Mortimore S, Wormald P J
Department of Otolaryngology, Groote Schuur Hospital.
Otolaryngol Head Neck Surg. 1999 Nov;121(5):639-42. doi: 10.1016/S0194-5998(99)70072-0.
Acute sinusitis is a relatively common problem; however, sinusitis associated with a complication is less frequent. Currently there is debate as to whether acute complicated sinusitis should be managed by frontal sinus trephine and sinus washout or by immediate frontoethmoidectomy/functional endoscopic sinus surgery. To assess the effectiveness of frontal sinus trephine in the management of acute complicated frontal sinusitis, we reviewed all patients admitted to Groote Schuur Hospital with acute pansinusitis (includes frontal, maxillary, and ethmoid) from 1989 to 1993. Eighty-seven patients were admitted, of whom 43 were treated medically and 44 were treated surgically. Of the surgical patients 38 had frontal trephines and management of associated complications. Thirty (80%) of the patients who received frontal trephines recovered without further surgery, and 8 required further sinus surgery for persistent disease. Frontal trephine with management of associated complications is an acceptable management option for patients with acute complicated pansinusitis. Frontoethmoidectomy or functional endoscopic sinus surgery can be held in reserve for those patients with persistent disease that does not resolve after the initial frontal trephine.
急性鼻窦炎是一个相对常见的问题；然而，伴有并发症的鼻窦炎则较为少见。目前，对于急性复杂性鼻窦炎应采用额窦环钻术和鼻窦冲洗术还是立即进行额筛窦切除术/功能性鼻内镜鼻窦手术存在争议。为了评估额窦环钻术治疗急性复杂性额窦炎的有效性，我们回顾了1989年至1993年期间入住格罗特·舒尔医院的所有急性全鼻窦炎（包括额窦、上颌窦和筛窦）患者。共收治87例患者，其中43例接受药物治疗，44例接受手术治疗。在手术患者中，38例行额窦环钻术及相关并发症处理。接受额窦环钻术的患者中有30例（80%）未经进一步手术即康复，8例因疾病持续存在而需要进一步的鼻窦手术。对于急性复杂性全鼻窦炎患者，额窦环钻术及相关并发症处理是一种可接受的治疗选择。对于那些在初次额窦环钻术后疾病仍未缓解的持续性疾病患者，可保留额筛窦切除术或功能性鼻内镜鼻窦手术。
