MSCT评估钩突上附着点分型及引流途径的临床价值
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摘要
目的:通过MSCT分析慢性鼻窦炎患者钩突上附着点(Superior attachment of uncinate process,SAUP)的解剖变异及其引流路径改变,并探讨其对额窦炎引流的影响。方法:收集拟行鼻内镜手术并行MSCT扫描的鼻窦炎患者111例222侧。通过MSCT观察确定SAUP各型的发生率,及其与钩突内、外引流的相关性;比较内、外引流组发生额窦炎的差异。结果:222侧SAUP分型中,最常见的分别是Ⅰ型(55%)、Ⅳ型(19.8%)、Ⅴ型(12.6%)。在额窦炎的评估方面,88侧(39.6%)有额窦炎,钩突内引流中57侧(46.7%)有额窦炎,外引流中31侧(31.0%)有额窦炎。慢性鼻窦炎患者中,与外引流相比,额窦炎更常见于SAUP的内引流中(46.7% vs 31.0%,P<0.05)。结论:鼻内镜术前需明确SAUP的解剖变异,SAUP分型所致额窦流出道的位置改变影响额窦炎的发生。慢性鼻窦炎患者中,当额窦引流的区域在内侧时,明显比外侧引流更容易发生额窦炎。
Objective: To analyze the anatomic variations of superior attachment of uncinate process(SAUP) and drainage pathway in patients with chronic sinusitis by MSCT, and to explore the influence on the frontal sinusitis. Methods: Two hundred and twenty-two sides of 111 patients with sinusitis who were candidates for endoscopic sinus surgery and underwent MSCT scanning were collected. The incidence of various types of SAUP, and the correlation between SAUP and internal and external drainage of uncinate process were determined by MSCT. The difference of frontal sinusitis between internal and external drainage groups was analyzed. Results: Among 222 SAUP types, the most common types of SAUP were type Ⅰ(55%),type Ⅳ(19.8%) and type Ⅴ(12.6%). In the evaluation of frontal sinusitis, 88(39.6%) had frontal sinusitis, 57 internal drainage(46.7%) and external drainage 31(31.0%). In patients with chronic sinusitis, the frontal sinusitis was more common in the internal drainage channels of SAUP than in the external drainage(46.7% vs 31.0%, P<0.05). Conclusions: Before nasal endoscopic surgery, we need to clarify the anatomical variation of SAUP, and the changes in the location of the outflow tract of frontal sinus caused by SAUP typing affect the incidence of the frontal sinusitis. In patients with chronic sinusitis, frontal sinusitis is more likely to occur when the frontal sinus drainage area is internal drainage than external drainage.
Objective: To analyze the anatomic variations of superior attachment of uncinate process(SAUP) and drainage pathway in patients with chronic sinusitis by MSCT, and to explore the influence on the frontal sinusitis. Methods: Two hundred and twenty-two sides of 111 patients with sinusitis who were candidates for endoscopic sinus surgery and underwent MSCT scanning were collected. The incidence of various types of SAUP, and the correlation between SAUP and internal and external drainage of uncinate process were determined by MSCT. The difference of frontal sinusitis between internal and external drainage groups was analyzed. Results: Among 222 SAUP types, the most common types of SAUP were type Ⅰ(55%),type Ⅳ(19.8%) and type Ⅴ(12.6%). In the evaluation of frontal sinusitis, 88(39.6%) had frontal sinusitis, 57 internal drainage(46.7%) and external drainage 31(31.0%). In patients with chronic sinusitis, the frontal sinusitis was more common in the internal drainage channels of SAUP than in the external drainage(46.7% vs 31.0%, P<0.05). Conclusions: Before nasal endoscopic surgery, we need to clarify the anatomical variation of SAUP, and the changes in the location of the outflow tract of frontal sinus caused by SAUP typing affect the incidence of the frontal sinusitis. In patients with chronic sinusitis, frontal sinusitis is more likely to occur when the frontal sinus drainage area is internal drainage than external drainage.
