Functional endoscopic sinus surgery for chronic rhinosinusitis
Editorial Group: Cochrane Ear, Nose and Throat Disorders Group
Published Online: 19 JUL 2006
Assessed as up-to-date: 17 NOV 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Khalil H, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004458. DOI: 10.1002/14651858.CD004458.pub2.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 19 JUL 2006
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2006.
Rhinosinusitis is a well-recognised clinical syndrome affecting patients of all ages and gender. Functional endoscopic sinus surgery (FESS) has now become a well-established strategy, comprising several techniques, for the treatment of chronic rhinosinusitis refractory to medical treatment.
The aim of this review was to assess the effectiveness of FESS as a treatment for patients with chronic rhinosinusitis.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 18 November 2008.
Randomised controlled trials. Inclusion criteria were any of the following criteria singly or in combination: patients with chronic rhinosinusitis diagnosed by a health professional; patients with sinusitis symptoms for more than 12 weeks; endoscopic evidence of sinusitis or radiological evidence of sinusitis. Exclusion criteria were immune suppression; cystic fibrosis; Wegener's disease; previous sinus surgery or sinonasal malignancy.
Data collection and analysis
All studies meeting the inclusion criteria underwent validity assessment and the two authors extracted data independently.
FESS versus medical treatment;
FESS versus conventional sinus surgery;
FESS + medical treatment versus medical treatment;
FESS + medical treatment versus conventional sinus surgery + medical treatment.
We included three randomised controlled trials involving 212 participants.
The evidence available does not demonstrate that FESS, as practised in the included trials, is superior to medical treatment with or without sinus irrigation in patients with chronic rhinosinusitis. A middle meatal antrostomy fashioned by FESS was also not shown to be superior to an inferior meatal antrostomy formed by traditional sinus surgery techniques, although the small sample size in the study does not exclude a type II error.
In one study there was a relapse rate of 2.4% in the FESS and sinus irrigation group compared to 5.6% in the sinus irrigation only group. The relapse rates were not mentioned in the other studies.
There were no major complications, such as orbital injury or cerebrospinal fluid leak, reported in any of the included trials.
FESS as currently practised is a safe surgical procedure. The limited evidence available suggests that FESS as practised in the included trials has not been demonstrated to confer additional benefit to that obtained by medical treatment (+/- sinus irrigation) in chronic rhinosinusitis. More randomised controlled trials comparing FESS with medical and other treatments, with long-term follow up, are required.
Plain language summary
Functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis
Rhinosinusitis is a common and well-recognised clinical syndrome affecting patients of all ages and gender. Functional endoscopic sinus surgery (FESS) is now a well-established strategy, which comprises several techniques, for the treatment of chronic rhinosinusitis which has not responded to medical treatment. FESS is a set of minimally invasive surgical techniques which allow direct visual examination and opening of the sinuses.
Three randomised controlled trials, involving 212 participants, met the inclusion criteria for this review. The evidence available does not demonstrate that FESS, as practised in the included trials, is superior to medical treatment with or without sinus irrigation in patients with chronic rhinosinusitis. There were no major complications in any of the included trials and FESS appears to be a safe procedure. More randomised controlled trials comparing FESS with medical and other treatments, with long-term follow up, are required.
功能性內視鏡鼻竇手術(Functional endoscopic sinus surgery)治療慢性鼻竇炎(rhinosinusitis)
搜尋了The Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 至 2006年１月) and EMBASE (1974 至2006年１月)。手動搜尋過參考目錄及聯絡了該領域的專家去找出更多合適的研究
Randomised controlled trials. 納入條件是以下任何一項或多項結合：被專業醫師診斷為慢性鼻竇炎的病人；有鼻竇炎症狀超過12個星期的病人；在鼻竇內視鏡或影像上有鼻竇炎證據的。排除條件是免疫被抑制；囊狀纖維化(cystic fibrosis); Wegener氏病(Wegener's disease)；之前接受過鼻竇手術或有鼻竇惡性腫瘤
符合要求被納入的3個研究為randomised controlled trials。目前證據顯示，對於慢性鼻竇炎的患者，無論有無鼻竇沖洗，研究當中所實行的功能性內視鏡鼻竇手術的效果沒有比藥物治療好。以功能性內視鏡鼻竇手術方式進行的中鼻道造口術的效果沒有比傳統鼻道手術進行的下鼻道造口術好，雖然此研究的樣本數小不能排除有type II error的誕生。其中一個研究顯示，功能性內視鏡鼻竇手術合併鼻竇沖洗這一組的復發率是2.4%，在只有鼻竇沖洗的那一組是5.6%，其他研究沒有提及復發率。被納入的研究當中，沒有發生主要併發症，如眼眶傷害或腦脊髓液外漏
目前被採用的功能性內視鏡鼻竇手術方法是一個安全的手術。目前研究提供有恨的證據顯示，對於慢性鼻竇炎的治療效果，功能性內視鏡鼻竇手術沒有比藥物有效(+/−鼻竇沖洗),需要更多比較功能性內視鏡鼻竇手術及藥物治療的長期效果追蹤的randomised controlled trials
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌
功能性內視鏡鼻竇手術治療慢性鼻竇炎。鼻竇炎是影響各年齡層及性別的臨床症候群。功能性內視鏡鼻竇手術是目前已完整建立的治療方式，包括了幾種術式，來治療藥物治療無效的慢性鼻竇炎。功能性內視鏡鼻竇手術是一系列的微創手術技巧，可直接目視及打開鼻竇。3個 randomised controlled trials符合此回顧的納入條件被採用，皆顯示對於慢性鼻竇炎的病人，功能性內視鏡鼻竇手術沒有比藥物有效，無論有無進行鼻竇沖洗。被納入的研究當中，沒有發生主要併發症，功能性內視鏡鼻竇手術似乎是安全的手術．但需要更多進一步比較功能性內視鏡鼻竇手術及藥物治療的長期效果追蹤的randomised controlled trials