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11
LONG-TERM RESULTS OF ENDOSCOPIC SURGERY FOR
CHRONIC SINUSITIS
1 2 Abdumutalipov U.Sh. ,Kosimov K.K.
Email: [email protected]
'Abdumutalipov Ulugbek Shukhratugli - Assistant; 2Kosimov Kobil Kosimovich - Doctor of Medical Sciences, Professor, Head of Department, DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: sinusitis is a group of diseases of the sinuses - paranasal sinuses. When any one sinus of the nose or two of the same name, located symmetrically to each other on different sides, becomes inflamed, the name of the sinus that is affected is indicated in the diagnosis. Sinuses are small cavities that lie deep within the cranial bones.
Chronic sinusitis is a common condition that both children and adults often face. With this disorder, inflammation of the mucous membrane of one or more paranasal sinuses occurs, lasting for a long time with periods of remission and exacerbations. In most cases with chronic sinusitis, polysinusitis occurs, in which multiple inflammation of the paranasal sinuses develops. In the absence of therapy, pathology easily leads to serious complications, which are sometimes even deadly. Treatment of chronic pathology is more difficult and longer than acute.
Keywords: chronic sinusitis, endoscopic surgery, separated results.
ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ЭНДОСКОПИЧЕСКИХ
ОПЕРАЦИЙ ПРИ ХРОНИЧЕСКИХ СИНУСИТАХ
12 Абдумуталипов У.Ш. , Косимов К.К.
'Абдумуталипов Улугбек Шухрат угли - ассистент; 2Косимов Кобил Косимович - доктор медицинских наук, профессор, заведующий
кафедрой, кафедра оториноларингологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: синуситами называется группа заболеваний синусов — околоносовых пазух. Когда воспаляется какая-либо одна пазуха носа либо две одноименных, расположенные симметрично друг другу по разным сторонам, в диагнозе указывается название той пазухи, которая поражена. Синусы - это полости небольшого размера, которые залегают в толще черепных костей. Хронический синусит - распространенное заболевание, с которым часто сталкиваются как дети, так и взрослые. При данном нарушении происходит воспаление слизистой оболочки одной или нескольких придаточных пазух носа, длящееся в течение продолжительного времени с периодами ремиссии и обострений. В большинстве случаев при хроническом синусите имеет место полисинусит, при котором развивается множественное воспаление околоносных пазух. При отсутствии терапии патология легко приводит к тяжелым осложнениям, которые иногда являются даже смертельно опасными. Лечение хронической патологии труднее и длительнее острой.
Ключевые слова: хронический синусит, эндоскопическая операция, отделенные результаты.
УДК 6'6.2'6-002-036.'' (075.8)
Relevance. Chronic sinusitis is a rare pathology and accounts for 2-3% of all inflammatory diseases of the paranasal sinuses in adult patients. In childhood, the incidence of isolated lesions of the maxillary sinus is even rarer and does not exceed 1-2.7% of cases [6].
The main sinus begins to develop as early as 3 months of a child's life due to the gradual resorption of the cancellous bone and completes its development by adolescence [3]. This paranasal sinus is the most difficult to diagnose and treat its pathology, especially in children. According to the literature, there are several reasons for the development of isolated sphenoiditis.
Infectious agents play an important role. Microbiological analysis of the discharge from the sphenoid sinus showed that the main causative agent of chronic sinusitis is Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis [4]. Some researchers point to children swimming or diving as the cause of chronic sinusitis.
In other studies, lingering allergic rhinitis was assigned a fundamental role [1]. The erased clinical picture of chronic lesions of the paranasal sinus, as well as nonspecific complaints, cause patients to stay for a long time without a diagnosis. According to a number of authors, in childhood, the clinical manifestations of sinusitis are: retroorbital headache, nausea, fever, and decreased or complete absence of vision on the affected side [2].
In other studies, lingering allergic rhinitis was assigned a fundamental role [1]. The erased clinical picture of chronic lesions of the paranasal sinus, as well as nonspecific complaints, cause patients to stay for a long time without a diagnosis. According to a number of authors, in childhood, the clinical manifestations of sinusitis are: retroorbital headache, nausea, fever, and decreased or complete absence of vision on the affected side [2].
The duration of treatment should be at least 3 or 4 weeks. If conservative therapy was not effective, or intracranial or ophthalmic complications appeared in the course of treatment, then surgical treatment should be resorted to immediately.
