鼻窦球囊扩张术治疗慢性上颌窦炎的非随机对照前瞻性临床研究

目的 评价鼻窦球囊扩张术与传统鼻内镜鼻窦开放术治疗慢性上颌窦炎的临床疗效、安全性及患者接受程度的差异。方法 将50例慢性上颌窦炎患者随机均分入两组,其中A组25例行鼻窦球囊扩张术,B组25例行鼻内镜下上颌窦开放术。术后随访12个月,评价临床疗效、安全性、患者手术舒适度。结果 术后检查及随访期间,A组脱落病例2例,B组脱落病例3例,共对45例患者进行评价。45例患者症状均明显改善,术后鼻内镜检查A组开放的33个窦口中有30个窦口开放、黏膜恢复良好,1个窦口狭窄,2个窦口周围黏膜水肿;B组开放的32个窦口中,27个开放完好,2个窦口狭窄,3个窦口黏膜水肿。两组患者术后均无视力改变、眼部肿胀及脑脊液鼻漏等其他并发症发生。A组与B组术后3个月、随访结束（术后12个月）SNOT-20评分以及CT评分均无统计学差异;术后3个月、随访结束后（术后12个月）Lund -Kennedy内镜黏膜形态评分得分以及手术舒适度评分（出院当天）A组明显优于B组（P<0.05）。结论 鼻窦球囊扩张术与传统内镜在治疗慢性上颌窦炎方面均具有较好的临床疗效及安全性,但在术后远期黏膜恢复及手术舒适度方面,鼻窦球囊扩张术明显优于传统鼻内镜手术,值得临床推广及应用。     

鼻窦球囊扩张治疗儿童慢性鼻窦炎的系统评价及Meta分析

目的 探讨鼻窦球囊扩张术治疗儿童慢性鼻-鼻窦炎的可行性、有效性和安全性。 方法 对采用鼻窦球囊扩张术治疗儿童慢性鼻窦炎的前瞻性临床研究进行系统评价。 结果 8个前瞻性临床研究符合纳入标准。可行性研究:纳入7个研究,235例患儿,549个病变的鼻窦,Meta分析结果显示术中98%成功开放窦口, 95%可信区间［0.95; 1.00］。有效性研究:纳入5个研究,172例患儿,比较手术前后SN-5数值的变化, Meta分析结果显示术后89%的患儿症状得到改善,95%可信区间［0.84; 0.93］。安全性研究:仅1篇研究有1例患儿术后出现眶周肿胀,1周后自行消退。 结论 鼻窦球囊扩张术治疗儿童慢性鼻窦炎,可行性好,疗效好,安全性好。     

鼻窦球囊导管扩张术的远期疗效分析

目的 评估鼻窦球囊导管扩张术的安全性和有效性.方法 应用鼻窦球囊导管扩张术治疗48例(94侧)慢性鼻窦炎伴或不伴鼻息肉以及霉菌性鼻窦炎和鼻窦囊肿患者,随访1年、2年,分析手术前后鼻内镜检查、冠状位鼻窦CT检查结果,用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评分观察手术效果,以SNOT-20调查表评价预后.结果 患者主观症状均有不同程度改善,SNOT-20评分表中各项与术前比较差异有统计学意义(P＜0.01).鼻内镜检查见窦口通畅,与术前比较差异有统计学意义(P＜0.01),7例(8侧)窦口肿胀、狭窄可在术后随访过程重新扩大处理.1例出现眶周淤斑,无颅底和眼眶等严重并发症.结论 鼻窦球囊导管扩张术操作简便,能有效解除窦口阻塞,同时能够保留鼻腔鼻窦的正常结构,手术微创,出血少,安全有效.鼻内镜检查和鼻窦CT客观上反映了手术的良好转归.对合适的伴或不伴鼻息肉的鼻窦炎病例,可单独应用鼻窦球囊导管扩张术或联合标准的鼻内镜鼻窦手术.     

根治性鼻窦手术自然窦口处理的临床分析

目的探讨根治性鼻窦手术中更为完善的上颌窦自然孔开窗术.方法为慢性鼻窦炎伴多发性鼻息肉66例行根治性鼻窦手术自然窦口扩大术,术后随访10～42个月,对慢性鼻窦炎伴多发性鼻息肉手术疗效与相关因素进行临床分析.结果患者均未发生并发症.结论根治性鼻窦手术中自然窦口的处理是治疗慢性鼻窦病变伴多发性鼻息肉的有效方法.     

