Akiyama Kosuke, Samukawa Yasushi, Takahashi Satoshi, Ouchi Youhei, Hoshikawa Hiroshi
Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan.
Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kita-gun, Miki-cho, Ikenobe 1750-1, Kagawa 761-0793, Japan.
Auris Nasus Larynx. 2018 Aug;45(4):765-771. doi: 10.1016/j.anl.2017.11.013. Epub 2017 Nov 26.
The preservation or resection of the middle turbinate (MT) during endoscopic sinus surgery (ESS) currently remains a matter of debate. The present study aimed to investigate the effects of submucosal middle turbinectomy (SMT) in ESS for eosinophilic chronic rhinosinusitis (ECRS).
The study included 38 ECRS patients (63 sides) who had undergone full-house ESS with SMT and 20 ECRS patients (40 sides) without SMT as a control group. Post-operative middle turbinate lateralization (MTL), synechia formation, and the patency grade of the olfactory cleft (OC) were assessed as the primary outcomes 3 months after surgery. CT scans and the T&T test were performed on the SMT group 3 months after surgery and assessed as secondary outcomes.
MTL and synechia formation rates were slightly higher in the control group than in the SMT group (20% vs. 7.9%, p=0.072, 17.5% vs. 9.5%, p=0.235), although neither reached statistically significance. The mean patency score of OC was significantly better in the SMT group than in the control group (0.5±0.6 vs. 1.3±0.7, <0.001). CT findings and T&T test scores showed good improvements after SMT combined with ESS. No major adverse events occurred due to SMT.
We demonstrated the potential advantages of SMT for ECRS patients. This method may avoid physiological functional loss through its preservation of the mucosa and structure of the MT.
在内镜鼻窦手术（ESS）中，中鼻甲（MT）的保留或切除目前仍存在争议。本研究旨在探讨黏膜下中鼻甲切除术（SMT）在ESS治疗嗜酸性粒细胞性慢性鼻窦炎（ECRS）中的效果。
本研究纳入38例接受了全鼻窦ESS联合SMT的ECRS患者（63侧），以及20例未接受SMT的ECRS患者（40侧）作为对照组。术后3个月，评估术后中鼻甲侧化（MTL）、粘连形成以及嗅裂（OC）的通畅程度作为主要结局。术后3个月对SMT组进行CT扫描和T&T试验，并作为次要结局进行评估。
对照组的MTL和粘连形成率略高于SMT组（分别为20%对7.9%，p=0.072；17.5%对9.5%，p=0.235），但均未达到统计学意义。SMT组OC的平均通畅评分显著优于对照组（0.5±0.6对l.3±0.7，p<0.001）。SMT联合ESS后，CT检查结果和T&T试验评分有明显改善。未发生因SMT导致的重大不良事件。
我们证明了SMT对ECRS患者的潜在优势。该方法通过保留MT的黏膜和结构，可避免生理功能丧失。
