功能性内窥镜鼻窦手术:更安全手术的要点。

Murat Kar, Nuray Bayar Muluk, Marwan Alqunaee, Felicia Manole, Cemal Cingi
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摘要

目的:回顾更安全的功能性内窥镜鼻窦手术(FESS)的措施。方法:使用 PubMed、EBSCO、UpToDate、Kırıkkale 大学 Proquest Central、Google 和 Google Scholar 进行文献综述。在 2000 年至 2024 年期间,使用 "功能性内窥镜鼻窦手术"、"FESS"、"安全性"、"图像引导 "和 "并发症 "等关键词进行了搜索。研究结果炎症性和感染性鼻窦疾病是 FESS 最常见的适应症。4 种最常见的 FESS 方法是内窥镜下鼻窦切除术、上颌窦前造口术/蝶窦切除术、前蝶窦切除术和后蝶窦切除术。FESS 的并发症发生率为:严重问题 0% 至 1.5%,轻微问题 1.12% 至 20.8%。通过精心的术前准备,鼻窦手术的效果可以得到改善,问题也可以避免。电动器械可能会增加问题的严重程度,而不是发生的次数。术中发现脑脊液漏时,必须立即定位并固定漏液结构。如果延迟检查,感染的危险就会增加,住院时间也会延长。在图像引导手术中,外科医生利用术前成像数据实时确定手术工具与周围解剖结构的准确位置。虽然内窥镜鼻窦手术最初是为神经外科设计的,但它已迅速成为这种技术最受欢迎的应用之一。结论:通过准确的 CT 扫描、良好的患者准备、外科知识和培训,以及在内窥镜鼻窦手术中使用图像引导,可以实现更安全的 FESS。
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Functional Endoscopic Sinus Surgery: Key Points for Safer Surgery.

Objectives: To review measures for safer functional endoscopic sinus surgery (FESS). Methods: PubMed, EBSCO, UpToDate, Proquest Central at Kırıkkale University, Google, and Google Scholar were used in the literature review. The search was performed using keywords of "functional endoscopic sinus surgery," "FESS," "Safety," "Image-Guided," and "complications" between 2000 and 2024. Results: Inflammatory and infectious sinus illnesses are the most prevalent indications for FESS. The 4 most common methods for FESS are endoscopic uncinectomy, maxillary antral ostomy/ethmoidectomy, anterior ethmoidectomy, and posterior ethmoidectomy. FESS has a complication rate of 0% to 1.5% for significant problems and 1.12% to 20.8% for minor issues. Sinus surgery outcomes can be improved and problems avoided with careful preoperative preparation. Powered instrumentation may enhance the severity of the problems rather than the number of occurrences. Intraoperative detection of cerebrospinal fluid leakage necessitates immediate localization and fixing of the leaking structure. The danger of infection increases and hospital stays are longer when investigation is delayed. In image-guided surgery, surgeons employ preoperative imaging data to pinpoint the exact position of a surgical tool concerning surrounding anatomical structures in real time. Although initially designed for use in neurosurgery, endoscopic sinus surgery has quickly become one of the most popular applications of this technique. Conclusion: Safer FESS can be accomplished with accurate CT scans, good patient preparation, surgical knowledge and training, and by using image guidance for endoscopic sinus surgery.

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