Myller Jyri P, Luukkainen Annika T, Huhtala Heini S A, Torkkeli Tommi V M, Rautiainen Markus E P, Toppila-Salmi Sanna K
Department of Otorhinolaryngology, University of Tampere, Tampere, Finland, ; Department of Otorhinolaryngology, Paijat-Hame Central Hospital, Lahti, Finland.
Allergy Rhinol (Providence). 2013 Spring;4(1):e6-e12. doi: 10.2500/ar.2013.4.0039.
Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for ≥12 weeks. Endoscopic sinus surgery (ESS) is considered during difficult to treat CRS. The minimally invasive technique focuses on the transition areas rather than on the ostia. The aim of this study was to evaluate symptoms, the number of acute sinusitis episodes, and satisfaction after ESS with either preservation or enlargement of the maxillary sinus ostium. Thirty patients with moderate nonpolypous CRS were enrolled. Uncinectomy only and additional middle meatal antrostomy were randomized for each side of each patient and performed single blindly. The symptoms questionnaires were filled at four time intervals. Significant symptom reduction was achieved independently of operation technique. The number of acute sinusitis episodes indicating the exacerbation rate decreased significantly at 9 and, on average, 68 months postoperatively. However, the exacerbation rate began to increase after 9 months postoperatively. Three revisions were performed on the side with uncinectomy only and one on the side with additional antrostomy. Most patients reported good satisfaction with both procedures. There was a trend for patients with asthma and/or job exposure to report insignificantly more frequently no satisfaction with surgery, especially with the uncinectomy-only procedure. Both procedures seem to be efficient in providing symptom relief and satisfaction. More studies are needed to evaluate if patients with risk factors benefit more from an ostium-enlarging procedure.
慢性鼻-鼻窦炎(CRS)是指鼻腔和鼻窦的炎症持续≥12周。对于难治性CRS可考虑行鼻内镜鼻窦手术(ESS)。这种微创技术侧重于过渡区域而非窦口。本研究的目的是评估ESS保留或扩大上颌窦口术后的症状、急性鼻窦炎发作次数及满意度。纳入30例中度非息肉性CRS患者。对每位患者的每侧随机进行单纯钩突切除术或附加中鼻道上颌窦造瘘术,并采用单盲法实施。在四个时间点填写症状问卷。症状显著减轻,且与手术技术无关。提示病情加重率的急性鼻窦炎发作次数在术后9个月及平均68个月时显著减少。然而,术后9个月后病情加重率开始上升。仅行钩突切除术一侧进行了3次修正手术,附加上颌窦造瘘术一侧进行了1次修正手术。大多数患者对两种手术均表示满意。哮喘和/或职业暴露患者对手术不满意(尤其是仅行钩突切除术)的报告频率略高,但无显著差异。两种手术在缓解症状和提高满意度方面似乎都有效。需要更多研究来评估有风险因素的患者是否从扩大窦口手术中获益更多。