Al-Arman Ahmad Muhammad, Moneir Waleed, Amer Hazem Emam, Saad Mahmoud, Ebada Hisham Atef
Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2437-2445. doi: 10.1007/s00405-025-09342-8. Epub 2025 Apr 12.
The aim of the current study was to evaluate the functional sinonasal outcomes after rescue flap versus double nasoseptal flap in endoscopic endonasal pituitary surgery.
This randomized clinical trial was conducted over 1.5 years over 60 patients who underwent endoscopic trans-sphenoid surgery for macroadenomas (more than 2 cm.). the patients were randomly allocated into 2 groups: the rescue flap group, (n = 30) and the double nasoseptal flap group (n = 30). Functional sinonasal outcomes were evaluated in both groups in terms of sinonasal outcome test (SNOT-22), crusting, adhesions, and olfaction.
the sinonasal outcome test (SNOT-22), as well as the olfaction scores were significantly better in the double flap group compared to the rescue flap group. Crusting and adhesions occurred more frequently in the rescue flap group. The nasal stage operative time was significantly longer in the double flap group than the rescue flap group.
Endoscopic pituitary surgery can adversely affect the sinonasal functions. Double nasoseptal flap technique allows posterior septectomy with bilateral septal mucosa preservation. Although it requires longer operative time than the rescue flap technique, better functional sinonasal outcomes and olfaction scores are achieved.
本研究旨在评估在鼻内镜下经鼻垂体手术中，挽救性皮瓣与双鼻中隔皮瓣术后鼻窦的功能预后。
这项随机临床试验历时1.5年，纳入60例因大腺瘤（直径超过2厘米）接受鼻内镜经蝶窦手术的患者。患者被随机分为两组：挽救性皮瓣组（n = 30）和双鼻中隔皮瓣组（n = 30）。通过鼻窦结局测试（SNOT-22）、结痂、粘连和嗅觉等方面对两组患者的鼻窦功能预后进行评估。
与挽救性皮瓣组相比，双皮瓣组的鼻窦结局测试（SNOT-22）以及嗅觉评分明显更好。挽救性皮瓣组结痂和粘连的发生率更高。双皮瓣组的鼻腔阶段手术时间明显长于挽救性皮瓣组。
鼻内镜垂体手术可能会对鼻窦功能产生不利影响。双鼻中隔皮瓣技术可在保留双侧鼻中隔黏膜的情况下进行后鼻中隔切除术。虽然它比挽救性皮瓣技术需要更长的手术时间，但能获得更好的鼻窦功能预后和嗅觉评分。
