淺談慢性鼻竇炎的手術治療       文/趙勻廷 醫師

慢性鼻竇炎是鼻腔及鼻竇黏膜的一種發炎性疾病，臨床表現為膿鼻涕、鼻塞、鼻涕倒流或甚至嗅覺喪失，通常症狀持續超過三個月。診斷需要靠症狀表現、內視鏡發現及影像學檢查。可能同時伴隨不同程度的鼻瘜肉而加重症狀。第一線的內科治療包括抗生素、化痰藥、類固醇及鼻道沖洗。當內科治療失敗，病人可能需要接受手術治療。功能性內視鏡鼻竇手術是治療慢性鼻竇炎的首選手術治療，這是一種移除鼻瘜肉及不健康黏膜的低侵襲性手術，而正常的黏膜盡量保留下來以維持其原有功能。內視鏡鼻竇手術在全身麻醉下進行，術中使用的內視鏡及手術器械從鼻孔進出，一般來說不會有其他傷口。術中使用最先進的手術導航系統，可讓我們即時知道器械在鼻腔中的位置，以避免傷及附近重要的構造，如大血管、顱底或眼眶。鼻竇的開口會被擴大以建立通暢的引流路徑。鼻息肉及不健康的黏膜是以微創動力旋轉刀小心地切割削除。最後以可吸收式敷料來做鼻填塞以減少流血。功能性內視鏡鼻竇手術目的在於移除鼻息肉及不健康的黏膜、建立通暢的鼻竇引流路徑，以及讓術後更容易進行鼻沖洗與類固醇噴劑治療。可能的風險與併發症包括黏膜沾黏、出血、鼻中膈破損、溢淚、眼眶周圍皮下氣腫、眼眶血腫、複視、視神經損傷、腦脊髓液漏、顱內傷害、術後粘液囊腫。關於慢性鼻竇炎的治療以及手術相關資訊，可進一步向耳鼻喉專科醫師尋求諮詢。

示意照片或手術圖片

Surgical treatment of chronic rhinosinusitis   Yun-Ting Chao, MD

Chronic rhinosinusitis with/without nasal polyposis (CRSwNP/ CRSsNP) is a chronic inflammatory disease of the mucosa in nasal cavity and paranasal sinuses. The clinical presentation includes purulent rhinorrhea, nasal obstruction, post-nasal dripping and even loss of smell. The symptoms should persist more than 3 months. The diagnosis is based on symptoms, endoscopic findings, and clinical images. Nasal polyposis may appear in sinonasal area in varying degree, aggravating the symptoms. Antibiotics, mucolytic agents, steroid, and saline irrigation are among the first-line medical treatments of CRS. The patient should undergo surgery if their CRS symptoms are poorly controlled by medical treatment. FESS is the mainstay of surgical treatment for CRS. It is a minimally invasive procedure to remove polyps and diseased mucosa. Normal sinonasal mucosa is left intact as much as possible to preserve its function. The procedure is performed under general anesthesia. The endoscope and each instrument are introduced through one of the nostrils. We use navigation technology to real-time monitor the position of the instrument in paranasal sinuses and to avoid injury of adjacent structures, such as great vessels, skull base or orbit. The openings of the sinuses are widened to establish adequate drainage pathway. The polyps and diseased mucosa are removed cautiously by microdebriders. The nasal cavity is packed by absorbable materials to stop the bleeding at the end of surgery. The FESS is to remove nasal polyps and diseased mucosa, to establish an adequate sinus drainage pathway, and to facilitate postoperative nasal irrigation and steroid spray administration. Risks & complications include: mucosal synechia, bleeding, septal perforation, epiphora, periorbital subcutaneous emphysema, orbital hematoma, diplopia, optic nerve injury, cerebrospinal fluid leakage, intracranial injury or postoperative mucocele. If you have any questions, please consult the otorhinolaryngology specialist for further information regarding CRS and FESS.