Department of Otorhinolaryngology, Polytechnic University of Marche, Via Tronto 10/A, 60126, Ancona, Italy.
Eur Arch Otorhinolaryngol. 2012 Mar;269(3):721-9. doi: 10.1007/s00405-011-1744-2. Epub 2011 Oct 9.
The aim of this study was to compare the incidence of complications of endoscopic sinus surgery (ESS) to the incidence of complications of traditional and microscopic sinus surgery. A meta-analysis was carried out on 28 series of patients (a total of 13,405) who had undergone ESS, 8 series of patients (3,887 in total) who had undergone traditional endonasal sinus surgery and 7 series of patients (1,630 in total) who had undergone microscopic sinus surgery. The authors used the Bayesian inference package WinBUGS operating from within the statistical computer program R (version 2.7.1). Major complications had a higher incidence after traditional sinus surgery than ESS but this fact did not cause a significant statistical difference, whereas microscopic surgery had significantly more complications than ESS (p < 0.05). Carrying out our meta-analytic study, comparing major and minor complications of endonasal surgical approaches, was very difficult due to several methodological biases of data extraction and evaluation from studies concerning a broad timespan. Regarding major complications, we only found a significant statistical difference (p < 0.05) between the endoscopic (1%) and the microscopic methods (2.0%), but, if we had analyzed the data considering the natural learning curve of the latest ESS surgical approach, and if we had not considered the results produced in the first 10 years (1988-1998) concerning ESS in our meta-analysis, we would have found a statistically significant difference (p < 0.05) between the endoscopic (0.4%) and the traditional (1.1%) approach as well.
本研究旨在比较内镜鼻窦手术（ESS）的并发症发生率与传统和显微镜鼻窦手术的并发症发生率。对 28 项患者系列研究（共 13405 例）进行了荟萃分析，这些患者接受了 ESS，8 项患者系列研究（共 3887 例）接受了传统经鼻内镜鼻窦手术，7 项患者系列研究（共 1630 例）接受了显微镜鼻窦手术。作者使用贝叶斯推断软件包 WinBUGS，通过统计计算机程序 R（版本 2.7.1）运行。传统鼻窦手术后主要并发症的发生率高于 ESS，但这一事实并未导致显著的统计学差异，而显微镜手术的并发症明显多于 ESS（p < 0.05）。由于在跨时间段的研究中，数据提取和评估存在多种方法学偏倚，因此，我们进行荟萃分析，比较经鼻手术方法的主要和次要并发症，非常困难。关于主要并发症，我们仅在内镜（1%）和显微镜方法（2.0%）之间发现了显著的统计学差异（p < 0.05），但如果我们考虑到最新 ESS 手术方法的自然学习曲线分析数据，如果我们没有在荟萃分析中考虑到 ESS 在 1988-1998 年的最初 10 年中产生的结果，我们会发现内镜（0.4%）和传统（1.1%）方法之间也存在统计学显著差异（p < 0.05）。
