鼻内镜修正性手术联合中鼻甲切除治疗难治性鼻-鼻窦炎患者疗效及对围术期指标和预后的影响

doi:10.3969/j.issn.1006-6233.2023.07.014

摘要
图/表
参考文献
相关文章 (13)

全文: PDF (1236 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 探讨难治性鼻-鼻窦炎患者采用鼻内镜修正性手术联合中鼻甲切除术治疗的效果及对患者围术期情况和预后的影响。方法: 将2019年1月至2022年1月我院收治的91例难治性鼻-鼻窦炎患者按随机数字表法分为对照组(n=45)与观察组(n=46),对照组行常规内镜下开放手术治疗,观察组采用鼻内镜修正性手术联合中鼻甲切除术治疗,比较两组手术疗效;手术前后采用T&T嗅觉计定量检查法评估嗅觉功能的变化;采用视觉模拟评分表(VAS)评估手术前后两组鼻塞、鼻分泌物和涕倒流、头面部胀痛、嗅觉减退、全身不适等主观症状变化;应用Lund-Kennedy评分系统评估患者手术前后客观病情(息肉、水肿、瘢痕、结痂、鼻漏等)的变化;使用鼻腔鼻窦结局测试-20(SNOT-20)量表对手术前后患者生活质量进行评估;并记录手术并发症发生情况,两组均随访1年统计复发率。结果: 观察组疗效分级优于对照组(P<0.05);观察组术后6个月嗅觉功能分级优于对照组(P<0.05);术后6个月,观察组鼻塞、鼻分泌物和涕倒流、头面部胀痛、嗅觉减退、全身不适等VAS积分低于对照组(P<0.05),息肉、水肿、瘢痕、结痂积分均低于对照组(P<0.05),观察组SNOT-20评分低于对照组(P<0.05);观察组鼻腔黏连、眶周青紫、眼内直肌损伤及随访复发率略低于对照组,但差异无统计学意义(P>0.05)。结论: 难治性鼻-鼻窦炎患者采用鼻内镜修正性手术联合中鼻甲切除术治疗疗效确切,可改善嗅觉功能,改善主客观症状,提高患者生活质量,降低复发风险。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈幸榕
	谢允平
	张智斌

关键词 ：鼻窦炎, 鼻内镜, 修正性手术, 中鼻甲切除, 嗅觉

Abstract：Objective: To investigate the effects of revised endoscopic nasal sinus surgery combined with middle turbinectomy in the treatment of patients with refractory rhinosinusitis and the influence on perioperative condition and the prognosis. Methods: A total of 91 patients with refractory rhinosinusitis were admitted to the hospital from January 2019 to January 2022.They were divided into the control group (n=45) and the observation group (n=46) by random number table method.The control group underwent conventional endoscopic open surgery,while the observation group underwent revised endoscopic sinus surgery combined with middle turbinectomy.Surgical effects of the 2 groups were compared.T & T olfactometry was used to assess changes in olfactory function before and after surgery.The Visual Analogue Scale (VAS) was used to assess changes in subjective symptoms such as nasal congestion,nasal secretions,nasal discharge,head and face swelling pain,hyposmia,and general malaise before and after surgery.The Lund-Kennedy scoring system was used to evaluate changes in objective condition (polyps,edema,scars,scabs,rhinorrhea,etc.),and the Sino-Nasal Outcome Test-20 (SNOT-20) was used to evaluate quality of life.The occurrence of surgical complications was recorded,and 1-year recurrence rate was counted. Results: The curative effect classification and olfactory function classification at 6 months after surgery in the observation group were better than those in the control group (P<0.05).Compared with the control group,the observation group had lower VAS scores for nasal congestion,nasal secretions,nasal discharge,head and face swelling pain,hyposmia and general malaise,lower scores for polyps,edema,scars and scabs,and lower SNOT-20 score at 6 months after surgery (all P<0.05).The incidence rates of nasal adhesion,periorbital bruising,intraocular rectus injury and follow-up recurrence rate in the observation group were slightly lower than those in the control group,but the differences were not statistically significant (P>0.05). Conclusion: Revised endoscopic sinus surgery combined with middle turbinectomy is effective in the treatment of patients with refractory rhinosinusitis,which can improve olfactory function,subjective and objective symptoms as well as quality of life,and reduce the risk of recurrence.

Key words： Sinusitis Nasal endoscope Revised surgery Middle turbinectomy Olfactory sensation

基金资助:福建省自然科学基金项目,(编号:2020J01607)

通讯作者: 张智斌

引用本文:

陈幸榕, 谢允平, 张智斌. 鼻内镜修正性手术联合中鼻甲切除治疗难治性鼻-鼻窦炎患者疗效及对围术期指标和预后的影响[J]. 河北医学, 2023, 29(7): 1130-1136.
CHEN Xingrong, XIE Yunping, ZHANG Zhibin. Efficacy of Revised Endoscopic Sinus Surgery Combined with Middle Turbinectomy in the Treatment of Patients with Refractory Rhinosinusitis and the Influence on Perioperative Indicators and the Prognosis. HeBei Med, 2023, 29(7): 1130-1136.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.07.014 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I7/1130

[1] 徐驰宇,谢立锋,朱丽,等.单纯或杂交鼻窦球囊扩张术治疗慢性鼻-鼻窦炎的有效性及安全性[J].中国微创外科杂志,2021,21(4):349-355.
[2] Han JK,Bachert C,Fokkens W,et al.Mepolizumab for chronic rhinosinusitis with nasal polyps (SYNAPSE):a randomised,double-blind,placebo-controlled,phase 3 trial[J].Lancet Respir Med,2021,9(10):1141-1153.
[3] Hopkins C,Wagenmann M,Bachert C,et al.Efficacy of dupilumab in patients with a history of prior sinus surgery for chronic rhinosinusitis with nasal polyps[J].Int Forum Allergy Rhinol,2021,11(7):1087-1101.
[4] Papagiannopoulos P,Brown HJ,Kim YJ,et al.Improved sinonasal symptom and endoscopy sinus scores with dose-escalated intranasal mometasone irrigation in patients with refractory chronic rhinosinusitis[J].Int Forum Allergy Rhinol,2022,12(7):955-957.
[5] 马菲,李斐,李雪娟.鼻内镜Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎伴鼻息肉患者鼻腔功能及炎性应激反应的影响[J].广东医学,2020,41(22):2317-2321.
[6] 中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南(2012年,昆明)[J].中国医刊,2013,48(11):103-105.
[7] 中华耳鼻咽喉头颈外科杂志编委会,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南[J].中国临床医生,2010,38(4):73-74.
[8] Psaltis A J,Li G,Vaezeafshar R,et al.Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures.[J].Laryngoscope,2014,124(10):2216-2223.
[9] 郑建文,何云生,张靖华.轮廓化鼻内镜手术治疗难治性慢性鼻-鼻窦炎的临床疗效分析[J].中国耳鼻咽喉头颈外科,2019,26(6):329-331.
[10] 张昌明,杨润琴,王剑,等.慢性鼻窦炎手术前后嗅觉功能变化的影响因素研究[J].中国中西医结合耳鼻咽喉科杂志,2020,28(3):187-190.
[11] 刘斌,胡国勤,郑文雯,等.2种不同中鼻甲成形术在慢性鼻窦炎鼻内镜术中的应用效果比较[J].安徽医学,2022,43(10):1149-1152.
[12] 杨花荣,陈影影,高英,等.慢性鼻-鼻窦炎伴鼻息肉鼻内镜术后复发调查及危险因素分析[J].陕西医学杂志,2023,52(2):184-187.