内镜下经鼻泪前隐窝入路的放射学可行性

文献信息

中文摘要

背景： 泪前隐窝（PLR）距离、内侧壁厚度以及梨状孔内角（APN）已被多项研究建议作为评估指标，用于判断经鼻泪前隐窝入路（TPRA）的可行性及术中难度，并存在种族差异。
目的： 评估内镜下TPRA在健康及病变鼻旁窦中的计算机断层扫描（CT）可行性。
方法： 我们的样本包括750名成年人（1,500侧），他们因各种适应证接受了鼻及鼻旁窦（PNS）CT检查。对CT扫描进行分析，以评估泪前隐窝的距离、厚度和角度在两侧相对于不同人口学参数（年龄和性别）的差异。将所有参数分为TPRA放射学可行性低、中或高。
结果： 546例健康PNS（72.8%）与204例慢性鼻窦炎病例（27.2%）之间的可行性参数没有差异。在所研究的1,500侧上颌窦中，仅2.7%具有高放射学可行性，53.1%具有中等放射学可行性，44.2%具有低放射学可行性以行TPRA。男性和30岁以下个体的距离显著更大、骨壁更薄，使窦腔更具手术可及性（p < 0.05）。
结论： 所研究的三个参数可共同应用于接受TPRA患者的术前评估，且炎症对可及性参数没有影响。预计42%的人群可能存在可及性困难，因此外科医生在实施TPRA时必须谨慎。

英文摘要

BACKGROUND: Prelacrimal recess (PLR) distance, medial wall thickness, and the internal angle of the pyriform notch (APN) have been suggested by various studies as assessment metrics to determine the feasibility and intraoperative difficulty of the transnasal prelacrimal recess approach (TPRA), with ethnic variations.
OBJECTIVE: To assess the computed tomography (CT) scan feasibility of endoscopic TPRA in healthy and diseased paranasal sinuses.
METHODS: Our sample consisted of 750 adults (1,500 sides) who had CT of the nose and paranasal sinuses (PNS) for various indications. The CT scans were analyzed to assess variations in the distance, thickness, and angle of the prelacrimal recess on both sides concerning different demographic parameters (age and gender). All parameters were grouped into low, median, or high radiological feasibility of TPRA.
RESULTS: There was no difference in feasibility parameters between 546 healthy PNS (72.8%) and 204 chronic rhinosinusitis cases (27.2%). Only 2.7% of the maxillary sinuses studied (1,500 sides) had high radiological feasibility, 53.1% had medium radiological feasibility, and 44.2% had low radiological feasibility for TPRA. Males and individuals younger than 30 years of age had a significantly greater distance and thinner walls, making the sinus more surgically accessible ( p  < 0.05).
CONCLUSION: The three parameters studied can be collectively applied to the preoperative assessment of patients subjected to TPRA with no effect of inflammation on accessibility parameters. Difficult accessibility can be anticipated in 42% of the population, so surgeons must have caution when practicing TPRA.