Choby Garret W, Hobson Candace E, Lee Stella, Wang Eric W
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):502-7. doi: 10.2500/ajra.2014.28.4097.
The middle turbinate (MT) is a structure that is often carefully preserved during endoscopic sinus surgery (ESS) in an effort to preserve nasal physiology and serve as an anatomic landmark. However, resection is performed in select cases because of involvement of the MT in the inflammatory process, obstruction, or instability. Therefore, significant controversy exists among surgeons regarding the indications for proceeding with MT resection in ESS. This study evaluates clinical outcomes of MT resection after ESS.
An English language search of the PubMed and Ovid databases was conducted for publications examining clinical outcomes of MT resection after ESS performed for chronic rhinosinusitis. Two authors independently examined the articles to identify those meeting inclusion criteria. Any differences over which studies to include were resolved by discussion and consensus. Bias assessment was conducted using the Cochrane Collaboration bias tool for randomized controlled trials and the Newcastle-Ottawa bias tool for cohort and case-control studies.
After initial screening, search results revealed 71 articles that warranted detailed evaluation. After applying inclusion criteria, 9 studies were selected. A total of 2123 patients were included among the studies. All studies were controlled. Within the limited available data, olfaction scores may be improved in the MT resection patients compared with MT preservation patients. No difference between the groups was noted for quality of life outcomes, nasal airway resistance, or rates of postoperative frontal sinusitis. In regard to postoperative endoscopic examinations, some studies note greater improvement in the MT resection group compared with the MT preservation group, while others were equivalent.
Although some studies show outcome benefit in MT resection patients compared with MT preservation patients, several others show no difference. When MT resection was appropriately indicated, no studies showed detrimental effects compared with MT preservation in their designated outcomes. Additional more stringent studies are warranted.
中鼻甲（MT）是一种在内镜鼻窦手术（ESS）中常被小心保留的结构，目的是维持鼻腔生理功能并作为解剖标志。然而，在某些情况下会进行切除，原因是中鼻甲参与了炎症过程、造成阻塞或结构不稳定。因此，外科医生对于ESS中进行中鼻甲切除的适应证存在重大争议。本研究评估了ESS后中鼻甲切除的临床结果。
在PubMed和Ovid数据库中进行英文检索，以查找有关慢性鼻窦炎ESS后中鼻甲切除临床结果的出版物。两位作者独立审查文章，以确定符合纳入标准的文章。关于纳入哪些研究的任何分歧通过讨论和达成共识来解决。使用Cochrane协作偏倚工具对随机对照试验进行偏倚评估，使用纽卡斯尔-渥太华偏倚工具对队列研究和病例对照研究进行偏倚评估。
初步筛选后，检索结果显示71篇文章值得详细评估。应用纳入标准后，选择了9项研究。这些研究共纳入2123例患者。所有研究均有对照。在有限的可用数据中，与保留中鼻甲的患者相比，中鼻甲切除患者的嗅觉评分可能有所改善。两组在生活质量结果、鼻气道阻力或术后额窦炎发生率方面没有差异。关于术后内镜检查，一些研究指出中鼻甲切除组比保留中鼻甲组改善更大，而其他研究则显示两者相当。
尽管一些研究表明与保留中鼻甲的患者相比，中鼻甲切除患者的结果更优，但其他一些研究则显示没有差异。当中鼻甲切除指征适当时，与保留中鼻甲相比，没有研究显示在其指定结果中有有害影响。需要进行更多更严格的研究。
