慢性鼻及鼻竇炎的常規及進階手術治療

近年來全球內視鏡鼻竇手術標準化之年執行率（annual rate）持續增加，身為耳鼻喉科醫師理，應對此手術近年來的實證研究有全面性的了解。慢性鼻及鼻竇炎患者經過適當內科治療仍無法緩解其臨床症狀時，就會考慮施行內視鏡鼻竇手術。鼻竇電腦斷層掃描是術前必備檢查，用以確認病灶的存在與範圍。EPOS指導委員會建議手術前可使用類固醇鼻噴劑，術中可使用全靜脈麻醉（TIVA）與reverse Trendelenberg姿勢來降低手術出血量與增進手術視野。手術治療方面首先要熟悉慢性鼻及鼻竇炎的基本手術，進而暸解多種內視鏡擴大型上頜竇手術與內視鏡擴大型額竇手術的效益、限制、可能併發症與運用時機，以期得到最佳的內視鏡鼻竇手術預後。而最後不要忘記外開式手術仍有其適應症，鼻科醫師必須熟悉這些術式，並傳承給年輕一代的醫師。

關鍵字

endoscopic modified Lothrop procedure ； extended frontal sinus approaches ； extended maxillary surgery ； middle meatal antrostomy ； neo-osteogenesis ； revision endoscopic surgery（內視鏡改良式Lothrop手術；擴大型額竇手術；擴大型上頜竇手術；中鼻道上頷竇造口術；骨質新生；修正式內視鏡手術）

並列摘要

The annual global rate of endoscopic sinus surgery has increased in the past few years. ENT surgeons need to be familiar with evidence-based practice in sinus surgery. Endoscopic sinus surgery should be considered only in patients refractory to appropriate medical therapy. A CT scan is mandatory before surgery, both to confirm the presence and show the extent of disease. The EPOS steering group advises total intravenous anesthesia and the reverse Trendelenberg position during ESS to improve the surgical field and decrease blood loss. Preoperative oral land intranasal corticosteroids, regional block, controlled hypotension and tranexamic acid could also be considered. Surgeons need to be familiar with the skills of primary sinus surgery to all sinuses. There is a range of extended endoscopic approaches to the maxillary and frontal sinuses, which all have their own anatomical limitations and potential complications. Understanding these surgical skills and surgical indications for both primary and revised endoscopic sinus surgery is very important in optimizing patient outcomes. External approaches should also be kept in our armamentarium and taught to younger rhinologists.

並列關鍵字

endoscopic modified Lothrop procedure ； extended frontal sinus approaches ； extended maxillary surgery ； middle meatal antrostomy ； neo-osteogenesis ； revision endoscopic surgery

國際替代計量

慢性鼻及鼻竇炎的常規及進階手術治療

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