Kirurško liječenje upala paranazalnih sinusa i njihovih komplikacija

master's thesis

• Title (english): Surgical management of paranasal sinus inflammations and associated complications
• Author: Denis Ferenec
• Mentor: Marko Velimir Grgić (mentor)
• Committee member: Tomislav Baudoin (predsjednik povjerenstva)
• Committee member: Mirko Ivkić (član povjerenstva)
• Committee member: Marko Velimir Grgić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Rinosinuitis (RS) kombinirana je upalna bolest sluznice nosa i paranazalnih sinusa. Uzrok upale može biti različita porijekla, uključujući, vrlo često, bakterijske uzročnike. Prema trajanju bolesti postoje 2 oblika bolesti: akutni (ARS) i kronični (KRS) rinosinuitis. Oba oblika bolesti u početku se liječe konzervativno, a kirurški je pristup uglavnom predviđen za kronični rinosinuitis i/ili komplikacije, kada konzervativno liječenje nije dovoljno. Cilj kirurškog liječenja je ponovna uspostava normalne drenaže i aeracije sinusa te rješavanje ili prevencija razvoja komplikacija. Za vrijeme kirurškog zahvata uzima se bris sinusa s ciljem dokazivanja infektivnog uzročnika i antibiograma. Prije i nakon operacije, pacijent prima empirijsku antibiotsku terapiju, pa antibiogram služi korekciji antibiotske terapije. Cilj ovog rada bio je prikazati najčešće indikacije za kirurško liječenje upala sinusa i njihovih komplikacija te istražiti najčešće bakterijske uzročnike i njihovu osjetljivost na antibiotike. Uvidom u provedene operacije upala paranazalnih sinusa tokom godine dana Klinike za otorinolaringologiju i kirurgiju glave i vrata KBC-a „Sestre milosrdnice“, nađeno je da se oko 10 % operacija paranazalnih sinusa provodi radi liječenja komplikacija upalnih bolesti sinusa. Istraživanje osjetljivosti je obuhvatilo 114 pacijenata koji su bili podvrgnuti ESS-u tokom 2016. god. zbog KRS-a i/ili komplikacija KRS-a. Tada im je uzet bris zahvaćenog sinusa koji je potom mikrobiološki testiran. Izolirano je ukupno 25 različitih mikrobioloških vrsta u 175 izolata. Gotovo 10 % briseva bilo je sterilno. Najčešći izolirani patogeni bili su Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus., Pseudomonas spp., Fusobacterium spp. i Haemophilus influenzae. Prema rezultatima antibiograma najčešćih izolata, može se zaključiti da je trenutno liječenje amoksicilinom i klavulanskom kiselinom dovoljno za zbrinjavanje većine najčešćih bakterijskih infekcija paranazalnih sinusa. S obzirom na rastući problem bakterijske rezistencije općenito, važno je savjesno koristiti antibiotike i budno pratiti dinamiku promjene rezistencija, kako ostalih, tako i ovih uzročnika.

Abstract (english)

Rhinosinusitis (RS) is a combined inflammation of nasal mucosa and paranasal sinuses. It can be divided into acute (ARS) and chronic (CRS) according to duration. Both forms of the disease are initially treated conservatively and the surgical approach is used primarily to treat chronic rhinosinusitis and / or complications, when conservative treatment is not enough. The aim of surgical treatment is to reestablish normal drainage and sinus aeration and to prevent and deal with complications. During the surgical procedure a nasal smear is taken to determine the infectious agent and to provide an antibiogram. The patient receives empirical antibiotic therapy both before and after surgery, so the antibiogram serves to adjust it properly. The aim of this paper was to show the most common indications for surgical treatment of inflammation of the sinuses and their complications and to investigate the most common bacterial pathogens and their susceptibility to antibiotics. By examining the performed operations of paranasal sinus inflammation during a period of one year at the Otolaryngology - Head & Neck Surgery Clinic of the Sisters of Charity Hospital in Zagreb, it was found that about 10% of paranasal sinus surgeries were performed to treat complications of inflammatory diseases of sinuses. The sensitivity study included 114 patients who had been subjected to ESS during 2016 due to CRS and / or CRS complications. Nasal smears of the affected sinuses were taken and then microbiologically tested. A total of 25 different microbiological species in 175 isolates were found. Almost 10% of smears were sterile. The most common among the isolated pathogens were: Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus., Pseudomonas spp., Fusobacterium spp. and Haemophilus influenzae. According to the results of antibiograms of the most common isolates, it can be concluded that treatment with amoxicillin and clavulanic acid is currently sufficient to treat the majority of the most common bacterial infections of paranasal sinuses. Given the growing problem of bacterial resistance in general, it is important to use antibiotics cautiously and to monitor the dynamics of ever-changing resistances, with these as well as the other agents.

• Keywords: kronični rinosinuitis; kirurško liječenje; infektivni uzročnici; antibiogram
• Keywords (english): chronic rhinosinusitis; surgical treatment; infectious agents; antibiogram
• Language: croatian
• URN:NBN: urn:nbn:hr:105:221219
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-29 08:42:02