功能性鼻內鏡術聯合游離鉤突黏膜骨瓣修補口腔上頜竇瘺的近期療效觀察

葉青 俞正堯 王正 仲芳

[摘要]目的：分析功能性鼻內鏡術聯合游離鉤突黏膜骨瓣修補口腔上頜竇瘺的近期療效。方法：選擇2017年1月-2020年1月筆者醫院65例并發上頜竇炎的口腔上頜竇瘺患者。給予所有患者功能性鼻內鏡術聯合游離鉤突黏膜骨瓣修補治療，隨訪1年。記錄患者住院指標、調查患者滿意度、術后并發癥、治愈率及術后復發率，隨訪過程中記錄患者上頜竇情況。結果：經治療后65例患者平均住院時間（8.20±2.32）d，平均住院費用8 069.75元。隨訪1年后，所有患者瘺口、瘺道均愈合，無鼻竇炎癥狀，鼻腔清潔，無膿性分泌物，上頜竇開口通暢，無局部塌陷，無復發病例。有83.08%（54/65）患者非常滿意，12.31%（8/65）患者較為滿意，4.62%（3/65）患者滿意，無不滿意患者。65例患者手術均成功，治愈率100%。術后無嚴重并發癥。結論：采用功能性鼻內鏡術聯合游離鉤突黏膜骨瓣治療合并上頜竇炎的口腔上頜竇瘺患者有較高治愈率，患者滿意度高，術后無嚴重并發癥發生，頜竇相關情況良好，降低患者住院時間，減少患者經濟負擔。

[關鍵詞]功能性鼻內鏡術;游離鉤突黏膜骨瓣修補;上頜竇瘺;近期療效;并發癥

[中圖分類號]R782.05? ? [文獻標志碼]A? ? [文章編號]1008-6455（2022）03-0014-03

Short-term Efficacy of Functional Nasal Endoscopic Surgery Combined with Free Uncinate Process Mucosal Bone Flap for Oroantral Fistula Repair

YE Qing，YU Zhengyao，WANG Zheng，ZHONG Fang

（Department of Otolaryngology，Songjiang District Central Hospital，Shanghai 201600，China）

Abstract： Objective To investigate the short-term efficacy of functional nasal endoscopic surgery combined with free uncinate process mucosal bone flap for oroantral fistula repair. Methods Sixty-five patients with oroantral fistula complicating maxillary sinusitis underwent functional nasal endoscopic surgery combined with free uncinate process mucosal bone flap in our hospital from January 2017 to January 2020 were enrolled. All patients received a one year follow-up. Various indexes were recorded， including hospitalization index， patient satisfaction， postoperative complications， cure rate， postoperative recurrence rate and maxillary sinus status. Results After treatment， the average length of hospital stay was （8.20±2.32）d， and the average cost of hospitalization was 8069.75 yuan. One year follow-up showed that all patients had healed fistulas and fistulae， with no sinusitis symptoms， clean nasal cavity， no purulent secretions， unobstructed maxillary sinus openings， no local collapse and no recurrence. Among all patients， 83.08% （54/65） of patients were well satisfied， 12.31% （8/65） were relatively satisfied， and 4.62% （3/65） were generally satisfied， and there were no unsatisfied patients. Operations were successful in all patients， with an overall cure rate of 100%. No serious complications occurred after surgery. Conclusion Treatment of oroantral fistula patients complicating maxillary sinusitis by functional nasal endoscopic surgery combined with free uncinate process mucosal bone flap has a high cure rate， high patient satisfaction， and no serious post-operative complications; moreover， patients have good maxillary sinus related conditions， short hospital stay length and low economic burden.

Key words： functional nasal endoscopic surgery; free uncinate process mucosa; oroantral fistula

上頜竇瘺為臨床口腔常見疾病，是由多因素導致瘺孔形成，如上頜磨牙拔除后、根管治療時操作過度、上頜骨囊腫等[1]。相關研究報道，上頜竇瘺發病率可達4.79%[2]。瘺孔形成后，由于口腔與上頜竇相通，易影響患者飲食、發音，長期可引發患者鼻部相關疾病，嚴重影響患者生活質量[3]。上頜竇瘺孔形成往往伴隨上頜竇炎，目前臨床上主要采用鼻內鏡技術處理上頜竇炎，清理病變組織[4]。……