Abuzeid Waleed M, Peterson Asa Z, Rathor Aakanksha, Xu Jordan C, Velasquez Nathalia, Rashan Ali R, Thamboo Andrew, Nayak Jayakar V
1 Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA.
2 Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Ann Otol Rhinol Laryngol. 2017 Dec;126(12):804-812. doi: 10.1177/0003489417737323. Epub 2017 Oct 19.
Ethmoid punch sinusotomy (EPS) is a feasible treatment for ethmoid sinusitis in a subset of chronic rhinosinusitis (CRS) patients per a recent report. This adjunctive work investigates the technical characteristics of EPS and determines if EPS measurably alters the topical delivery of irrigant into the ethmoid sinuses in a cadaveric model.
The sinonasal cavities of 10 human cadaver heads were irrigated with a solution containing methylene blue and radio-opaque contrast prior to and following EPS. Procedural characteristics and irrigant distribution were assessed by endoscopy and computed tomography.
Forty EPS procedures were performed through the ethmoid bulla and basal lamella. Compared to controls, EPS enhanced dye distribution into the anterior (90% vs 35%, P < .004) and posterior (90% vs 35%, P < .002) ethmoid sinuses, representing a 157% increase for each of these sites. Contrast was detected in a higher proportion of anterior (65% vs 5%, P < .001) and posterior (60% vs 0%, P < .001) ethmoid sinuses. Endoscopically guided catheter instillation of contrast through the EPS sites achieved radiotracer distribution throughout the ethmoid complex.
Ethmoid punch sinusotomy sites can be reliably created via micro-minimally invasive procedures. Ethmoid punch sinusotomy improves irrigant delivery to the ethmoid sinuses, providing mechanistic understanding for the clinical outcomes observed in CRS patients.
根据最近的一份报告，筛窦打孔鼻窦切开术（EPS）是治疗一部分慢性鼻-鼻窦炎（CRS）患者筛窦炎的一种可行方法。这项辅助研究调查了EPS的技术特点，并确定EPS是否能在尸体模型中显著改变灌洗液向筛窦的局部递送。
在进行EPS之前和之后，用含有亚甲蓝和不透射线造影剂的溶液冲洗10个人类尸头的鼻窦腔。通过内窥镜检查和计算机断层扫描评估手术特点和灌洗液分布情况。
通过筛泡和基板进行了40次EPS手术。与对照组相比，EPS使染料在前筛窦（90%对35%，P <.004）和后筛窦（90%对35%，P <.002）的分布增加，这些部位的分布均增加了157%。在前筛窦（65%对5%，P <.001）和后筛窦（60%对0%，P <.001）中检测到造影剂的比例更高。在内窥镜引导下通过EPS部位进行导管造影剂滴注，使放射性示踪剂分布于整个筛窦复合体。
可通过微微创手术可靠地创建筛窦打孔鼻窦切开术部位。筛窦打孔鼻窦切开术可改善灌洗液向筛窦的递送，为在CRS患者中观察到的临床结果提供了机制性理解。