鼻窦球囊导管扩张术治疗慢性额窦炎

目的 评估鼻窦球囊导管扩张术治疗慢性额窦炎的安全性和有效性。方法 前瞻性分析14例(21侧)慢性额窦炎患者的临床资料,术前行冠状位鼻窦CT判定额隐窝开口位置,指导手术操作。采用SNOT 20调查表评价预后。结果 术后随访观察48周,患者主观症状均有不同程度改善,鼻内镜检查见额窦口开放良好,术腔完全上皮化12例(19侧),窦口周围黏膜水肿息肉样变,窦口狭窄2例(3侧)。术后无脑脊液鼻漏、视力改变、复视等严重并发症。SNOT 20评分显示,术后24周和48周得分较术前基线分数有明显改善(1.08 vs 2.28, P＜0.001;1.17 vs 2.28, P＜0.001)。结论 鼻窦球囊导管扩张术操作安全,能有效缓解窦口阻塞情况,且效果持久。患者术后症状较术前有明显改善,患者对手术效果满意。     

儿童慢性鼻窦炎的外科治疗研究进展

近年来,儿童慢性鼻窦炎(CRS)越来越受到耳鼻咽喉科医生的重视。临床上,有一部分儿童CRS患者经过规范的药物治疗(不少于12周)后症状仍难以改善,甚至加重,或是经常复发,导致治疗失败。大量的临床实践表明,儿童鼻窦FESS手术可以取得比较满意的临床疗效,但仍有医师对儿童鼻窦FESS手术治疗存在质疑。鼻窦球囊扩张术治疗慢性鼻窦炎于2005年被引入耳鼻咽喉科。在过去的十几年里,有充分的证据支持它在治疗成人慢性鼻窦炎(CRS)方面的安全性和有效性。鼻窦球囊扩张术手术过程中不去除骨质,保留大部分或全部鼻窦黏膜,以极低的风险恢复鼻窦的通气,这样微创的方式适用于儿童。本文将对儿童慢性鼻窦炎外科治疗的相关研究进展做一综述。     

塑料管扩张上颌窦口在鼻内窥镜术后的应用

目的：探讨鼻内窥镜术后用塑料管扩张上颌窦口避免上颌窦口闭塞及术腔黏连的临床效果。方法：为106例、190侧慢性鼻窦炎、鼻息肉患者在鼻内窥镜术后应用塑料管扩张上颌窦口。结果：随访12个月以上,根据内窥镜鼻窦手术疗效评定标准（1997,海口）,治愈率为87．9％（167／190）,好转率为12．1％（32／190）。无1例术腔黏连及上颌窦口闭塞。结论：鼻内窥镜术后用塑料管扩张上颌窦口方法简便,效果满意,可作为常规方法应用。     

鼻窦球囊扩张术

鼻窦球囊扩张术是一种新的治疗鼻窦炎的手术方法,具有微创、手术简单、效果好、并发症少等优点.随着这一技术的逐步推广和改进,在伴有鼻息肉的慢性鼻-鼻窦炎、鼻窦炎修正术、儿童鼻窦炎、药物治疗无效的急性鼻窦炎以及全身情况较差的鼻窦炎等患者的治疗方面取得了较好的效果.本文就鼻窦球囊扩张术的适应证、机制、手术方法、疗效及并发症等方面的最新研究进展做一综述.     

CO_2激光辅助中鼻道上颌窦造口术

目的探讨鼻内镜下应用CO2激光辅助中鼻道上颌窦造口术的手术疗效。方法慢性鼻窦炎、鼻息肉患者44例(78侧),随机分成2组,其中鼻内镜下辅助CO2激光开放上颌窦窦口10例(17侧),常规鼻窦外科器械行上颌窦窦口开放术34例(61侧)。术后鼻内镜复查和鼻窦CT检查判定手术疗效。随访1年至1年6个月。结果鼻内镜下辅助应用CO2激光开放上颌窦窦口10例(17侧)中无1例窦口狭窄及闭塞,治愈8例,好转2例。而常规鼻窦外科器械上颌窦窦口开放术34例(61侧)中有4例(4侧)出现上颌窦窦口狭窄,1例(1侧)因上颌窦窦口闭塞而再次手术。治愈18例,好转11例,无效5例。结论鼻内镜下CO2激光辅助上颌窦造口术可有效地减少上颌窦窦口狭窄或闭塞的机率,从而提高慢性鼻窦炎、鼻息肉的治愈率。     

