继发的鼻窦炎患者)。统计各型CRS中鼻中隔的变异情况及中鼻甲变异情况。为了明确两者之间的相关性,本次研究将研究对象进行了正常组和慢性鼻窦炎组的分组,选择了共计178侧的观察对象进行观测,得出了较为详尽的数据。由于鼻腔鼻窦的解剖变异较多,本研究对目前已被认同的最常见的解剖结构异常：中重度鼻中隔偏曲、中鼻甲气化及反向偏曲、直行中鼻甲进行观察研究。结果鼻中隔解剖变异与CRS发生的关系密切,随着鼻中隔变异程度的加重,双侧CRS的发生率及严重程度亦在增加。鼻中隔偏曲程度及位置与慢性鼻窦炎之间相关性差异有显著性；鼻中隔偏曲方向与慢性鼻窦炎之间相关性差异无显著性。同时研究中鼻甲变异情况,发现病例组中鼻甲反向偏曲、中鼻甲(垂直板、广泛)气化、直行中鼻甲的发生率高于正常组,认为它们是CRS的危险因素；除此之外,其它OMC的解剖变异尚不能认为是CRS的危险因素。结论探讨鼻中隔及中鼻甲的解剖、变异及其与CRS的关系对临床诊断和治疗具有非常重要的意义。本研究采用多排螺旋CT对这方面进行研究,得出以下结论： 1.鼻窦冠状位CT扫描技术可以清晰显示鼻腔鼻窦的解剖、变异及病变范围,已被临床上常规应用。术前行规范化鼻窦CT对于明确鼻腔各部结构至关重要,及早了解鼻腔结构变异对CRS临床治疗有莫大帮助。 2.鼻腔的解剖变异与慢性鼻-鼻窦炎病人的发生有密切关系,最常见的解剖异常为鼻中隔偏曲及中鼻甲病变。综上可知,CRS的发生既与鼻腔病变有关,也与局部解剖结构变异有关。鼻腔鼻窦疾病实为一整体,在治疗鼻腔鼻窦炎症应用慢性鼻-鼻窦炎这一概念很有意义。 3.今后对于OMC的解剖变异在CRS发病中的意义的研究还有赖于多因素分析。
[Abstract]:Purpose The anatomical structure and variation of nasal septum and adjacent structure (middle turbinate) of normal and sinusitis patients were observed by multislice spiral thin slice CT scanning. To investigate the relationship between the anatomic variation of nasal septum and chronic sinusitis (CRS). Method Select the department of otolaryngology of our hospital from January 2009 to December to perform thin slice spiral CT scan of nasal sinuses in adults with or without CRS and proved to be anatomic variation of nasal septum. 50 cases were studied (. Remove fungal infections. Patients with nasal sinusitis secondary to inverted papilloma of nasal cavity and various benign and malignant tumors of nasal cavity were analyzed for the variation of nasal septum and middle turbinate in various types of CRS. In order to clarify the correlation between the two, the study subjects were divided into normal group and chronic sinusitis group, and 178 sides of observation subjects were selected to observe. Due to the large anatomic variation of nasal cavity and paranasal sinuses, the most common anatomical abnormalities identified in this study are moderate and severe septal deviation, middle turbinate gasification and reverse deviation. The middle turbinate was observed and studied directly. Results The anatomical variation of nasal septum is closely related to the occurrence of CRS. The incidence and severity of bilateral CRS were also increasing. There was significant correlation between the degree and location of deviation of nasal septum and chronic sinusitis. There was no significant difference between the direction of deviation of nasal septum and chronic sinusitis. At the same time, the study of the variation of middle turbinate found that the middle turbinate reverse deviation, middle turbinate (vertical plate, extensive) gasification. The incidence of direct transit middle turbinate was higher than that of normal group, and they were considered as risk factors of CRS. In addition, the anatomic variation of other OMC cannot be considered as a risk factor for CRS. Conclusion It is very important for clinical diagnosis and treatment to study the anatomy, variation and relationship between nasal septum and middle turbinate and its relationship with CRS. This study uses multi-slice spiral CT to study this aspect. Draw the following conclusions: 1. Coronal CT scan can clearly show the anatomy, variation and pathological range of nasal cavity and paranasal sinus. Canonical sinus CT before operation is very important to clarify the structure of nasal cavity. It is of great help to understand the structural variation of nasal cavity early for clinical treatment of CRS. 2.The anatomic variation of nasal cavity is closely related to the occurrence of chronic rhinosinusitis, the most common anatomic abnormality is nasal septum deviation and middle turbinate disease. The disease of nasal cavity and paranasal sinus is a whole, so it is very meaningful to use the concept of chronic rhinosinusitis in the treatment of sinusitis. 3. The significance of anatomical variation of OMC in the pathogenesis of CRS depends on multivariate analysis.
【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.4

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