慢性鼻窦炎患者内镜鼻窦手术中中鼻甲切除与保留的疗效与安全性：系统评价与荟萃分析
Efficacy and safety of middle turbinate resection versus preservation during endoscopic sinus surgery in patients with chronic rhinosinusitis: a systematic review and meta-analysis.
文献信息
| PMID | 42900199 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Muath Abdullah Almaimoni |
| 作者单位 | College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, 13611, Saudi Arabia. almaimonimarnd@outlook.com. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 慢性鼻窦炎（CRS）是一种常见的炎症性疾病，显著损害生活质量。当药物治疗后症状仍持续时，需行内镜鼻窦手术（ESS）。在ESS中，中鼻甲应切除还是保留仍存在争议：切除可能改善手术入路并减少术后阻塞，而保留则维持解剖结构，并可能支持正常愈合和气流。比较两种方法的证据有限且不一致，因此其相对疗效和安全性仍不明确。
方法： 在多个数据库中进行全面文献检索，截至2026年1月，以识别相关研究。使用ROB2和纽卡斯尔-渥太华量表（NOS）工具评估质量，并使用R软件进行分析。
结果： 检索共识别4,265条记录；经过筛选和全文评估，最终纳入31项研究。与保留相比，中鼻甲切除在Lund-Kennedy内镜评分方面显示出统计学显著改善（MD = -0.58），而通过SNOT测量的症状改善无显著差异。切除显著减少术后粘连/粘连（RR = 0.35）和窦口再狭窄（RR = 0.41）。对于次要结局，两组间嗅觉和POSE评分无显著差异，结痂和中鼻道开窗通畅性也无显著差异。切除组术后出血风险较高（RR = 2.24），而切除组外侧化（RR = 0.29）和息肉复发（RR = 0.58）较低。
结论： 在CRS的ESS中切除中鼻甲似乎可改善术后内镜愈合和通畅性相关结局（包括减少粘连和窦口再狭窄），但并未在患者报告的症状方面带来一致优势，且与更高的术后出血风险相关；因此，中鼻甲处理应个体化并以解剖/风险为导向，而非常规进行。
英文摘要
BACKGROUND: Chronic rhinosinusitis (CRS) is a common inflammatory disease that significantly impairs quality of life. When symptoms persist despite medical therapy, endoscopic sinus surgery (ESS) is performed. During ESS, whether to resect or preserve the middle turbinate remains controversial: resection may improve access and reduce postoperative obstruction, while preservation maintains anatomy and may support normal healing and airflow. Evidence comparing both approaches is limited and inconsistent, so their relative efficacy and safety remain unclear.
METHODS: A comprehensive literature search was conducted across various databases until January 2026 to identify relevant studies. The quality was assessed using the ROB2 and Newcastle-Ottawa Scale (NOS) tools and the analysis was performed using R software.
RESULTS: The search identified 4,265 records; after screening and full-text assessment, 31 studies were included. Compared with preservation, middle turbinate resection showed a statistically significant improvement in Lund-Kennedy endoscopic score (MD = - 0.58), while symptom improvement measured by SNOT showed no significant difference. Resection significantly reduced postoperative adhesion/synechiae (RR = 0.35) and sinus ostium restenosis (RR = 0.41). For secondary outcomes, olfaction and POSE scores did not differ significantly between groups, and crustation and middle meatal antrostomy patency were not significantly different. Postoperative bleeding risk was higher with resection (RR = 2.24), whereas lateralization (RR = 0.29) and polyp recurrence (RR = 0.58) were lower with resection.
CONCLUSION: Middle turbinate resection during ESS for CRS appears to improve postoperative endoscopic healing and patency-related outcomes (including reduced synechiae and ostial restenosis), but it does not confer a consistent advantage in patient-reported symptoms and is associated with a higher risk of postoperative bleeding; therefore, MT management should be individualized and anatomy-/risk-guided rather than routine.