Lenze Nicholas R, Quinsey Carolyn, Sasaki-Adams Deanna, Ewend Matthew G, Thorp Brian D, Ebert Charles S, Zanation Adam M
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
J Neurol Surg B Skull Base. 2021 May 29;83(Suppl 2):e353-e359. doi: 10.1055/s-0041-1729978. eCollection 2022 Jun.
There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients. This is a retrospective cohort study. The findings of this study come from a single-institution tertiary care center from 2008 to 2019. In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. The main outcome measures were perioperative complications and reoperation. Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; = 0.043), postoperative complications (19.5 vs. 3.7%; = 0.001), and all-cause complications (21.0 vs. 3.7%; < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach ( = 1.000 and 0.741, respectively). The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.
关于恶性鼻窦病变患者接受开放手术与内镜手术的比较结果，相关数据较少。大多数现有研究的样本量不足100例患者，存在局限性。
这是一项回顾性队列研究。本研究的结果来自于一家单一机构的三级医疗中心，时间跨度为2008年至2019年。共有199例接受恶性鼻窦疾病手术的患者参与了本研究。主要结局指标为围手术期并发症和再次手术。我们样本中的患者平均年龄为59.7岁（标准差为20.4）。总体而言，62%为男性，72%为白人。41%的患者采用单纯内镜手术方法，59%的患者采用开放手术或联合手术方法。鳞状细胞癌是最常见的病理类型（43.0%），其次是肉瘤（9.5%）、皮肤癌（6.5%）、鼻窦未分化癌（6.5%）和腺癌（5.5%）。全因并发症发生率为14.6%。接受开放切除术的患者术中并发症发生率较高（5.9%对0%；P = 0.043），术后并发症发生率较高（19.5%对3.7%；P = 0.001），全因并发症发生率也较高（21.0%对3.7%；P < 0.001）。早期再次手术（<6个月）或晚期再次手术（>6个月）的可能性在手术方式上无显著差异（P分别为1.000和0.741）。
对于特定患者，内镜手术切除恶性鼻窦疾病是可行的，与开放手术相比，其并发症发生率可能较低。
