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目的探讨鼻窦胆固醇肉芽肿患者的病因、发病机理以及治疗方法。方法回顾性总结分析1996年3月至2003年3月经手术和病理证实的24例鼻窦胆固醇肉芽肿患者的临床资料。结果24例患者中,术前诊断为慢性鼻窦炎10例,鼻窦黏液囊肿8例,鼻息肉或出血坏死性鼻息肉5例,考虑可能为胆固醇肉芽肿者仅1例。主要症状有鼻塞(20/24)、鼻漏(18/24)、嗅觉减退(10/24)、头痛(7/24)、眼眶痛(5/24)、复视(2/24)等。鼻窦CT及MRI提示为慢性鼻窦炎、鼻窦囊肿以及鼻息肉和(或)黏膜息肉样变。所有病例均因保守治疗无效而采取外科手术治疗,即鼻内镜术或CaldwellLuc术,仅1例行鼻侧切开术。23例手术效果良好,随访1年以上无复发;仅1例CaldwellLuc术后2年复发,再次行鼻内镜术,术后3年未复发。结论鼻窦胆固醇肉芽肿的病因主要有三:含气腔通气受阻、引流障碍、含气腔出血。鼻窦胆固醇肉芽肿似乎与鼻窦慢性炎性疾病关系密切,尤其是鼻窦黏液囊肿。术式的选择应根据病变范围和程度来决定,其原则是彻底清除病变,保持鼻窦通畅引流。
Objective To investigate the etiology, pathogenesis and treatment of patients with sinus granuloma of the sinuses. Methods The clinical data of 24 patients with sinusitis granulomatosis confirmed by surgery and pathology from March 1996 to March 2003 were retrospectively analyzed. Results Among 24 patients, 10 cases were diagnosed as chronic sinusitis preoperatively, 8 cases were as mucocele of nasal cavity, 5 cases were nasal polyposis or hemorrhagic necrotic nasal polyp. Only 1 case was considered for possible cholesterol granuloma. The main symptoms are stuffy nose (20/24), rhinorrhea (18/24), loss of smell (10/24), headache (7/24), orbital pain (5/24), diplopia (2/24) and so on. Sinus CT and MRI tips for chronic sinusitis, sinus cysts and nasal polyps and (or) mucosal polypoid change. All cases were treated conservatively because of ineffective surgical treatment, namely endoscopic or CaldwellLuc surgery, only 1 case of nasal incision. Twenty-three cases had satisfactory results. No recurrence was found after more than one year of follow-up. Only one case of Caldwell-Luc recurred after 2 years and underwent endoscopic sinus surgery again. No recurrence occurred after 3 years. Conclusion There are three main causes of sinusitis granuloma: gas-containing ventilation blocked, drainage disorders, including gas-chamber hemorrhage. Cholesterol granuloma of the sinuses appears to be closely related to chronic inflammatory diseases of the sinuses, especially sinus mucosal cysts. The choice of surgical procedures should be based on the extent and extent of the lesion, the principle is the complete removal of lesions, maintaining sinus drainage.