Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, 1530 3rd Avenue S., Birmingham, AL 35294, USA.
Am J Rhinol Allergy. 2012 Jan-Feb;26(1):70-5. doi: 10.2500/ajra.2012.26.3705.
Chronic rhinosinusitis has a major impact on the quality of life of patients with cystic fibrosis (CF) and may contribute to progression of chronic lung disease. Despite multiple sinus surgeries, maxillary sinus involvement is a recurrent problem. The modified endoscopic medial maxillectomy (MEMM) permits debridement in the clinic, improves mucus clearance with nasal irrigations, and increases access for topical delivery of therapeutics. However, clinical outcomes of aggressive sinus surgery with regimented postoperative medical treatment have not been systematically evaluated.
CF patients completed the 22-Item Sinonasal Outcome Test questionnaires before sinus surgery (and bilateral MEMM) and at sequential postoperative visits. Objective measures included Lund-Kennedy endoscopic score and pulmonary function tests (forced expiratory volume at 1 second percent [FEV(1)%] predicted). Culture-directed antibiotic therapy, prednisone, and topical irrigations were initiated postoperatively.
Twenty-two patients (mean age, 26.5 years; 4.9 prior sinus operations) underwent MEMM and sinus surgery. Symptom scores were significantly reduced at 60 days (primary outcome, 64.7 ± 18.4 presurgery versus 27.5 ± 15.3 postsurgery; p < 0.0001) and up to a year postoperatively (27.6 ± 12.6; p < 0.0001). Endoscopic scores were also reduced after surgery (10.4 ± 1.1 presurgery versus 5.7 ± 2.4 [30 days], 5.7 ± 1.4 [60 days], 5.8 ± 1.3 [120 days], and 6.0 ± 1.1 [1 year]; p < 0.0001)]. There were no differences in FEV(1)% predicted up to 1 year postoperatively, but hospital admissions secondary to pulmonary exacerbations significantly decreased (2.0 ± 1.4 versus 3.2 ± 2.4, respectively; p < 0.05).
Prospective evaluation indicates sinus surgery with MEMM is associated with marked improvement in sinus disease outcomes. Additional studies are necessary to confirm whether this treatment paradigm is associated with improved CF pulmonary disease.
慢性鼻-鼻窦炎对囊性纤维化（CF）患者的生活质量有重大影响，并可能导致慢性肺部疾病的进展。尽管进行了多次鼻窦手术，上颌窦受累仍是一个反复出现的问题。改良内镜下内侧上颌窦切除术（MEMM）可在诊室进行清创，通过鼻腔冲洗改善黏液清除，增加局部药物输送的通道。然而，系统评估强化鼻窦手术后联合规范术后药物治疗的临床疗效尚未见报道。
CF 患者在鼻窦手术（双侧 MEMM）前和术后连续就诊时完成 22 项鼻-鼻窦结局测试问卷。客观指标包括 Lund-Kennedy 内镜评分和肺功能检查（1 秒用力呼气容积占预计值的百分比 [FEV1%]）。术后立即开始进行基于培养的抗生素治疗、泼尼松和局部冲洗。
22 例患者（平均年龄 26.5 岁，之前有 4.9 次鼻窦手术）接受了 MEMM 和鼻窦手术。术后 60 天（主要结局，术前 64.7±18.4 分，术后 27.5±15.3 分；p＜0.0001）和 1 年时症状评分显著降低（27.6±12.6 分；p＜0.0001）。术后内镜评分也降低（术前 10.4±1.1 分，术后 30 天 5.7±2.4 分，60 天 5.7±1.4 分，120 天 5.8±1.3 分，1 年 6.0±1.1 分；p＜0.0001）。术后 1 年时 FEV1%预计值无差异，但因肺部恶化而住院的次数显著减少（分别为 2.0±1.4 次和 3.2±2.4 次；p＜0.05）。
前瞻性评估表明，MEMM 联合鼻窦手术可显著改善鼻窦疾病结局。还需要进一步研究来证实这种治疗方案是否与 CF 肺部疾病的改善相关。
