Welch Kevin C, Stankiewicz James A
Department of Otolaryngology-Head and Neck Surgery, Loyola University School of Medicine, Maywood, Illinois, USA.
Laryngoscope. 2009 Nov;119(11):2258-68. doi: 10.1002/lary.20618.
Chronic rhinosinusitis is estimated to nearly 25 million people annually in the United States alone. The medical management of these patients is often successful; however, when medical management fails, surgery may be indicated to bring relief. Unfortunately, surgery for chronic rhinosinusitis is not standardized and we remain without a consensus on both the extent of surgery required and the manner in which it is performed. In the past 25 years, three philosophies or schools of thought have arisen to help guide the surgical treatment of chronic rhinosinusitis. Functional endoscopic sinus surgery aims to surgically treat problem areas by ventilating the sinuses through the natural ostia and addressing all diseased sinuses when necessary. This procedure is not standardized and is patient and surgeon dependent. The minimally invasive sinus technique has been proposed as a method whereby each surgical procedure is standardized regardless of disease severity. Lastly, balloon catheter dilatation of the sinus ostia, which by itself is not truly a procedure, is also discussed as a separate philosophy since these specific tools used during endoscopic sinus surgery have quickly energized the sinus community. All three schools of thought possess benefits and drawbacks, even when used appropriately. The concepts, tools, and technologies will be reviewed here as well as outcomes in the hopes that this article will provide an understanding of the surgical options to successfully treat chronic rhinosinusitis.
据估计，仅在美国，每年就有近2500万人患有慢性鼻窦炎。对这些患者的药物治疗往往是成功的；然而，当药物治疗失败时，可能需要手术来缓解症状。不幸的是，慢性鼻窦炎的手术治疗并不规范，在所需手术范围和手术方式上我们仍未达成共识。在过去25年里，出现了三种理念或思想流派来指导慢性鼻窦炎的手术治疗。功能性鼻内镜鼻窦手术旨在通过自然开口使鼻窦通气，并在必要时处理所有患病鼻窦，从而对问题区域进行手术治疗。该手术并不规范，取决于患者和外科医生。微创鼻窦技术被提议作为一种方法，即无论疾病严重程度如何，每个手术过程都是标准化的。最后，鼻窦开口的球囊导管扩张术本身并非真正的手术，但由于在内镜鼻窦手术中使用的这些特定工具迅速引起了鼻窦学界的关注，也被作为一种单独的理念进行讨论。即使合理使用，这三种思想流派都有其优缺点。本文将对这些概念、工具和技术以及治疗结果进行综述，希望能让读者了解成功治疗慢性鼻窦炎的手术选择。
