Scangas George A, Remenschneider Aaron K, Bleier Benjamin S, Holbrook Eric H, Gray Stacey T, Metson Ralph B
1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
2 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2017 Nov;157(5):874-879. doi: 10.1177/0194599817706929. Epub 2017 May 16.
Objective To evaluate the impact of bilateral middle turbinate resection (BMTR) on patient-reported quality of life following primary and revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Study Design Prospective cohort study. Setting Tertiary care center. Subjects and Methods Patients with CRS who were recruited from 11 otolaryngologic practices completed the Sino-Nasal Outcome Test-22, Chronic Sinusitis Survey, and EuroQol 5-Dimension questionnaires at baseline, as well as 3 and 12 months after ESS. In the primary ESS cohort (n = 406), patients who underwent BMTR (n = 78) at the time of surgery were compared with patients (n = 328) whose middle turbinates were preserved. In the revision ESS cohort (n = 363), a similar comparison was made between patients who did (n = 64) and did not (n = 299) undergo BMTR. Results Sino-Nasal Outcome Test-22, Chronic Sinusitis Survey, and EuroQol 5-Dimension scores showed similar improvements for both the turbinate resection and preservation cohorts at 3 months ( P < .001) and 12 months ( P < .001) after surgery. For patients who underwent revision surgery, the performance of BMTR resulted in greater improvement in Chronic Sinusitis Survey scores at 1 year as compared with the turbinate preservation group (change from baseline: 28.1 vs 20.7, respectively; P = .026). History of tobacco use and the presence of nasal polyps did not affect clinical outcomes at any time point. Conclusion Patients who underwent BMTR during primary and revision sinus surgery reported similar benefits in quality-of-life outcomes 1 year after surgery. In select patients undergoing revision sinus surgery, the performance of BMTR results in improved disease-specific quality of life.
目的 评估双侧中鼻甲切除术（BMTR）对慢性鼻-鼻窦炎（CRS）初次及翻修鼻内镜鼻窦手术（ESS）后患者报告的生活质量的影响。研究设计 前瞻性队列研究。研究地点 三级医疗中心。研究对象与方法 从11家耳鼻喉科诊所招募的CRS患者在基线时以及ESS术后3个月和12个月完成了鼻-鼻窦结局测试-22、慢性鼻窦炎调查问卷和欧洲五维健康量表问卷。在初次ESS队列（n = 406）中，将手术时接受BMTR的患者（n = 78）与中鼻甲保留的患者（n = 328）进行比较。在翻修ESS队列（n = 363）中，对接受（n = 64）和未接受（n = 299）BMTR的患者进行了类似的比较。结果 鼻-鼻窦结局测试-22、慢性鼻窦炎调查问卷和欧洲五维健康量表评分显示，鼻甲切除组和保留组在术后3个月（P <.001）和12个月（P <.001）时均有相似的改善。对于接受翻修手术的患者，与鼻甲保留组相比，BMTR在1年时慢性鼻窦炎调查问卷评分的改善更大（与基线相比的变化分别为：28.1对20.7；P =.026）。吸烟史和鼻息肉的存在在任何时间点均不影响临床结局。结论 在初次和翻修鼻窦手术中接受BMTR的患者在术后1年报告的生活质量结果有相似的益处。在某些接受翻修鼻窦手术的患者中，BMTR可改善疾病特异性生活质量。
