改良内镜鼻窦手术对合并变应性鼻炎的慢性鼻窦炎伴鼻息肉的疗效分析

Efficacy analysis of modified endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps complicated by allergic rhinitis

  • 摘要:
    目的 观察改良内镜鼻窦手术(ESS)对合并变应性鼻炎(AR)的慢性鼻窦炎伴鼻息肉(CRSwNP)的疗效。
    方法 将拟行ESS治疗的伴有常年性AR的全组CRSwNP患者40例分为研究组和对照组, 每组20例。对照组采用常规ESS治疗,研究组在ESS基础上切除大部中鼻甲以加强中鼻道引流。比较2组术后黏膜转归、并发症,以及术前、术后3个月、术后1年的视觉模拟评分法(VAS)、鼻腔鼻窦结局测试-20量表(SNOT-20)评分和鼻内镜Lund-Kennedy评分。
    结果 对照组术后3个月中鼻甲外移与鼻腔外侧壁局部粘连3例,术后1年中鼻甲水肿10例,其中中鼻甲伴有局部息肉样变4例,筛窦及额隐窝区域息肉样增生。研究组未出现并发症,术区上皮化较好,且术后1年鼻塞评分、嗅觉减退评分和Lund-Kennedy评分均低于对照组,差异有统计学意义(P<0.05)。
    结论 改良ESS可显著改善合并常年性AR的全组CRSwNP患者的鼻塞和嗅觉减退症状,有效提高患者的生活质量。

     

    Abstract:
    Objective To observe the efficacy of modified endoscopic sinus surgery (ESS) in treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) complicated by allergic rhinitis (AR).
    Methods Forty patients with CRSwNP and perennial AR who were scheduled for ESS were divided into study group and control group, with 20 cases in each group. The control group was treated with conventional ESS, while the study group underwent resection of a large part of the middle turbinate on the basis of ESS to enhance middle meatal drainage. The postoperative mucosal outcomes, complications, as well as the Visual Analog Scale (VAS), sino-nasal outcome test-20 (SNOT-20), and nasal endoscopic Lund-Kennedy scores before surgery, at 3 months after surgery, and at 1 year after surgery were compared between the two groups.
    Results In the control group, there were 3 cases of local adhesion between the displaced middle turbinate and the lateral nasal wall at 3 months after surgery, and 10 cases of middle turbinate edema at 1 year after surgery, including 4 cases with local polypoid changes in the middle turbinate and polypoid hyperplasia in the ethmoid sinus and frontal recess regions. No complications were observed in the study group, and the epithelialization of the surgical area was good. Moreover, the nasal congestion score, olfactory score, and Lund-Kennedy score at 1 year after surgery in the study group were lower than those in the control group, with statistically significant differences (P < 0.05).
    Conclusion Modified ESS can significantly improve nasal congestion and olfactory symptoms in patients with CRSwNP complicated by perennial AR and effectively enhance their quality of life.

     

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