Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Division of Otolaryngology, Hospital Kardinal Schwarzenberg, Schwarzach, Austria.
Int J Comput Assist Radiol Surg. 2019 May;14(5):895-902. doi: 10.1007/s11548-019-01930-4. Epub 2019 Mar 6.
Image-guidance systems (IGS) have gained widespread use in endoscopic sinus surgery (ESS) and have been thoroughly analysed. In this study, we looked for a new parameter to determine if patients could directly benefit from the use of IGS during primary ESS. We questioned if IGS could improve the quality of ESS in chronic rhinosinusitis (CRS) patients via allowing a more comprehensive treatment of all involved sinus compartments.
In a pilot feasibility study, we evaluated uncomplicated CRS patients following primary ESS with and without IGS between January 2011 and June 2012 using preoperative and postoperative CT scans. The preoperative CT scans identified the sinus compartments requiring surgery. The postoperative CT scans were used to evaluate the treatment effect in these compartments. From these data, we calculated a missing ratio (missed compartments/compartments requiring surgery) for each patient.
Of the 169 ESS patients who were treated, ten patients were retrospectively identified as complying with the inclusion and exclusion criteria following ESS with IGS. Ten patients treated without IGS were then randomly chosen. The median missing ratio for non-IGS patients was 36%, and for IGS patients, the median missing ratio was 0% (p = 0.046). However, the missing ratio was depended on the number of compartments requiring surgery. Stratification of the number of compartments requiring surgery resulted in an exact p value of 0.13.
IGS could help the surgeon to more completely address diseased sinus compartments. For better scientific merit, a comparative study of ESS with and without IGS seems feasible, using the proposed failing score missed compartments/compartments requiring surgery as the primary outcome parameter.
影像引导系统（IGS）已在鼻窦内窥镜手术（ESS）中得到广泛应用，并进行了深入分析。在这项研究中，我们寻找了一个新的参数，以确定患者是否可以直接受益于在原发性 ESS 中使用 IGS。我们质疑 IGS 是否可以通过允许对所有受累鼻窦腔室进行更全面的治疗，从而改善慢性鼻-鼻窦炎（CRS）患者的 ESS 质量。
在 2011 年 1 月至 2012 年 6 月期间，我们在一项初步可行性研究中评估了接受和未接受 IGS 的原发性 ESS 后的单纯 CRS 患者，使用术前和术后 CT 扫描。术前 CT 扫描确定了需要手术的鼻窦腔室。术后 CT 扫描用于评估这些腔室的治疗效果。根据这些数据，我们为每个患者计算了一个缺失比（未手术的鼻窦腔室/需要手术的鼻窦腔室）。
在接受 ESS 治疗的 169 例患者中，有 10 例患者经回顾性分析符合 ESS 联合 IGS 治疗的纳入和排除标准。然后随机选择了 10 例未接受 IGS 治疗的患者。非 IGS 患者的中位缺失率为 36%，而 IGS 患者的中位缺失率为 0%（p=0.046）。然而，缺失率取决于需要手术的鼻窦腔室数量。对需要手术的鼻窦腔室数量进行分层后，精确 p 值为 0.13。
IGS 可以帮助外科医生更全面地解决患病的鼻窦腔室。为了获得更好的科学价值，使用提出的失败评分缺失的鼻窦腔室/需要手术的鼻窦腔室作为主要结局参数，对 ESS 联合和不联合 IGS 进行比较研究似乎是可行的。
