Moses R L, Cornetta A, Atkins J P, Roth M, Rosen M R, Keane W M
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107-5098, USA.
Ear Nose Throat J. 1998 Mar;77(3):190, 193-5, 199-202.
Since its introduction, functional endoscopic sinus surgery (FESS) has demonstrated success rates of 76% to 98%. A small group of the patients in whom initial FESS and optimal medical therapy fail require revision endoscopic sinus surgery (RESS). This group has recently been studied by several authors, and we have evaluated a group of 90 RESS patients selected from 753 consecutive primary FESS patients. Patients were followed for a mean of 22.8 months. Extent of disease, history of polyps, allergy, previous traditional endonasal sinus surgery, male gender, chronic steroid use, and the presence of a deviated septum all appeared to adversely affect RESS outcome. The surgeon's knowledge of the sinus anatomy is critical, especially in revision sinus cases in which landmarks are distorted or absent. In our review, RESS was associated with a 1% major complication rate and was successful in 67% of patients. Computer-assisted endoscopic sinus surgery integrates preoperative imaging with realtime endoscopic visualization, augments the surgeon's knowledge of anatomy, and helps to minimize patient risk.
自功能性鼻内镜鼻窦手术（FESS）问世以来，其成功率已达76%至98%。一小部分初次接受FESS和最佳药物治疗失败的患者需要进行翻修性鼻内镜鼻窦手术（RESS）。近期有多位作者对这一群体进行了研究，我们评估了从753例连续的初次FESS患者中选取的90例RESS患者。对患者进行了平均22.8个月的随访。疾病范围、息肉病史、过敏、既往传统鼻内鼻窦手术史、男性、长期使用类固醇以及鼻中隔偏曲的存在似乎均对RESS的结果产生不利影响。外科医生对鼻窦解剖结构的了解至关重要，尤其是在翻修鼻窦手术中，此时标志可能已扭曲或缺失。在我们的综述中，RESS的主要并发症发生率为1%，67%的患者手术成功。计算机辅助鼻内镜鼻窦手术将术前成像与实时内镜可视化相结合，增强了外科医生对解剖结构的了解，并有助于将患者风险降至最低。
