Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA,
Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA.
ORL J Otorhinolaryngol Relat Spec. 2021;83(2):93-96. doi: 10.1159/000512495. Epub 2020 Dec 17.
Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization.
This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia.
Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission.
This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.
慢性鼻-鼻窦炎（CRS）在囊性纤维化（CF）人群中几乎普遍存在，许多患者在其一生中需要多次进行内镜鼻窦手术。最近的研究表明，全面治疗 CRS 可带来深远的肺部和全身健康益处。气管内插管和机械通气以及住院治疗都对 CF 患者构成重大风险。本研究的目的是评估仅使用局部麻醉在门诊环境下为 CF 患者进行修正性内镜鼻窦手术的安全性和可行性，以减少对机械通气和住院治疗的需求。
这是一项在三级护理学术医疗中心进行的前瞻性队列研究，该中心设有 CF 基金会认可的护理中心。纳入标准为既往手术和药物治疗后仍存在难治性 CRS 的 CF 患者。在门诊使用仅局部麻醉进行全面修正性 ESS。
共纳入 5 例患者，均无并发症发生。术前的鼻-鼻窦结局测试-22 评分平均为 52.0±12.1，术前 Lund-Mackay 评分平均为 15.2±3.8。没有患者因疼痛、不适或任何其他原因要求提前终止手术。没有患者需要延长观察或术后住院。
本前瞻性试点研究首次证明了在门诊环境下仅使用局部麻醉为 CF 患者进行全面修正性内镜鼻窦手术的安全性和可行性。
