【作者】 于洪波；

【导师】 吴恩余；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 窦口鼻道复合体(Ostiomeatal Complex,OMC)是鼻科学近年来比较新兴解剖学名词。主要在中鼻甲(middle turbinate)、中鼻道(middle meatus)及附近区域解剖结构,是以筛漏斗为中心的附近区域,包括:筛漏斗、钩突、筛泡、半月裂、中鼻道、中鼻甲、前组筛房、额窦口及上颌窦自然开口等一系列结构。鼻窦的炎性病变多发生于此区域。本研究主要目的是通过对窦口鼻道复合体炎性病变的影像学观察,加深对窦口鼻道复合体炎性病变影像学特征的认识,提高对窦口鼻道复合体的炎性病变影像诊断水平。本研究收集了150例经临床证实的鼻窦炎患者,全部采用德国SIEMENS公司生产的Sensatian 16型多层螺旋CT扫描仪,进行常规扫描和使用CT工作站行多平面重建(Multipliate Plane Reconstruction,MPR)图像两种方法对OMC区炎性病变进行观察,比较两种方法在显示炎性病变方面的优劣。通过对比研究发现MPR方法在显示微小软组织病变及小的窦壁骨质改变,尤其在显示窦壁骨质增生硬化和窦壁骨质吸收破坏方面具有非常明显的优势。结果表明多层螺旋CT扫描中MPR重建图像能清晰的显示OMC区的炎性病变的大小、侵及范围及周围毗邻关系,是临床医生正确认识鼻窦炎影像特征和避免FESS手术治疗并发症,必不可少的检查方法。更多还原

【Abstract】 Ostiomeatal complex (OMC) is a relatively new nasal anatomy term in recent years, which mainly refers to the middle turbinate, the middle meatus and the nearby anatomical structure, as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. Sinus inflammatory disease often occurr in this region. It was first proposed by Naumann as an anatomy of a concept with with popular agreement of many medical professionors. Then Stammberger suggessed that paranasal nasal sinus infection always occurred in nasal cavity, the middle meatus ethmoidal infundibulum and the narrow area neighboring middle meatus-OMC theory in 1986. But the theory didn’t receive wide attention, because of the restrict of the science ,technology and economic condition level, the influence of the traditional concept to today surgical treatment ,the low requisition of life quality , and other factors. In the last 10 years, endoscopic sinus surgery and endoscopy equipment improved and matured, particularly Functional Endoscopic Sinus Surgery(FESS) developed and widespread, following the development of country economics and the improvement of people living standards.More and more nose branch doctor gradually realize the close relationship between OMC sinusitis abnormal structure and pathological changes and the incidence of sinusitis,and realize the importance of OMC in emergement of sinusitis.Now imaging examination has always been a major means of clinical inspection before endoscopic sinus surgery, because of pain-free, micromesh, convenience and close to the entities anatomy. It is the main method of first choice to evaluate the OMC anatomical variations, making sure the lacation and region of lesion. But due to complicated OMC complex structure,deep location, too many overlapping of X-ray film and unclear layer, it is difficult to get detailed image of OMC structure and soft tissue condition. Now high-field MRI can clearly show the abmormality of OMC region. But its high cost and long examine time limit MRI application. The new examin method-multipliate plane reconstruction(MPR) by multislice helical CT scan can clearly shows the OMC lesions, the neighbouring structure and the anatomical structure variation.Its the reconstruction of coronal images is similar to or better than conventional coronal scan images, and can show clearly the structure (such as the ethmoid, transsphenoidal) which endoscope can not reach.The purpose of this study is to deepen the understanding of ostiomeatal complex inflammatory disease imaging features, and to improve the imaging diagnostic level of ostiomeatal complex inflammatory disease, through the imaging observation of OMC.Materials and methods: This study collected 150 cases of clinically proved sinusitis over a year. All the patients received conventional scaning without reconstruction and interval reconstruction of 1.0mm after that by the German SIEMENS Sensatian 16 of the multi-slice helical CT scanner. All the data were sent to CT workstations to do MPR, mainly coronal view. Image analysis was based in the cross-sectional image and adjust direction to get the best visual image, for better observing OMC inflammatory lesions and the surrounding area adjacent. Because nasal cavity and nasal sinus distribut in paires, and function independently, this study analyzes by "side" to compare the value of conventional CT scan and MPR in assess OMC inflammatory lesions.Results:(1) OMC is a complex, which refers to the anatomical structures as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. MPR images is able to show clearly OMC anatomical variations, besides the region and extent of OMC lesions and sinus bone wall from all directions. (2) We found that sinus mucosal thickening (230:203), sinus polyps (184:156), sinus bone hyperplasia sclerosis (95:60), sinus bone absorption destruction (106:71) and gas-liquid plane in sinus (49:35) were the image feature of OMC inflammatory lesions, which were seen both in conventional CT scan and MPR. But MPR displayed OMC lesions more detailed than conventional CT scan, (P<0.05).Conclusion: (1) multi-slice helical CT scan reconstruction of the MPR images can show very clearly the region and the extent of OMC inflammatory lesions and the surrounding structures. (2) Because MPR technology is superior to conventional CT scanning in displaying sinus mucosal thickening , sinus polyps , sinus bone hyperplasia sclerosis , sinus bone absorption destruction and gas-liquid plane in sinus, so we should take MPR images, when checking nasal sinusal inflammatory disease, or before FESS sinus surgery or conventional surgery, particularly those OMC diseases involving anatomical variaties.In a word, multi-slice helical CT scan reconstruction of the MPR images can clearly show the OMC lesions. It is a necessary tool for clinical doctors to knew he condition of OMC lesions and prevent beforehand FESS sinus surgery complication.更多还原