Comparison of natural ostiodilatation and endoscopic sinus surgery in the same patient with chronic sinusitis

Abstract Introduction Chronic rhinosinusitis is a broad clinical syndrome characterized by mucosal inflammation of the nose and paranasal sinuses. In order for the paranasal sinuses to maintain their physiological functions; the ostiomeatal complex drainage pathways must be open. Surgical procedures are an important treatment option in patients who do not respond adequately to medical treatment. Although the methods and instruments used in functional endoscopic sinus surgery have continued to improve in recent years, the scar tissue formed during operation disrupts the drainage of the sinuses and reduces postoperative success. The natural ostiodilatation method, which is performed by balloon sinoplasty method, has become more and more popular in recent years. Objectives To compare the technique of balloon sinoplasty with the classical functional endoscopic sinus surgery method by considering the severity of chronic sinusitis on the same patient. Methods Total of 61 chronic sinusitis patients was included in the study. Paranasal sinus tomography of the patients was taken and according to the Lund-Mackay scoring, chronic sinusitis levels were determined. Cases were divided into two groups: Group 1 (severe chronic sinusitis group) and Group 2 (mild chronic sinusitis). Results There was no statistically significant difference in the results of comparison of sinuses which underwent balloon sinoplasty and classical functional endoscopic sinus surgery in Group 2 after Lund-Mackay scores. However in Group 1, the results of the comparison of postoperative Lund-Mackay scores of the balloon sinoplasty and the classical endoscopic operation were statistically significantly lower than those of the face half operated with the classical functional endoscopic sinus surgery. Conclusion The success of balloon sinoplasty in patients with mild sinusitis is the same as in classic functional endoscopic sinus surgery. However, as the severity of sinusitis increases, the efficacy of balloon sinoplasty decreases.

引言：慢性鼻-鼻窦炎（Chronic rhinosinusitis, CRS）是一类以鼻及鼻窦黏膜炎症为特征的广义临床综合征。鼻窦维持正常生理功能的前提是窦口鼻道复合体（ostiomeatal complex, OMC）的引流通道保持通畅。对于药物治疗应答不佳的患者，外科手术是重要的治疗选择。尽管近年来功能性鼻内镜鼻窦手术（functional endoscopic sinus surgery, FESS）所使用的术式与器械持续改进，但术中形成的瘢痕组织会破坏鼻窦引流，降低术后治疗成功率。通过球囊鼻窦扩张术（balloon sinoplasty, BSP）实施的自然窦口扩张术，近年来应用愈发广泛。
研究目的：本研究旨在基于同一患者自身对照，结合慢性鼻窦炎的严重程度，对比球囊鼻窦扩张术与经典功能性鼻内镜鼻窦手术的术式效果。
研究方法：本研究共纳入61例慢性鼻-鼻窦炎患者。对所有患者行鼻窦断层扫描，依据Lund-Mackay评分确定慢性鼻窦炎的严重程度。将患者分为两组：组1（重度慢性鼻窦炎组）与组2（轻度慢性鼻窦炎组）。
研究结果：组2中，接受球囊鼻窦扩张术与经典功能性鼻内镜鼻窦手术的鼻窦术后Lund-Mackay评分对比无统计学显著差异。而组1中，接受球囊鼻窦扩张术的鼻窦术后Lund-Mackay评分显著低于接受经典功能性鼻内镜鼻窦手术的对侧半鼻窦。
研究结论：轻度鼻窦炎患者接受球囊鼻窦扩张术的治疗效果与经典功能性鼻内镜鼻窦手术相当。但随着鼻窦炎严重程度升高，球囊鼻窦扩张术的疗效会出现下降。