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微型切割器辅助下鼻甲成形术与低温等离子射频消融下鼻甲成形术的对比研究

Microdebrider-Assisted Turbinoplasty Versus the Coblation Method of Turbinoplasty: A Comparative Study.

作者信息

Rajeev Reshma, H T Lathadevi, Karadi R N, T Shashikumar, Ajur Shivshankar

机构信息

Otorhinolaryngology- Head and Neck Surgery, Shri B M Patil Medical College, Hospital and Research Centre, Bijapur Lingayat District Education Association (BLDE) (Deemed to be University), Vijayapura, IND.

出版信息

Cureus. 2025 Apr 17;17(4):e82422. doi: 10.7759/cureus.82422. eCollection 2025 Apr.

Abstract

Background Inferior turbinate hypertrophy is a major cause of chronic nasal obstruction, significantly impairing nasal airflow and overall quality of life. Although medical management with antihistamines, decongestants, and corticosteroids is the first line of treatment, a subset of patients remains symptomatic and requires surgical intervention. Various surgical techniques, like mucosal sparing and non-mucosal sparing techniques, have become available recently. Microdebrider-assisted turbinoplasty (MAT) and coblation-assisted turbinoplasty (CAT) are two widely used mucosa-sparing techniques. However, limited comparative studies exist evaluating their efficacy, safety, and long-term outcomes. This study aims to compare the clinical outcomes of MAT and CAT in the surgical management of inferior turbinate hypertrophy. Methods This prospective comparative study included 60 patients diagnosed with symptomatic inferior turbinate hypertrophy unresponsive to medical therapy. Patients were assigned to undergo either MAT (n=30) or CAT (n=30) under general anesthesia using a lottery system. While the CAT group underwent controlled radiofrequency ablation with a coblator wand prior to outfracturing the turbinate, the MAT group underwent submucosal tissue removal and turbinate lateralization using a microdebrider. Postoperative outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) score and objective airflow measurements at the seventh day, second, and third months following surgery. Additionally evaluated were intraoperative time, bleeding, complications, and postoperative healing. Results Both MAT and CAT showed significant improvements in NOSE scores, with mean scores improving from 72.4 ± 8.6 preoperatively to 18.7 ± 4.2 at three months in the MAT group and from 73.1 ± 7.9 to 19.3 ± 5.1 in the CAT group; however, there is no statistical difference between the two procedures in terms of symptomatic relief (p > 0.05). Peak nasal inspiratory flow (PNIF) improved by 62.3% in the MAT group and 58.7% in the CAT group at three months (p > 0.05). Intraoperative blood loss was slightly lower in the CAT group (21.5 ± 5.2 mL vs. 27.8 ± 6.4 mL in MAT, p < 0.05). Postoperative crusting and healing times were comparable between the two groups, with no significant difference in complication rates or recurrence of turbinate hypertrophy. Conclusion MAT and CAT are both effective and safe surgical options for managing inferior turbinate hypertrophy. While CAT offers a slight advantage in intraoperative hemostasis, both techniques provide comparable symptom relief, nasal airflow improvement, and mucosal preservation, making either a viable choice based on surgeon preference and patient-specific factors.

摘要

背景

下鼻甲肥大是慢性鼻阻塞的主要原因,严重影响鼻气流和整体生活质量。尽管使用抗组胺药、减充血剂和皮质类固醇进行药物治疗是一线治疗方法,但仍有一部分患者症状持续,需要手术干预。近年来出现了各种手术技术,如保留黏膜和不保留黏膜的技术。微型切割器辅助下鼻甲成形术(MAT)和低温等离子辅助下鼻甲成形术(CAT)是两种广泛应用的保留黏膜技术。然而,评估它们的疗效、安全性和长期结果的比较研究有限。本研究旨在比较MAT和CAT在下鼻甲肥大手术治疗中的临床结果。

方法

这项前瞻性比较研究纳入了60例诊断为有症状的下鼻甲肥大且药物治疗无效的患者。采用抽签系统将患者分配接受MAT(n = 30)或CAT(n = 30)手术,均在全身麻醉下进行。CAT组在将鼻甲骨折外移之前,先用低温等离子刀进行可控射频消融,而MAT组使用微型切割器进行黏膜下组织切除和鼻甲外移。在术后第7天、第2个月和第3个月,使用鼻阻塞症状评估(NOSE)评分和客观气流测量来评估术后结果。此外,还评估了手术时间、出血情况、并发症和术后愈合情况。

结果

MAT和CAT的NOSE评分均有显著改善,MAT组术前平均评分为72.4 ± 8.6,术后3个月为18.7 ± 4.2;CAT组术前平均评分为73.1 ± 7.9,术后3个月为19.3 ± 5.1;然而,在症状缓解方面,两种手术方法之间没有统计学差异(p > 0.05)。术后3个月,MAT组的鼻吸气峰流速(PNIF)提高了62.3%,CAT组提高了58.7%(p > 0.05)。CAT组术中失血量略低(21.5 ± 5.2 mL,MAT组为27.8 ± 6.4 mL,p < 0.05)。两组术后结痂和愈合时间相当,并发症发生率和下鼻甲肥大复发率无显著差异。

结论

MAT和CAT都是治疗下鼻甲肥大有效且安全的手术选择。虽然CAT在术中止血方面有轻微优势,但两种技术在症状缓解、改善鼻气流和保留黏膜方面效果相当,可根据外科医生的偏好和患者的具体情况选择其中任何一种。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8663/12084892/fa8336f9c461/cureus-0017-00000082422-i01.jpg

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