Bernal-Sprekelsen M, Sudhoff H, Dazert S
Hospital Clínic, HNO-Universitätsklinik der Universität Barcelona, Spain.
Laryngorhinootologie. 2004 Jan;83(1):23-8. doi: 10.1055/s-2004-814098.
There are sufficient reports on the incidence of complications after endonasal surgery of the paranasal sinuses. It is the aim of this study to calculate the incidence of typical complications after primary and revision surgery, after "functional" and "extended" operations, together with the influence of expertise and of different optical devices on the complications rate. Preoperative computer tomography of the paranasal sinuses are the golden standard. There exists a historical interest to compare the complication rate in patients operated without and those with a CT, especially in those countries where the availability of CTs is low or not existent.
266 consecutive patients who underwent an endonasal surgery of the paranasal sinuses from January 1989 to December 1990 were revised to study the incidence and relative risk rate of typical complications after primary and revision surgery, after "functional" or "extended" surgery, the rate for more experienced or less experienced surgeons, as well as the differences between endoscopic or microscopic surgery. The study also compares the complication rate of patients operated on with and without a preoperative computed tomography.
207 out of 263 patients (78.7 %) had no complication. 58 minor and three severe complication were registered for 56 patients. 6 patients had two or more minor complications. No surgeon showed a higher complication rate compared to others (p = 0.33), and there was no statistically significant difference (p = 0.279) in the complication rate between experienced and less experienced surgeons. Endoscopic or microscopic surgery showed no statistically significant differences (p = 0.117) and extended sinus surgery displayed more complications compared to minor surgery (p = 0.041), as well as primary surgery compared to revision surgery (p = 0.003). No statistically significant differences could be found for surgeries performed with or without computed tomography (p = 0.097).
A higher complication rate is to be expected for primary surgery and after extended sinus surgery, especially when an infundibulotomy was performed. In our series no learning curve was observed, especially as the variable "experience" showed no statistically significant difference. Endonasal surgery without CAT scan is not recommended, however, no higher complication rate was found in surgery without CAT scan.
关于鼻内鼻窦手术后并发症发生率已有足够的报道。本研究的目的是计算初次手术和翻修手术后、“功能性”和“扩展性”手术后典型并发症的发生率，以及专业水平和不同光学设备对并发症发生率的影响。鼻窦的术前计算机断层扫描是金标准。比较未进行CT检查和进行CT检查的患者的并发症发生率具有历史意义，特别是在那些CT设备可用性低或不存在的国家。
对1989年1月至1990年12月连续接受鼻内鼻窦手术的266例患者进行回顾，以研究初次手术和翻修手术后、“功能性”或“扩展性”手术后典型并发症的发生率和相对风险率，经验丰富或经验不足的外科医生的并发症发生率，以及内镜手术或显微镜手术之间的差异。该研究还比较了术前进行计算机断层扫描和未进行计算机断层扫描的患者的并发症发生率。
263例患者中有207例（78.7%）无并发症。56例患者出现58例轻微并发症和3例严重并发症。6例患者有两种或更多种轻微并发症。没有外科医生的并发症发生率高于其他医生（p = 0.33），经验丰富和经验不足的外科医生之间的并发症发生率没有统计学显著差异（p = 0.279）。内镜手术或显微镜手术没有统计学显著差异（p = 0.117），与小型手术相比，扩展性鼻窦手术显示出更多并发症（p = 0.041），与翻修手术相比，初次手术也显示出更多并发症（p = 0.003）。术前进行计算机断层扫描和未进行计算机断层扫描的手术之间没有发现统计学显著差异（p = 0.097）。
初次手术和扩展性鼻窦手术后预计并发症发生率较高，尤其是进行了漏斗切开术时。在我们的系列研究中未观察到学习曲线，特别是因为变量“经验”没有统计学显著差异。不建议在没有CAT扫描的情况下进行鼻内手术，然而，在没有CAT扫描的手术中未发现更高的并发症发生率。
