Bhandarkar Naveen D, Smith Timothy L
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):49-53. doi: 10.1097/MOO.0b013e328334d974.
There are numerous available surgical techniques in use to address inferior turbinate hypertrophy. The current review will discuss the most widely used and recently studied techniques for turbinate surgery and highlight recent publications discussing clinical outcomes.
Microdebrider-assisted inferior turbinoplasty and radiofrequency ablation are mucosal sparing techniques that have been recently studied in direct comparison. Outcomes of the two techniques are at least equal to 6 months, although only microdebrider-assisted inferior turbinoplasty had sustained outcomes to 3 years. Recent study suggests unfavorable histological changes with radiofrequency ablation although earlier studies reported no change in nasal physiologic function. The two measures have been studied simultaneously but follow-up was only 2 months. The holmium:yttrium-aluminum-garnet (Ho:YAG) laser was found superior to the diode laser in long-term nasal patency. Few recent studies address turbinectomy. The ultrasound may be a new technique on the horizon.
Inferior turbinate surgery results in favorable outcomes and continues to be recommended as a treatment for turbinate hypertrophy not responsive to medical therapy. Evidence level in the literature is improving. Future well designed studies involving prospective data collection, validated outcome measures, statistical analysis, comparison or control groups, and long-term follow-up would strengthen the level of evidence.
目前有多种手术技术可用于治疗下鼻甲肥大。本综述将讨论下鼻甲手术中使用最广泛且近期研究较多的技术,并重点介绍近期有关临床结果的出版物。
微切吸刀辅助下鼻甲成形术和射频消融是近年来经直接比较研究的保留黏膜技术。两种技术在6个月时的效果至少相当,不过只有微切吸刀辅助下鼻甲成形术在3年时仍有持续疗效。近期研究表明射频消融会导致不良组织学改变,尽管早期研究报告其对鼻腔生理功能无影响。这两种方法曾同时进行研究,但随访仅2个月。钬激光在长期鼻腔通畅方面被发现优于二极管激光。近期很少有研究涉及下鼻甲切除术。超声可能是一种新出现的技术。
下鼻甲手术效果良好,对于药物治疗无效的鼻甲肥大仍被推荐作为一种治疗方法。文献中的证据水平正在提高。未来设计良好的研究,包括前瞻性数据收集、验证的结局指标、统计分析、比较或对照组以及长期随访,将加强证据水平。