基于术前CT三维重建的上颌窦良性病变定位对经鼻内镜不同入路选择的指导价值研究OA

Objective:To explore the guiding value of benign lesions of maxillary sinus localization based on preoperative computed tomography(CT)three-dimensional reconstruction in the selection of middle nasal meatus combined with inferior nasal meatus fenestration approach and anterior lacrimal recess approach.Methods:116 patients with benign lesions of maxillary sinus admitted to our hospital from January 2021 to July 2024 were selected and divided into two groups according to the random number table method.The three-dimensional reconstruction group(n=58)underwent the middle nasal meatus combined with inferior nasal meatus fenestration approach or anterior lacrimal recess approach based on the lesion location of preoperative CT three-dimensional reconstruction,while the control group(n=58)underwent the middle nasal meatus combined with inferior nasal meatus fenestration approach or anterior lacrimal recess approach based on conventional two-dimensional CT axial/coronal imaging combined with nasal endoscopy findings.The incidence rateof adjusting approach decision during operation,complete resection rate of lesions,surgical indexes(intraoperative blood loss,operation time,hospitalization time),visual analogue scale of pain(VAS)and incidence rateof complications were compared between the two groups,and the clinical efficacy of patients was evaluated after operation,and the recurrence rate was recorded after one-year follow-up.Results:The complication rate and recurrence rate of the three-dimensional reconstruction group were lower than those of the control group(P＜0.05),and the complete resection rate of the lesion was higher than that of the control group(P＜0.05),and the intraoperative blood loss was less than that of the control group(P＜0.05).The pain VAS scores of the two groups:3 months after operation＜48 h after operation＜6 h after operation＜24 h after operation(P＜0.05),and the pain VAS scores of the three-dimensional reconstruction group at 6 h,24 h and 48 h after operation were lower than those of the control group(P＜0.05),but there was no statistical difference in the pain VAS scores of the two groups at 3 months after operation(P＞0.05).There was no significant difference in clinical efficacy between the two groups(P＞0.05).Conclusion:The localization of benign lesions of maxillary sinus based on preoperative CT three-dimensional reconstruction has guiding value for the selection of middle nasal meatus combined with inferior nasal meatus fenestration approach and anterior lacrimal recess approach,which canimprove the complete resection rate of lesions,reduce surgical trauma and pain,reduce complications,improve surgical efficacy and reduce postoperative recurrence,without compromising overall clinical efficacy.