摘要
可能造成初次功能性內視鏡鼻竇手術（functional endoscopic sinus surgery, FESS）失敗的原因，包括全身性疾病、解剖異常、手術技術缺失和術後照護不足。在手術方面，殘餘氣囊（air cell）和上頜竇口狹窄是修正式內視鏡鼻竇手術（revision endoscopic sinus surgery, RESS）中最常見初次FESS手術失敗的原因，而大部分接受RESS的患者在上頜竇、篩竇和蝶竇都仍存在有病灶。RESS的手術步驟與初次FESS的手術步驟基本上相似，然而，RESS更困難。相較於初次FESS，RESS中缺少解剖標誌、傷口易出血、構造有粘連以及醫生缺少RESS手術經驗。RESS常會使用殘餘的中鼻甲、蝶竇開口、眶內壁和顱底作為解剖標誌。除了解剖標誌之外，影像導引系統有助於手術中識別解剖構造，尤其在RESS過程中。RESS手術對於粘液膿性鼻漏和鼻息肉，有良好治療效果；透過RESS能大幅改善粘液膿性鼻漏的症狀。然而，開完RESS後，最常見的症狀是鼻後倒流。除了手術技術外，可能還需要積極的術後照護，以降低RESS的失敗率。RESS併發症的發生率為1.1%至12.5%。透過鼻竇解剖構造的深入了解、手術技術的熟練以及仔細的術前和術中準備都有助於減少RESS併發症的發生。影像導引系統也有助於減少困難的RESS併發症的發生。
並列摘要
Failure of primary functional endoscopic sinus surgery (FESS) may be attributable to systemic disease, anatomical abnormalities, lack of an appropriate surgical technique, and insufficient postoperative care. Residual air cells and maxillary ostial stenosis are the most common primary contributors to FESS failure in cases of revision endoscopic sinus surgery (RESS); most patients who undergo RESS present with residual lesions in the maxillary, ethmoid, and sphenoid sinuses. The RESS procedure is similar to that used for primary FESS. However, RESS is technically more challenging owing to unavailability of anatomical landmarks, a high risk of bleeding, development of adhesions, and lesser surgical experience in RESS compared with primary FESS. The residual middle turbinate, sphenoid sinus opening, orbital wall, and skull base are used as anatomical landmarks during RESS. In addition to these landmarks, image guidance systems are used for intraoperative identification of anatomical structures, particularly during RESS. In patients in whom RESS is performed for treatment of mucopurulent rhinorrhea and nasal polyps, mucopurulent rhinorrhea tends to show significant improvement postoperatively. Posterior nasal drip is the most common residual symptom observed after RESS. In addition to the implementation of the appropriate surgical technique, active postoperative care is essential to reduce the failure rate of RESS. The incidence of RESS-induced complications ranges from 1.1% to 12.5%. Thorough understanding of sinus anatomy, proficiency in surgical techniques, and careful pre- and intraoperative preparation are important to reduce RESS-induced complications. Image guidance is also useful to minimize complications associated with difficult RESS.
延伸閱讀
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