Anatomic findings in patients undergoing revision endoscopic sinus surgery
Anatomic findings in patients undergoing revision endoscopic sinus surgery
复制标题
DOI：
10.1016/j.amjoto.2004.06.002
复制
发表时间：
2004-11-01
影响因子：
2.5
通讯作者：
Kountakis, SE
中科院分区：
文献类型：
--
作者：
Musy, PY;Kountakis, SE
目的：报告翻修功能性内窥镜鼻窦手术(FESS)患者持续性鼻窦炎的解剖学发现。方法：前瞻性收集连续两年内在一所三级医院接受FESS翻修的患者的资料。患者接受鼻腔内窥镜检查，并在鼻窦炎长期药物治疗失败后进行鼻窦计算机断层扫描。结果：初次手术失败最常见的解剖因素是中鼻甲偏侧(78%)，其次是不完全前筛窦切除(%)、额隐窝疤痕(50%)、不完全后筛窦切除(41%)和中鼻道造口狭窄(39%)。此外，49%的患者发现鼻翼滞留，37%的患者发现钩突保留。37%的患者出现复发性息肉。其他因素，如持续性蝶骨疾病和蝶窦口狭窄的发生率较低。结论：原发性FESS的失败最常与口鼻道复合体区域的解剖阻塞有关。术中仔细注意这一区域，排除阻塞的解剖结构，避免瘢痕形成和鼻甲不稳，可能会降低初次FESS后的失败率。(C)2004 Elsevier Inc.保留所有权利。
Objective: To report the anatomic findings that contribute to persistent sinusitis in patients requiring revision functional endoscopic sinus surgery (FESS).Methods: Data were collected prospectively on consecutive patients requiring revision FESS at a tertiary institution over a 2-year period. Patients were evaluated with endoscopic examination of the sinonasal cavities, and computed tomography of the sinuses was performed after patients failed prolonged medical therapy for sinusitis. Information was also collected during the revision surgery.Results: The most common anatomic factor associated with primary surgery failure was lateralization of the middle turbinate (78%) followed by incomplete anterior ethmoidectomy (64%), scarred frontal recess (50%), incomplete posterior ethmoidectomy (41%), and middle meatal antrostomy stenosis (39%). In addition, retained agger nasi and retained uncinate process were identified in 49% and 37% of the patients, respectively. Recurrent polyposis was seen in 37% of the patients. Other factors such as persistent sphenoid disease and sphenoid ostium stenosis were less frequent.Conclusion: Failure of primary FESS is most often associated with anatomic obstruction in the area of the ostiomeatal complex. Meticulous attention in this area during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary FESS. (C) 2004 Elsevier Inc. All rights reserved.