Alt konka hipertrofisi tedavisinde radyofrekans termal ablasyon ve mikrodebrider tekniğinin etkinliğini visuel analog skala, rinomanometri ve manyetik rezonans görüntülemesi ile karşılaştırılması
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Dosyalar
Tarih
2016
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmanın amacı kronik nazal obstrüksiyonun izole alt konka hipertrofisine bağlı olduğu belirlenen olgularda RFTA ve mikrodebrider tekniğinin etkinliğini visuel analog skala (VAS), rinomanometri ve MR görüntülemesi ile incelemek ve bu iki tekniği karşılaştırmaktır. Gereç ve Yöntem: Bu çalışmaya Mayıs 2014-Aralık 2015 tarihleri arasında Kulak Burun Boğaz Hastalıkları Anabilim Dalı kliniğine kronik nazal tıkanıklık şikayeti ile başvuran ve izole alt konka hipertrofisi tespit edilen 40 erişkin hasta dahil edildi. Hastalar eşit sayıda iki gruba ayrıldı. Grubun birine RFTA uygulandı.Hastaların alt konkalarına bilateral üç noktaya 350'şer joule enerji verilerek, hedef sıcaklık 75° C,12W ve toplam 1050 joule enerji verildi. Mikrodebrider uygulanan hasta alt konkalarına on beş numaralı bistüri kullanarak alt konka kaudal ucuna vertikal bir insizyon yapıldı. Bu insizyon yerinden mikrodebrider (Xomed mikrodebrider düz uç 2 mm) ile girildi ve kemik konka üzerinden submukozal dokular debride edildi. Konkaların objektif değerlendirilmesi preoperatif dönem ve postoperatif 2.ayda çekilen manyetik rezonans görüntüleri, preoperatif ve postoperatif (1. Hafta, 2. Ay) rinomanometri ölçümleri karşılaştırılarak yapıldı. Ayrıca başka bir hekim konka boyutlarını VAS ile değerlendirildi. Hastalar tarafından, nazal obstrüksiyonun VAS değerlendirmesi yapıldı. Nazal mukosiliyer klirens ölçümü sakkarin klirensi testi ile yapıldı. Bulgular: Hastaların yaşları 19 ile 62 yaşları arasında (RFTA grubu ortalama 32,56 , mikrodebrider grubu ortalama 33,80) değişmekte idi. Aksiyel ve koronal plan manyetik rezonans ile iki grupta da konkaların postoperatif 2. ayda küçüldüğü saptandı (p<0,05). Gruplar karşılaştırıldığında ise mikrodebrider uygulanan grubun MR sonuçları RFTA uygulanan gruba göre anlamlı derecede fark bulundu (P<0,05). Yapılan rinomanometri ölçümlerinde RFTA ve microdebrider tekniği uygulanan grupların ikisinde de istatiksel anlamlı derecede toplam dirençte azalma saptandı. Gruplar karşılaştırıldığında microdebrider tekniği uygulanan grupta erken dönem ve 2. Ay kontrolde daha fazla direnç azalması olduğu saptanmıştır (p<0.05). Başka bir hekim tarafından kaydedilen VAS'da, iki grupta da konkalarda küçülme olduğu görüldü (p<0,05). Postoperatif kontrollerde hastaların nazal tıkanıklık şikayetlerinde anlamlı derecede azalma saptandı (p<0,05). iki hasta grubunda da preoperative ve postoperative (1. Hafta, 2. Ay) sakkarin klirensi ölçümlerinde anlamlı bir fark bulunamamıştır(p>0.05) Sonuç: Alt konka hipertrofilerine bağlı olarak gelişen nazal obstrüksiyonun tedavisinde, radyofrekans ile termal ablasyon tedavisi ve mikrodebrider tekniği etkin, ciddi komplikasyonlara yol açmayan, mukosiliyer klirensi bozmayan güvenli yöntemlerdir. Sonuçlarımız değerlendirildiğinde mikrodebrider tekniğinin RFTA tekniğine göre daha etkin ve daha erken dönemde sonuç verdiği kanaatine varılmıştır.
