Abuzeid Waleed M, Mace Jess C, Costa Milena L, Rudmik Luke, Soler Zachary M, Kim Grace S, Smith Timothy L, Hwang Peter H
Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR.
Int Forum Allergy Rhinol. 2016 Jun;6(6):597-604. doi: 10.1002/alr.21726. Epub 2016 Feb 16.
In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis.
Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics.
A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p < 0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy.
The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.
在药物治疗无效的慢性额窦炎中，不进行额窦口器械操作的筛窦切除术可能会缓解额窦疾病。我们的目的是确定单纯筛窦切除术治疗慢性额窦炎的疗效。
前瞻性纳入一项多中心研究的患有慢性鼻-鼻窦炎且计算机断层扫描显示有额窦炎的成年人被分为两组：（1）包括筛窦切除术但不包括额窦切开术的鼻内镜鼻窦手术（ESS）；（2）包括额窦切开术的ESS。主要结局是22项鼻-鼻窦结局测试（SNOT-22）评分的改善。次要结局包括内镜评分以及皮质类固醇和抗生素的使用情况。
共分析了196例行额窦切开术的病例和30例未行额窦切开术的筛窦切除术治疗的病例，两组在人口统计学上具有可比性。鼻息肉、既往ESS、哮喘和阿司匹林不耐受的患病率在额窦切开术组中更为常见（p<0.050）。额窦切开术组术前内镜检查和计算机断层扫描评分更高（p≤0.001）。术后，两组的SNOT-22评分相当，但额窦切开术组的内镜评分更差（p=0.038）。两组间SNOT-22总分和子域评分的术后改善情况相当。额窦切开术组鼻内镜评分改善程度更大（p=0.023）。额窦切开术组术后局部使用类固醇的持续时间更长（p=0.007）。2.6%的额窦切开术患者需要再次手术，未行额窦切开术的患者中这一比例为0%。
对于鼻窦疾病不太严重的患者，通过筛窦切除术治疗慢性额窦炎是额窦切开术的一种潜在替代方法，可实现类似的生活质量（QOL）改善。
