Wormald Peter John
Department of Surgery, Section of Otolaryngology Head and Neck Surgery, Adelaide and Flinders Universities, Adelaide, South Australia, Australia.
Laryngoscope. 2003 Feb;113(2):276-83. doi: 10.1097/00005537-200302000-00015.
OBJECTIVES/HYPOTHESIS: Until recent years, the osteoplastic flap with frontal sinus obliteration has been the gold standard for recalcitrant frontal sinusitis. The present series evaluated the role of the endoscopic modified Lothrop procedure, which has recently been advocated as an alternative.
Prospective non-randomized interventional case series.
The study prospectively assessed 83 consecutive patients who underwent endoscopic modified Lothrop procedure. The mean age was 52.4 years (SD = 13.6 y) with a male-to-female ratio of 3:1. Patients had a mean of six previous sinus surgical procedures with 17 patients having undergone previous frontal sinus obliteration with mucocele formation. Seventy-six patients (91%) had frontal pain or headache as their primary presenting symptom, with 72 having nasal discharge. There were 14 patients who presented with 17 complications of frontal sinus disease. There were eight erosions of the posterior table of the frontal sinus with extension of the mucocele intracranially, seven orbital complications, and one cerebrospinal fluid leak. Twenty-four patients (30%) had fungus cultured from their sinuses at the time of surgery.
Six of the 83 patients (7%) developed frontal ostium stenosis resulting in a 93% primary success rate after an average follow-up of 21.9 months (SD = 6.1 mo). These patients all underwent a revision modified Lothrop procedure and had a patent frontal ostium at their last review. Twenty-one patients (25%) developed recurrent symptoms, which were managed medically. Of these 21 patients, 9 with previously diagnosed fungal sinusitis developed mucosal changes again in their frontal sinuses, but their ostia have remained patent. Four patients have had recurrent infections in the frontal sinuses, and three patients with aspirin-sensitive asthma and polyps have developed polyps again in their frontal sinuses. Five patients continued to have frontal pain without radiological evidence of further frontal disease. No patients required an osteoplastic flap procedure.
The endoscopic Lothrop procedure is a successful short-term management option for recalcitrant and complicated frontal sinusitis caused by a wide range of diseases.
目的/假设：直到近年来，额窦闭塞的骨成形瓣一直是难治性额窦炎的金标准。本系列研究评估了内镜改良Lothrop手术的作用，该手术最近被提倡作为一种替代方法。
前瞻性非随机干预病例系列。
该研究前瞻性评估了83例连续接受内镜改良Lothrop手术的患者。平均年龄为52.4岁（标准差=13.6岁），男女比例为3:1。患者平均之前接受过6次鼻窦手术，其中17例曾接受过额窦闭塞并形成黏液囊肿。76例患者（91%）以额部疼痛或头痛为主要症状，72例有鼻分泌物。14例患者出现17例额窦疾病并发症。有8例额窦后板侵蚀伴黏液囊肿向颅内扩展，7例眼眶并发症，1例脑脊液漏。24例患者（30%）在手术时鼻窦培养出真菌。
83例患者中有6例（7%）发生额窦口狭窄，平均随访21.9个月（标准差=6.1个月）后，初次成功率为93%。这些患者均接受了改良Lothrop手术翻修，在最后一次复查时额窦口通畅。21例患者（25%）出现复发症状，采用药物治疗。在这21例患者中，9例先前诊断为真菌性鼻窦炎的患者额窦再次出现黏膜改变，但窦口仍通畅。4例患者额窦反复感染，3例阿司匹林敏感性哮喘和息肉患者额窦再次出现息肉。5例患者持续有额部疼痛，但无进一步额窦疾病的影像学证据。没有患者需要进行骨成形瓣手术。
内镜Lothrop手术是治疗由多种疾病引起的难治性和复杂性额窦炎的一种成功的短期治疗选择。
