Studie hodnotí přínos CT navigace u endoskopických operací VDN a zlepšení kvality života pacientů po operaci. V prospektivní studii (779 operací u 439 nemocných v období 2011-2015) jsme srovnávali efektivitu a rozsah chirurgického výkonu, vztah k přidruženým chorobám (alergie, astma bronchiale). Dále jsme hodnotili kvalitu života operovaných dotazníkem SNAQ-11. Vyhodnotili jsme také výsledky primárních a revizních operací VDN a porovnávali jsme stav čichu po operačních výkonech provedených bez a s CT navigací. Pooperačně jsme dosáhli zlepšení kvality života o 79 %, v rozmezí od 72 do 83 %. Zachování nebo zlepšení čichu u primárních operací bylo dosaženo v 86 %, u revizních výkonů v 55 %. Užití CT navigace v chirurgii VDN minimalizuje počet operačních komplikací při operování v obtížných anatomických podmínkách. U alergiků užitím CT navigace dosahujeme výrazně lepšího stavu čichu po operaci. Revizní operace snižuje šanci na pooperační zlepšení čichu. Všechny revizní operace VDN by měly být prováděny zkušeným operatérem a ideálně s využitím CT navigace.

Background and aim: One of the most common indication of CT navigation surgery is the surgery of nasal sinuses and especially the revision surgery. The aim of this paper was to prove importance of surgical radicality of FESS on the improvement of quality of life and/or improvement of the sense of smell in particular surgical groups and on reduction of the number of revision surgeries. Patients and Methods: In the 5-year period between 2011 and 2015 in prospective study we performed a total of 374 navigated procedures (in 198 subjects) and 405 classical endoscopic endonasal paranasal operations (in 241 subjects). The decision about use of the CT navigation depended mostly on the quality of the CT scans. If the protocol used for the imaging allowed subsequent navigated procedure, then the navigation procedure was preferred. The quality of life was studied on a cohort of 439 patients as a prospective cohort study: on operated patients was the quality of life assessed using the SNAQ – 11 questionnaire (Sino nasal assessment questionaire - Czech version). The surgery was performed by a randomly selected surgeon from our rhinology group. For investigationg the olfactory function the Sniffin Sticks test was routinly used. The regularly postoperatiove follow-ups for our patients were scheduled in intervals of 1, 4, 12 weeks and 6 and 12 months in the first year after surgery, and later once to twice yearly. Results: We observed an improvement of 79% in quality of life, with a range from 72 to 83%. Olfactory deterioration is the most sensitive indicator of recurrent chronic rhinosinusitis. We reviewed the relationship between sense of smell and procedures performed both with and wihout the use of CT navigation. With surgical treatment, the sense of smell was maintained or improved in 86% of patients, while this figure reached only 55% in revision procedures. We observed significantly better results with navigated surgery, at a ratio of 85% to 46%, regardless of whether a primary operation or revision was performed. In patients without allergies, the results with and without navigation were the same. Conclusion: Allergic patients operated with CT navigation had a significantly better sense of smell than patients operated by the endonasal method without CT assistance. The postoperative sense of smell in patients without allergies is comparable in both methods and all members of both groups had improved quality of life.

Department of ENT and Maxillofacial surgery 3rd Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Faculty of Military Health Science in Hradec Kralove University of Defence Corresponding

Přínos CT navigace v endoskopické chirurgii vedlejších nosních dutin: vyhodnocení pooperační kvality života a funkce čichu