Kar Murat, Bayar Muluk Nuray, Alqunaee Marwan, Manole Felicia, Cingi Cemal
Department of Otorhinolaryngology, Alaaddin Keykubat University, Alanya Training and Research Hospital, Alanya, Antalya, Turkey.
Department of Otorhinolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.
Ear Nose Throat J. 2024 Nov;103(3_suppl):5S-14S. doi: 10.1177/01455613241287280. Epub 2024 Sep 27.
To review measures for safer functional endoscopic sinus surgery (FESS). PubMed, EBSCO, UpToDate, Proquest Central at Kırıkkale University, Google, and Google Scholar were used in the literature review. The search was performed using keywords of "functional endoscopic sinus surgery," "FESS," "Safety," "Image-Guided," and "complications" between 2000 and 2024. Inflammatory and infectious sinus illnesses are the most prevalent indications for FESS. The 4 most common methods for FESS are endoscopic uncinectomy, maxillary antral ostomy/ethmoidectomy, anterior ethmoidectomy, and posterior ethmoidectomy. FESS has a complication rate of 0% to 1.5% for significant problems and 1.12% to 20.8% for minor issues. Sinus surgery outcomes can be improved and problems avoided with careful preoperative preparation. Powered instrumentation may enhance the severity of the problems rather than the number of occurrences. Intraoperative detection of cerebrospinal fluid leakage necessitates immediate localization and fixing of the leaking structure. The danger of infection increases and hospital stays are longer when investigation is delayed. In image-guided surgery, surgeons employ preoperative imaging data to pinpoint the exact position of a surgical tool concerning surrounding anatomical structures in real time. Although initially designed for use in neurosurgery, endoscopic sinus surgery has quickly become one of the most popular applications of this technique. Safer FESS can be accomplished with accurate CT scans, good patient preparation, surgical knowledge and training, and by using image guidance for endoscopic sinus surgery.
回顾更安全的功能性鼻内镜鼻窦手术（FESS）的措施。在文献综述中使用了PubMed、EBSCO、UpToDate、基利卡莱大学的Proquest Central、谷歌和谷歌学术。检索在2000年至2024年期间使用“功能性鼻内镜鼻窦手术”、“FESS”、“安全性”、“图像引导”和“并发症”等关键词进行。炎性和感染性鼻窦疾病是FESS最常见的适应证。FESS最常见的4种方法是内镜钩突切除术、上颌窦造口术/筛窦切除术、前筛窦切除术和后筛窦切除术。FESS严重问题的并发症发生率为0%至1.5%，轻微问题的并发症发生率为1.12%至20.8%。通过仔细的术前准备可以改善鼻窦手术的结果并避免问题。动力器械可能会增加问题的严重程度而非发生次数。术中发现脑脊液漏需要立即定位并修复漏液结构。如果延迟检查，感染风险会增加且住院时间会延长。在图像引导手术中，外科医生利用术前成像数据实时确定手术工具相对于周围解剖结构的确切位置。尽管最初设计用于神经外科手术，但鼻内镜鼻窦手术已迅速成为该技术最受欢迎的应用之一。通过准确的CT扫描、良好的患者准备、手术知识和培训以及使用鼻内镜鼻窦手术的图像引导，可以实现更安全的FESS。