Currently, Functional Endoscopic Sinus Surgery (FESS) is an actively used minimally invasive method of sanitation and drainage of an inflammation focus, especially in a deeply located area. FESS in pediatrics is associated with a number of features, such as: narrowness of the nasal cavity, thinness of bone structures that separate the sphenoid sinus from the optic nerve trunk, underdevelopment of the sphenoid sinus.
The listed anatomical features can lead to serious complications, for example, damage to the base of the skull with the subsequent development of liquorrhea. Surgical approaches in childhood consist in using the most gentle, but at the same time, effective surgical approaches that provide a positive result. Such features of childhood gave rise to the use of the term PESS [5] instead of FESS.
Purpose of the study. To conduct a comprehensive assessment of the effectiveness of endoscopic operations on the paranasal sinuses in chronic rhinosinusitis in the long-term postoperative period.
Materials and research methods. The paper analyzes the results of an outpatient examination of 102 patients who underwent endoscopic surgery on the paranasal sinuses (SNP). The time after surgery ranged from 1 to 13 years.
Research results. Modern objective research methods: endoscopy of the nasal cavity, computed tomography of the paranasal sinuses, assessment of the functions of the nasal cavity using anterior active rhinomanometry, polymer colored films, supplemented by the method of assessing the quality of life of patients in total, make it possible to reliably assess the long-term results of treatment.
Based on the complex of examination used, it was shown that endoscopic functional rhinosinus surgery allows to obtain good and satisfactory long-term results in 89.8% in patients with polypous rhinosinusitis and in 97.7% of cases in patients with chronic purulent rhinosinusitis.
Unsatisfactory results in the treatment of patients with chronic rhinosinusitis (6.8% of patients) are due to a number of factors, in particular: the presence of concomitant general diseases (bronchial asthma); underestimation of the existing changes in the intranasal structures (curvature of the nasal septum, hypertrophy of the turbinates); insufficient treatment in the postoperative period with dynamic observation of the patient.
In patients with chronic rhinosinusitis, the main representatives of microflora were staphylococci (60.9%). The presence of pathogenic microflora requires appropriate antibacterial therapy in the postoperative period.
The integral indicator of the quality of life in patients after endoscopic surgery (125.7) is higher than before surgery (116.4), but does not reach the level of indicators of healthy individuals (140.4).
Prevention of chronic sinusitis is a necessary measure in case of a tendency to this pathology, since it is much easier to prevent the occurrence of a violation than to cure it. The main protective measures against the disease are:
timely treatment of any inflammatory diseases of the nose and throat; regular treatment of carious teeth; maintaining sufficient humidity in the room.
It also greatly helps to reduce the risk of developing pathology and a correct lifestyle. Output. Endoscopic endonasal sinusotomy is the optimal method for the surgical treatment of CVA; it is better to evaluate the results of surgical treatment by measuring the volume of the maxillary sinus on both sides before and after the operation and compare these values over time; timely performed surgical intervention allows to restore sinus ventilation and create conditions for spontaneous enlargement of the sinus in volume, prevent the progression of enophthalmos, preserve the normal development of SNP and the facial skeleton of the child.
References / Список литературы
1. Angotoeva I.B. Errors of YAMIK-therapy // Ros.rinology, 2007. № 2. Р. 55.
2. Ivanova M.A., Piskunov G.Z. Comparative characteristics of the microflora of the nasal cavity and paranasal sinuses in patients with recurrent inflammatory diseases // Ros. Rhinology, 2007. № 3. Р. 18-21.
3. Piskunov G.Z., Piskunov S.Z. Do the size and location of the anastomoses affect the nature of the pathological process in the paranasal sinuses? // Bulletin of otorhinolaryngology, 2011. № 4. Р. 44-45.
4. Shevchenko Yu.L. The concept of research on the quality of life in cardiology // Bulletin of the Russian Military Medical Academy, 2010. № 1. Р. 5-13.
5. Hopcinsetal. Complicationsofsurgeryfornasalpolyposisandcronicrhinosinusitis: theresultsof a nationalauditinEnglandandWales // Laryngoscope, 2016. Aug.; 116 (8): 1494-9.
6. Stammberger H. Functional endoscjpic sinus surgery. TheMesserklingertechnique / Philadelphia: B.C. Decker, 2011. Р. 529.
7. Weber R., Draf W. Komplikationen der endonasalenmikro-endoscopischenSieben-operation // HNO, 2012. Bd. 40. S. 170-175.