鼻内窥镜术上颌窦自然开口的处理

探讨内窥镜鼻窦手术治疗慢性鼻窦炎，鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法 配对研究５６例双侧鼻窦炎，鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果 窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分分别为９２．９％和８０．４％。     

Effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis without polyposis

IntroductionBalloon sinuplasty is a minimally invasive endoscopic procedure, developed with the aim of restoring patency of the paranasal sinuses ostia with minimal damage to the mucosa.ObjectiveTo evaluate the effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis.MethodsThis was a prospective cohort study comprising 18 patients with chronic rhinosinusitis without polyposis who underwent balloon sinuplasty. Patients were evaluated for clinical criteria, quality of life (Sino-Nasal Outcome Questionnaire Test-20 [SNOT-20]), and computed tomography of the sinuses (Lund–Mackay staging) preoperatively and three to six months after the procedure.ResultsOut of 18 patients assessed, 13 were included, with a mean age of 39.9 ± 15.6 years. Ostia sinuplasty was performed in 24 ostia (four sphenoid, ten frontal, and ten maxillary sinus). At the follow-up, 22 (92%) ostia were patent and there was no major complication. There was symptomatic improvement (SNOT-20), with Cronbach coefficients for consistency of the questionnaire items of 0.86 (95% CI: 0.73–0.94) preoperatively and of 0.88 (95% CI: 0.77–0.95) postoperatively, the difference being statistically significant (p < 0.001). In addition, there was marked reduction of the computed tomography signs, an average of 4.2 point score (p < 0.001).ConclusionSinuplasty is effective in reducing symptoms and improving quality of life as a treatment option for chronic rhinosinusitis in selected patients.     

Kathetergestützte Ballondilatation des Ostium frontale, maxillare und sphenoidale

Background

Endoscopic sinus surgery is the procedure of choice for treating chronic rhinosinusitis. This paper describes a new minimally invasive method to restore ostium patency without removing tissue: the balloon sinuplasty technique.

Patients and methods

Two patients were treated with the new procedure. One patient had her maxillary and sphenoid ostia dilated; the other patient had both frontal ostia, both maxillary ostia, and the right sphenoid ostia dilated.

Results

The balloon dilatations of the ostia were achieved successfully without impairing the mucosal circumference. There was no bleeding, and nasal packing was not necessary. The postoperative healing process showed no complications.

Conclusion

This paper discusses the advantages and disadvantages as well as the indications and contraindications of this method. The balloon sinuplasty technique is an easily performed surgery; for selected indications, it seems especially suited for opening blocked ostia.     

Limitations of balloon sinuplasty in frontal sinus surgery

Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6 months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.     

Comparison of intra-operative characteristics and early post-operative outcomes between endoscopic sinus surgery and balloon sinuplasty

Conclusion: In terms of operation time, anesthesia method, and low complication rate, ESS and balloon sinuplasty seemed comparable. The advantages of balloon sinuplasty were shown to be shortness of sick leave, possibility to be performed as an in-office procedure, and lower adhesion formation.

Background: Endoscopic sinus surgery (ESS) has been considered as a treatment of choice for persistent chronic rhinosinusitis (CRS). During the last decade balloon sinuplasty has been introduced as an alternative technique to dilate the ostium. Although balloon sinuplasty is considered relatively safe and efficient, comparative evidence of its putative intra-operative and post-operative advantages remain limited.

Objectives: The aim of this retrospective controlled study was to evaluate intra-operative factors and early post-operative outcomes among CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique.

Materials and methods: Data were collected from 208 patients with CRS treated either with ESS or balloon sinuplasty during the years 2008–2010. Intra- and peri-operative factors were collected from patient records of the patients who met the inclusion criteria (n?=?39 in ESS group and n?=?36 in balloon sinuplasty group).

Results: There was no significant difference in operation time and anesthesia method between the two groups. No complications occurred with either technique. All ESS procedures and 67% of the balloon sinuplasty procedures were done in the hospital setting, whereas 33% of the balloon sinuplasty procedures were done in the office setting. The duration of sick leave and the number of patients with adhesions were significantly higher in the ESS group compared to the balloon sinuplasty group.     

Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction

Conclusion This is the first controlled study of balloon sinuplasty’s long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery.

Background Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty.

Objective The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria.

Materials and methods Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus ≥?2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether.

Results Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.     

Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation

OBJECTIVES: Endoscopic sinus surgery (ESS) is an effective option for managing patients in whom medical therapy for rhinosinusitis fails. However, ESS is not always successful, and serious complications can occur. New techniques and instrumentation that improve outcomes and reduce complications would be seriously welcomed. Innovative catheter-based technology has improved treatment of several conditions such as coronary artery disease, peripheral vascular disease, and stroke. Recently, catheter devices have been developed for the paranasal sinuses. Cadaver studies confirm the potential use of these devices in rhinosinusitis. The objective of this investigation was to ascertain the feasibility and safety of these newly developed devices in performing catheter-based dilation of sinus ostia and recesses in patients with rhinosinusitis. METHODS: A nonrandomized prospective cohort of 10 ESS candidates was offered treatment with a new technique of balloon catheter dilation of targeted sinus ostia. The frontal, maxillary, and sphenoid sinuses were considered appropriate for this innovative catheter-based technology. The primary study end points were intraoperative procedural success and absence of adverse events. RESULTS: A total of 18 sinus ostial regions were successfully catheterized and dilated, including 10 maxillary, 5 sphenoid, and 3 frontal recesses. No adverse events occurred. Mucosal trauma and bleeding appeared to be less with catheter dilation than is typically observed with ESS techniques. CONCLUSIONS: Dilation of sinus ostial regions via balloon catheter-based technology appears to be relatively safe and feasible. Larger multicenter clinical trials are now warranted to further establish safety and to determine the role of this new technique.     

鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿

目的 评价鼻内镜鼻窦手术和鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿的疗效。方法 分析14例(19个上颌窦,3个额窦)应用鼻窦球囊导管扩张术联合纤维鼻咽喉镜手术切除鼻窦囊肿(球囊组)和16例(23个上颌窦,8个额窦)采用常规鼻内镜鼻窦手术方式切除鼻窦囊肿(常规组)病例的临床资料。依视觉模拟量表(visual analogue scale, VAS)记录手术难度评分和手术时间。手术前后均行鼻内镜检查、冠状位鼻窦CT检查,采用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评价预后。结果 球囊组手术难度高于常规组,手术时间也较长,两组间差异有统计学意义（P<0.001）。术后观察8、24周, 鼻内镜检查见窦口通畅,Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分结果显示,所有病例术腔恢复良好,术后鼻窦CT影像示改善明显,但两组比较差异无统计学意义（P>0.05）。结论 球囊组与常规组行鼻窦囊肿手术可获得同-良好的疗效。球囊组的手术方式能够保留鼻腔鼻窦的正常结构,手术微创。由于纤维鼻咽喉镜手术器械的限制,手术难度较常规组高,手术时间较长。     

Balloon sinuplasty,an initial assessment: 10 cases,results and follow-up

Introduction and aims: Balloon sinuplasty has been the object of recent discussions and papers. It is believed that the use of these tools can bring benefits, when compared with traditional endoscopic sinus surgery. Although there already are papers on the efficacy of this new instrument in the literature, there is no study in our country with a series of cases and follow-up of patients undergoing sinuplasty. Our study aims to review the information of 10 patients who underwent balloon sinuplasty, alone or in combination, discussing the indications, complementary therapy and follow up evaluation.Methodretrospective study.ResultsOf 10 patients, 6 were males and 4 females. Their ages ranged from 7 to 58 years. All patients had chronic rhinosinusitis without nasal polyps, of which 8 are associated with allergic disease. 3 patients underwent sinuplasty only, and 7 had other procedures done during the same procedure. Follow-up ranged from 2 to 7 months. Of the 10 patients, 9 showed symptoms improvement in imaging studies.Conclusionsinuplasty was successfully performed in all patients, without major technical difficulties or complications. This instrument can become an alternative surgical treatment for some groups of patients.     

The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels

BACKGROUND: Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of "mini-functional endoscopic sinus surgery" has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. METHODS: Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. RESULTS: This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. CONCLUSIONS: The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.