内窥镜经蝶窦手术后继发性蝶窦感染的原因和治疗方法。

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-11-09 DOI:10.1002/lio2.70033

Yi Dong MD, Bing Zhou MD, Shunjiu Cui MD, Qian Huang MD, Yan Sun MD, Zhenxiao Huang PhD, MD, Jingying Ma MD, Quanjie Yang MD, Na Liang MD

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摘要

目的本研究分析了内窥镜经蝶窦颅底手术后蝶窦（SS）感染（SSI）的原因，并确定了适当的治疗方法：本研究包括31例内窥镜经蝶窦颅底手术（ETSA；SSI组）后继发性SSI病例和246例无SSI病例（非SSI组）。收集的数据包括 ETSA 后的病理结果、人工颅底重建材料的类型以及 SS 的通畅情况。对于 SSI 组，数据包括从 ETSA 到症状出现的时间、内窥镜和成像结果、第二次手术的术中情况以及视觉模拟量表（VAS）评分的变化：二次 SSI 的发生率为 11.19%。在 SSI 组中，26 名患者（83.87%）报告头痛，24 名患者（77.42%）出现 SS 管腔狭窄或关闭（SSO）。非 SSI 组没有任何症状，236 名患者（95.93%）的 SSO 闭合良好。在 SSI 组中，有 20 名患者（64.5%）观察到 SS 管壁向心力过强 (CHO)。SSI 组和非 SSI 组分别有 5 例（16.13%）和 215 例（87.40%）患者使用了可吸收材料，而使用不可吸收材料的患者分别有 24 例（77.42%）和 20 例（8.13%）。使用不可吸收合成材料的 SSI 风险是使用不可吸收合成材料的 9.42 倍。第二次手术后3个月和12个月，SSI症状的VAS评分和Lund-Kennedy评分明显下降：ETSA术后继发性SSI可引起持续症状。结论：ETSA术后继发性SSI可导致持续症状，应避免使用非吸收性合成修复材料，以防止继发性SSI。扩大鼻翼切除术和去除人工材料可迅速缓解 SSI 症状：4.

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Causes and treatment of secondary sphenoid sinus infection post-endoscopic transsphenoidal approach

Objective

This study analyzed the causes of sphenoid sinus (SS) infection (SSI) following endoscopic transsphenoidal skull base surgery and determined appropriate treatment methods.

Methods

This study included 31 cases of secondary SSI following the endoscopic transsphenoidal approach (ETSA; SSI group) and 246 cases without SSI (non-SSI group). Data collected included post-ETSA pathological results, types of artificial skull base reconstruction materials, and SS patency. For the SSI group, data included time from ETSA to symptom onset, endoscopic and imaging findings, intraoperative conditions during the second surgery, and changes in visual analog scale (VAS) scores.

Results

The incidence of secondary SSI was 11.19%. In the SSI group, 26 patients (83.87%) reported headaches, and 24 (77.42%) had stenosis or closure of the SS ostium (SSO). The non-SSI group reported no symptoms, and 236 patients (95.93%) had well-opened SSOs. Centripetal hyperosteogeny (CHO) in the SS walls was observed in 20 patients (64.5%) in the SSI group. Absorbable materials were used in five cases (16.13%) and 215 cases (87.40%) in the SSI and non-SSI groups, respectively, while non-absorbable materials were used in 24 cases (77.42%) and 20 cases (8.13%), respectively. SSI risk was 9.42 times higher with non-absorbable synthetic materials. VAS scores for SSI symptoms and Lund–Kennedy scores significantly decreased at 3 and 12 months post-second surgery.

Conclusion

Secondary SSI after ETSA can cause persistent symptoms. Non-absorbable synthetic repair materials should be avoided to prevent secondary SSI. Extended sphenoidectomy and removal of artificial materials can lead to rapid resolution of SSI symptoms.