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目的:探讨以慢性咳嗽为主要表现的儿童慢性鼻窦炎的临床特征、影像学特点及治疗。方法:对咳嗽超过3~4周,免疫功能及肺部X线检查正常的慢性咳嗽且内科治疗无明显效果的患儿,行常规耳鼻咽喉科检查和(或)鼻内镜、鼻窦CT检查,确诊为鼻窦炎的患儿按正规鼻窦炎治疗方案治疗6~8周,伴腺样体肥大者行腺样体切除术。结果:53例CT检查43例患儿确诊为慢性鼻窦炎,年龄2岁10个月~13岁,平均7岁。该类患儿主要临床表现为慢性咳嗽,但无明显梨状孔漏,前鼻镜或鼻内镜检查可发现中鼻甲水肿,35例鼻道内有脓液,8例为白色黏性分泌物,31例咽后壁有脓性分泌物及28例咽后壁淋巴滤泡增生,6例伴腺样体肥大,A/N比值>0.7。鼻窦炎临床分期:Ⅰ型3期19例(36侧),Ⅰ型2期19例(29侧),Ⅰ型1期5例(7侧),未发现有Ⅱ型或Ⅲ型患儿。以上颌窦、筛窦病变严重程度最高,其次为额窦、蝶窦。确诊慢性鼻窦炎的患儿经正规治疗6~8周后,81.4%痊愈,18.6%好转,4例行腺样体切除,2例行鼓膜置管术。结论:儿童慢性鼻窦炎与慢性咳嗽关系密切,且与成人鼻窦炎相比区别较大,常表现为全身症状而分散就诊,易造成误诊、漏诊。
Objective: To investigate the clinical features, imaging characteristics and treatment of chronic sinusitis in children with chronic cough as the main manifestation. Methods: Children with cough for more than 3 to 4 weeks, immunocompetent and chronic cough with normal pulmonary X-ray examination and no significant medical treatment were performed routine otorhinolaryngology examination and / or endoscopic sinus surgery, sinus CT examination, Patients diagnosed as sinusitis according to the treatment of regular sinusitis treatment of 6 to 8 weeks, with adenoid hypertrophy adenoidectomy. Results: 43 cases of CT examination in 53 cases were diagnosed as chronic sinusitis, aged 2 months and 10 months to 13 years old with an average of 7 years. The main clinical manifestations of these children with chronic cough, but no obvious pear-like hole leakage, anterior or endoscopic nasal endoscopic turbinate edema found in 35 cases of nasal pus, 8 cases of white viscous secretions, 31 cases of posterior pharyngeal wall purulent secretions and 28 cases of retropharyngeal lymphoid follicular hyperplasia, 6 cases with adenoid hypertrophy, A / N ratio> 0.7. The clinical stage of sinusitis was as follows: stage Ⅰ and stage Ⅲ in 19 cases (36 sides), type Ⅰ and Ⅱ stage in 19 cases (29 sides), type Ⅰ and stage 1 in 5 cases (7 sides). No type Ⅱ or Ⅲ children were found. The maxillary sinus, ethmoid sinus lesions the highest severity, followed by the frontal sinus, sphenoid sinus. The diagnosis of chronic sinusitis in children after formal treatment of 6 to 8 weeks, 81.4% recovered, 18.6% improvement, 4 cases of adenoid resection, 2 cases of tympanic membrane catheterization. Conclusion: Children with chronic sinusitis and chronic cough are closely related, and with large differences between adult sinusitis, often manifested as systemic symptoms and decentralized treatment, easily lead to misdiagnosis, missed diagnosis.