引文
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[14]沙炎,罗德红,李恒国.头颈部影像学——耳鼻咽喉头颈外科卷[M].北京:人民卫生出版社,2014:138.
[15]王振常,鲜军舫,兰宝森.中华影像医学头颈部卷[M].北京:人民卫生出版社,2011:233-238.
[16]Fokkens WJ,Lund VJ,Mullol J,et al.EPOS 2012:European position paper on rhinosinusitis and nasal polyps 2012.A summary for otorhinolaryngologists[J].Rhinology,2012,50(1):1-12.
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[18]Günel C,Bleier BS,Bozkurt G.Microarray analysis of the genes associated with osteitis in chronic rhinosinusitis[J].Laryngoscope,2017,127(3):E85-E90.
[2]李源.实用鼻内镜外科学技术及应用[M].北京:人民卫生出版社,2009:4-9.
[3]Tuli IP,Sengupta S,Munjal S,et al.Anatomical variations of uncinate process observed in chronic sinusitis[J].Indian J Otolaryngol Head Neck Surg,2013,65(2):157-161.
[4]杨雄明,张立东,陈永泉.鼻腔解剖变异及其与鼻窦炎的相关性分析[J].中国CT和MRI杂志,2014,12(1):48-50.
[5]Mahmutoglu AS,Celebi I,Akdana B,et al.Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis[J].J Craniofac Surg,2015,26(1):87-90.
[6]郑雪丽,朱宏,朱少军,等.64排螺旋CT三维重建在内镜鼻窦手术中的应用价值[J].中国CT和MRI杂志,2012,10(2):32-33.
[7]邓星河,梁秀卿,史剑波,等.慢性额窦炎额窦引流系统CT解剖特征及临床价值[J].中华放射学杂志,2005,39(2):155-160.
[8]Yüksel Aslier NG,Karabay N,Zeybek G,et al.Computed Tomographic Analysis:The Effects of Frontal Recess Morphology and the Presence of Anatomical Variations on Frontal Sinus Pneumatization[J].J Craniofac Surg,2017,28(1):256-261.
[9]Srivastava M.Role of Anatomic variations of Uncinate Process in Frontal Sinusitis[J].Indian J Otolaryngol Head Neck Surg,2016,68(4):441-444.
[10]万宏燕,杨瑜,王振常.成人窦口鼻道复合体区钩突及邻近结构影像解剖学研究[J].中国耳鼻咽喉头颈外科,2013,20(7):363-366.
[11]Netto B,Piltcher OB,Meotti CD,et al.Computed tomography imaging study of the superior attachment of the uncinate process[J].Rhinology,2015,53(2):187-191.
[12]Han D,Zhang L,Ge W,et al.Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms[J].ORL J Otorhinolaryngol Relat Spec,2008,70(2):104-112.
[13]中华放射学杂志编委会.头颈部CT、MR扫描规范指南(修改稿)[J].中华放射学杂志,2007,41(9):996-999.
[14]沙炎,罗德红,李恒国.头颈部影像学——耳鼻咽喉头颈外科卷[M].北京:人民卫生出版社,2014:138.
[15]王振常,鲜军舫,兰宝森.中华影像医学头颈部卷[M].北京:人民卫生出版社,2011:233-238.
[16]Fokkens WJ,Lund VJ,Mullol J,et al.EPOS 2012:European position paper on rhinosinusitis and nasal polyps 2012.A summary for otorhinolaryngologists[J].Rhinology,2012,50(1):1-12.
[17]Sautter NB,Delaney KL,Hausman FA.Tissue remodeling gene expression in a murine model of chronic rhinosinusitis[J].Laryngoscope,2012,122(4):711-717.
[18]Günel C,Bleier BS,Bozkurt G.Microarray analysis of the genes associated with osteitis in chronic rhinosinusitis[J].Laryngoscope,2017,127(3):E85-E90.