Ramadan Hassan H, Terrell Andrew M
Department of Otolaryngology, West Virginia University School of Medicine, PO Box 9200, Morgantown, WV 26506-9200, USA.
Ann Otol Rhinol Laryngol. 2010 Sep;119(9):578-82. doi: 10.1177/000348941011900902.
Adenoidectomy is the first step in the surgical management of children with chronic rhinosinusitis (CRS). Adenoidectomy, however, is only effective in half of these children. Although endoscopic sinus surgery is effective for CRS, there is concern for facial growth retardation and major complications. We propose that balloon catheter sinuplasty (BCS) is a minimally invasive, effective procedure in the treatment of pediatric CRS.
We undertook a nonrandomized, controlled, prospective review of children with failed medical management of CRS who underwent BCS or adenoidectomy. Outcomes were assessed at 1 year of follow-up and were based on SN-5 scores and the need for revision surgery.
Forty-nine children who satisfied the inclusion criteria were reviewed. Thirty of the children had BCS. The age range was 4 to 11 years (mean, 7.7 years), and the mean computed tomography score (Lund-Mackay system) was 7.5. Twenty-four of the 30 patients (80%) who underwent BCS showed improvement of their symptoms after 12 months of follow-up, compared with 10 of the 19 patients (52.6%) who underwent adenoidectomy (p < 0.05). A multivariate analysis using logistic regression analysis with age, sex, asthma, and computed tomography score as covariables showed that BCS was also more effective than adenoidectomy in older children. None of the other variables showed statistical significance.
Balloon catheter sinuplasty offers a procedure that is more effective than adenoidectomy and less invasive than endoscopic sinus surgery in the treatment of pediatric CRS.
腺样体切除术是慢性鼻-鼻窦炎（CRS）患儿外科治疗的第一步。然而，腺样体切除术仅对半数此类患儿有效。虽然鼻内镜鼻窦手术对CRS有效，但人们担心其会导致面部生长发育迟缓及严重并发症。我们提出球囊导管鼻窦成形术（BCS）是治疗小儿CRS的一种微创且有效的手术方法。
我们对CRS药物治疗失败后接受BCS或腺样体切除术的患儿进行了一项非随机、对照的前瞻性研究。在随访1年时根据SN-5评分及再次手术需求评估结果。
对49名符合纳入标准的患儿进行了研究。其中30名患儿接受了BCS。年龄范围为4至11岁（平均7.7岁），平均计算机断层扫描评分（Lund-Mackay系统）为7.5。接受BCS的30例患者中有24例（80%）在随访12个月后症状改善，而接受腺样体切除术的19例患者中有10例（52.6%）症状改善（p<0.05）。以年龄、性别、哮喘及计算机断层扫描评分为协变量进行逻辑回归分析的多变量分析显示，在年龄较大的儿童中BCS也比腺样体切除术更有效。其他变量均未显示出统计学意义。
在小儿CRS的治疗中，球囊导管鼻窦成形术提供了一种比腺样体切除术更有效且比鼻内镜鼻窦手术侵入性更小的手术方法。
