| Objective Functional endoscopic sinus surgery (FESS) is a revolution for the diagnosis and therapy of chronic sinusitis in modern rhinology, the theoretical core roots on the relationship between ostiomeatal complex and chronic sinal inflammations; operation and endoscopically postoperative managements are two essential parts of FESS. This paper initiated with a microecological view, so as to explore the significance of microecology in etiology and therapeutics for chronic sinusitis. Ostiomeatal complex was then regarded as another microecosytem in human beings, and some indexes are documented based on its features to analyze and evaluate its microecological status. Highlights focused on its general composition and influence via FESS(aerobes> anaerobes and fungi were in majority). We meant to afford some certain viewpoints for consequent improvements in curing sinusitis with FESS.Materials and methods During April to November in 2001, two hundred and twenty adult patients were grouped into eleven according to type I or type II as well as pre or post operation, and a control group included(with twenty patients).Samples were taken with swabs from three different sites in each individual, cultivations and identifications of aerobes ^ anaerobes and fungi were performed simultaneously;then the microecological status was analysesed by some indexes: culture rate> identity rate of cutlures in three sites > predominant microorganisms and polymicrobial coexistence etc.Results All aerobes belonged to thirteen genera thirty species, anaerobes were of three species and three major species of fungus recovered, most ofthem had none or less virulences. Predominant aerobes were Staphylococcusiiepidermidis, Enterobacter aerogenes, Corynebacterium pseudodiphtheriticum , Stenotrophomonas maltophilia, Staphylococcus aureus, Haemophilus influenzae; anaerobes were Eubacterium lentum^ Eubacterium limosum and Peptococcus asaccharolyticus ; and predominant fungi were Aspergillus, Penicillium and Mucor .statistically, none significance of difference were shown between type I and II(P>0.05);as to the categories and quantities of aerobes , difference between lesion group and control group has significance(P<0.01); quantitively, it descends in the postoperative group while the difference has no significance compares to lesion group(P>0.05); difference in three-site-identical rate of aerobes between lesion and control group was significant(P<0.01), while hadn't between postoperative group and control one. (P>0.05).Taking fungi into account, differences between these groups had no significance(P>0.05),;anaerobes are rare in all groups.Conclusions These indexes we adopted in the research seem to be valid in comprehensive evaluations for microecosytem in ostiomeatal complex. Results in this paper indicates:1 .Being another microecosytem in organism, ostiomeatal complex has its individual microecological characters: the space exists as a whole and being relatively clean with a possible existance of few aerobes^ anaerobes and fungi in healty condition; while chronic inflammation separates different parts of which from each other and many microorganisms may coexist;2.There are no obvious microecological differences between type I and type II no matter in preoperative inflammation and postoperative recovering period;3.Predominant microorganisms in inflammatory ostiomeatal complex are majorly virulenceless or with weak pathogenecity. Microorganisms may play a rather limited role in chronic sinusitis whether it's with single species orpolymicrobial cultures;4.Funtional endoscopic sinus surgery somewhat influences the microecosystem of microecosystem, it does reverse and recover it as a whole again.Aerobes may be eliminated gradually after operation, and it's likely to reach the normal state; the postoperative recovery of mucosa and mucociliary transport system seems to be a vital contributor for it. Two months maybe a transition during the repairing stage if systemaitcally postoperative cares engaged;5. Insights fro... |
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