Department of Otorhinolaryngology, Guangzhou Twelfth People's Hospital (Guangzhou Otolarynology-Head and Neck Surgery Hospital), Tianhe District, No 1. Tianqiang Road, Guangzhou, 510620, Guangdong, China.
Eur Arch Otorhinolaryngol. 2020 Nov;277(11):3079-3089. doi: 10.1007/s00405-020-06184-4. Epub 2020 Jul 11.
The population of patients with chronic rhinosinusitis (CRS) has greatly increased. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. In the present study, the value of two different therapies for the middle turbinate to optimize surgical outcomes was observed. Our objective was to determine a better management approach for the middle turbinate to effectively preserve the middle turbinate mucosa and function and avoid complications following ESS, such as nasal adhesions on the operative side.
Thirty patients [group A; treated prior to 2015 (primary surgery)] undergoing resection of the middle turbinate bone during complete ESS for CRS and 30 patients [group B; treated after 2015 (later surgery)] undergoing middle turbinate preservation and multiapproach therapy during complete ESS for CRS were observed. Nasal cavities were compared using perioperative sinus endoscopy (POSE) and Lund-Kennedy (LKES) scores preoperatively and at 15 days, 2 months and 1 year after ESS.
Preoperatively, the POSE (8.83 ± 3.81 vs 9.15 ± 3.85, p = 0.45, for groups A and B, respectively) and LKES (4.23 ± 0.74 vs 4.13 ± 0.70, p = 0.34) scores were similar between groups. In group A, anterior adhesions were reported on six sides of the middle turbinate, severe adhesions were observed on two sides, mild adhesions were observed on one side, and adhesions occurred on two sides during follow-up. After retreatment, adhesions were still observed on two sides at 1 year. In group B, only mild anterior adhesions were observed on two sides. There was no difference between group A and group B at 15 days, and the POSE (4.31 ± 1.19 vs 4.07 ± 1.42, p = 0.11, for groups A and B, respectively) and LKES (3.35 ± 0.82 vs 3.33 ± 0.90, p = 0.91) scores were similar between groups. There was no significant difference in LKES (0.22 ± 0.49 vs 0.10 ± 0.35, p = 0.15) scores at 1 year between the two groups. There was a significant difference in the nasal cavities between group A and group B at 2 months and 1 year, where group B showed a better endoscopic appearance than group A at 2 months and 1 year (with POSE scores of 3.48 ± 0.83 vs 2.43 ± 1.38 (p = 0.00) and LKES scores of 1.35 ± 0.86 vs 1.15 ± 0.90 (p = 0.02) at 2 months for groups A and B, respectively, and POSE scores of 1.00 ± 0.96 vs 0.62 ± 0.87 (p = 0.001) at 1 year for groups A and B, respectively).
Our results show that middle turbinate preservation and combined therapy was a better ESS method for CRS. Multiapproach middle conchoplasty, which is predominately a submucoperiosteal surgery, can preserve more of the mucosa and functions of the middle turbinate. Unlike the single-approach middle conchoplasty described in previous research, multiapproach middle conchoplasty is achieved by combining a three-step surgical procedure ("surgery, packing and removal") with "cocktail-style" postoperative packing and removal.
慢性鼻-鼻窦炎（CRS）患者人群大幅增加。当医学治疗失败时，会考虑进行内镜鼻窦手术（ESS）。在本研究中，观察了两种不同的中鼻甲治疗方法对优化手术结果的价值。我们的目的是确定一种更好的中鼻甲管理方法，以有效地保留中鼻甲黏膜和功能，并避免 ESS 后出现并发症，例如手术侧的鼻腔粘连。
观察了 30 例[组 A；2015 年之前（初次手术）]接受 CRS 完全 ESS 中鼻甲骨切除术的患者和 30 例[组 B；2015 年之后（后期手术）]接受 CRS 完全 ESS 中鼻甲保留和多方法治疗的患者。术前及 ESS 后 15 天、2 个月和 1 年，使用围手术期鼻窦内镜（POSE）和 Lund-Kennedy（LKES）评分比较鼻腔。
术前，组 A 和组 B 的 POSE（8.83±3.81 与 9.15±3.85，p=0.45）和 LKES（4.23±0.74 与 4.13±0.70，p=0.34）评分相似。在组 A 中，有 6 侧中鼻甲发生前粘连，2 侧严重粘连，1 侧轻度粘连，随访时 2 侧发生粘连。在再次治疗后，1 年时仍观察到 2 侧粘连。在组 B 中，仅观察到 2 侧轻度前粘连。15 天时组 A 和组 B 之间没有差异，POSE（4.31±1.19 与 4.07±1.42，p=0.11）和 LKES（3.35±0.82 与 3.33±0.90，p=0.91）评分相似。组 B 在 1 年时的 LKES（0.22±0.49 与 0.10±0.35，p=0.15）评分无显著差异。2 个月和 1 年时，组 A 和组 B 的鼻腔有显著差异，组 B 在 2 个月和 1 年时的内镜表现均优于组 A（POSE 评分分别为 3.48±0.83 与 2.43±1.38（p=0.00）和 LKES 评分分别为 1.35±0.86 与 1.15±0.90（p=0.02），组 A 和组 B 分别为 1 年时的 POSE 评分分别为 1.00±0.96 与 0.62±0.87（p=0.001））。
我们的结果表明，中鼻甲保留和联合治疗是治疗 CRS 的一种更好的 ESS 方法。多方法中鼻甲成形术主要是一种黏膜下骨膜手术，可以保留更多的中鼻甲黏膜和功能。与之前研究中描述的单一方法中鼻甲成形术不同，多方法中鼻甲成形术通过将三步手术（“手术、填塞和取出”）与“鸡尾酒式”术后填塞和取出相结合来实现。