The aim of this study was to compare the efficacy of RFTA and microdebrider by using visual analog scale (VAS), rhinomanometry and magnetic resonance imaging in selected cases of chronic nasal obstruction due to isolated inferior turbinate hypertrophy. MATERIALS AND METHOD: 40 patients who presented with chronic nasal obstruction and were diagnosed with isolated inferior turbinate hypertrophy between May 2014 and December 2015 were included into the study. Patients were grouped into two equal groups. One of the groups had RFTA applied. These patients' bilateral inferior turbinates were each administered with 350 joules at three different points, targeted heat temperature of 75° C, 12 W totalling 1050 joules of energy. Those patients who were operated on with microdebrider, the inferior turbinate's caudal end was vertically incised using surgical blade number 15. Microdebrider (Xomed straight point 2 mm) was inserted at this incision point and submucosal tissues debrided from the bony turbinate. The objective evaluation of the turbinates was done by comparing the magnetic resonance images taken during the preoperative period and at the second month postoperative period, and also the preoperative and first week and second month postoperative rhinomanometric measurements were compared. Another physician evaluated the volume of the turbinates using VAS. VAS evaluation of nasal obstruction was done by the patients. Nasal mucociliary clearance was measured using the saccharine clearance test. RESULTS: The patients's ages ranged from 19 to 62(mean age in the RFTA group was 32.56, in the microdebrider group it was 33.80). The turbinates in both groups were found to have reduced when evaluated with magnetic resonance axial and coronal planes at the second month postoperatively (p<0,05). When the groups are compared it was found that the MRI results in the microdebrider group were significantly different with regards to the RFTA group (p<0,05). Using rhinomanometry measurements it was found that the total resistance reduced and was statistically significant in both groups that had RFTA and microdebrider techniques applied. When the groups are compared it was found that much more resistance reduced in the early period and at the second month of follow up in the group that had microdebrider technique applied(p<0,05). In the VAS that was recorded by another physician the turbinates were seen to have reduced in both groups(p<0,05). The patients's nasal obstruction complaints were seen to have significantly reduced during the postoperative follow up period(p<0,05). Saccharine clearance test was not significantly different in the perioperative and postoperative periods(first week, second month) in the two patient groups(p>0,05). CONCLUSION: Thermal ablation with radiofrequency and microdebrider technique are effective and safe methods used for the treatment of nasal obstruction due to inferior turbinate hypertrophy and neither cause serious complications nor damage mucociliary clearance. From our results we have come to the conclusion that microdebrider technique compared to RFTA technique is more effective and gives results in the early postoperative period.
The aim of this study was to compare the efficacy of RFTA and microdebrider by using visual analog scale (VAS), rhinomanometry and magnetic resonance imaging in selected cases of chronic nasal obstruction due to isolated inferior turbinate hypertrophy. MATERIALS AND METHOD: 40 patients who presented with chronic nasal obstruction and were diagnosed with isolated inferior turbinate hypertrophy between May 2014 and December 2015 were included into the study. Patients were grouped into two equal groups. One of the groups had RFTA applied. These patients' bilateral inferior turbinates were each administered with 350 joules at three different points, targeted heat temperature of 75° C, 12 W totalling 1050 joules of energy. Those patients who were operated on with microdebrider, the inferior turbinate's caudal end was vertically incised using surgical blade number 15. Microdebrider (Xomed straight point 2 mm) was inserted at this incision point and submucosal tissues debrided from the bony turbinate. The objective evaluation of the turbinates was done by comparing the magnetic resonance images taken during the preoperative period and at the second month postoperative period, and also the preoperative and first week and second month postoperative rhinomanometric measurements were compared. Another physician evaluated the volume of the turbinates using VAS. VAS evaluation of nasal obstruction was done by the patients. Nasal mucociliary clearance was measured using the saccharine clearance test. RESULTS: The patients's ages ranged from 19 to 62(mean age in the RFTA group was 32.56, in the microdebrider group it was 33.80). The turbinates in both groups were found to have reduced when evaluated with magnetic resonance axial and coronal planes at the second month postoperatively (p<0,05). When the groups are compared it was found that the MRI results in the microdebrider group were significantly different with regards to the RFTA group (p<0,05). Using rhinomanometry measurements it was found that the total resistance reduced and was statistically significant in both groups that had RFTA and microdebrider techniques applied. When the groups are compared it was found that much more resistance reduced in the early period and at the second month of follow up in the group that had microdebrider technique applied(p<0,05). In the VAS that was recorded by another physician the turbinates were seen to have reduced in both groups(p<0,05). The patients's nasal obstruction complaints were seen to have significantly reduced during the postoperative follow up period(p<0,05). Saccharine clearance test was not significantly different in the perioperative and postoperative periods(first week, second month) in the two patient groups(p>0,05). CONCLUSION: Thermal ablation with radiofrequency and microdebrider technique are effective and safe methods used for the treatment of nasal obstruction due to inferior turbinate hypertrophy and neither cause serious complications nor damage mucociliary clearance. From our results we have come to the conclusion that microdebrider technique compared to RFTA technique is more effective and gives results in the early postoperative period.
Açıklama
Anahtar Kelimeler
Konka Hipertrofisi., Turbinate hypertrophy,, Radyofrekans., Radiofrequency., Mikrodebrider., Microdebrider.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Gül, Z. (2016). Alt konka hipertrofisi tedavisinde radyofrekans termal ablasyon ve mikrodebrider tekniğinin etkinliğini visuel analog skala, rinomanometri ve manyetik rezonans görüntülemesi ile karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Kulak Burun Boğaz Anabilim Dalı, Konya.
