慢性鼻-鼻窦炎伴嗅觉障碍患者鼻内镜手术前后嗅觉变化分析

Analysis of olfactory rehabilitation after endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

目的:对74例慢性鼻-鼻窦炎(CRS)伴嗅觉障碍患者鼻内镜手术前后的嗅觉情况进行动态性观察,分析影响鼻内镜手术后嗅觉恢复的因素。方法:采用T&T嗅觉测试方法,对74例(148侧)慢性鼻-鼻窦炎患者行术前嗅觉测试,同时行鼻窦CT和鼻内镜检查,根据是否伴有变应性鼻炎分成2组进行对照,分别进行LundMackey鼻窦CT评分及Lund-Kennedy鼻内镜评分,并行标准鼻内镜手术及规范围手术期处理,术后不同时期行嗅觉功能测试,分析嗅觉恢复情况与变应性鼻炎、慢性鼻-鼻窦炎病变程度的关系。结果:1患者嗅觉总体水平术后不同时期情况较术前均有明显提高;患者术后12、24周嗅觉测试较术后4周有明显改善;2Lund-Mackey鼻窦CT评分与术后嗅觉恢复的程度有关(P<0.05),术前CT评分越高,术后嗅觉恢复相对较差;3Lund-Kennedy鼻内镜评分的变化与术后嗅觉恢复程度有关(P<0.05),术前评分越高,术后嗅觉恢复相对较差;4变应性鼻炎是CRS伴嗅觉障碍术后嗅觉恢复的因素,伴有变应性鼻炎的患者,术后嗅觉恢复较不伴变应性鼻炎患者差;5病程也是影响CRS伴嗅觉障碍术后嗅觉恢复的因素,病程越长,嗅觉恢复越差;6嗜酸粒细胞计数情况与CRS伴嗅觉障碍术后嗅觉恢复有关,嗜酸粒细胞计数值越高,嗅觉恢复越差。结论:鼻内镜手术对CRS患者的嗅觉障碍有明显改善作用。在手术彻底清除炎性病变、解除嗅裂阻塞的基础上,更应注重对嗅区嗅黏膜的保护;同时,规范化的围手术期处理、对变应性鼻炎的治疗和术后定期随访也十分重要。

Objective：To evaluate the influence of endoscopic sinus surgery on olfactory disorder caused by chronic sinusitis and nasal polyps,by testing the olfactory function of seventy-four patients before and after endoscopic sinus surgery,and evaluate the outcomes of olfactory dysfunction after endoscopic sinus surgery in patients with choinc rhinosinusitis and the related factors.Method：The olfactory function of the seventy-four patients with chronic sinusitis and nasal polyps were tested by the TT olfactory testing method at pre-operation and four weeks,twelve weeks,twenty-four weeks of post-operation.Patients were divided into two groups,according to whether combined with allergic rhinitis.Data were achieved by the scores of endoscopic appearances of Kennedy,and CT staging system of Lund-Mackey.Parallel processing standard endoscopic operation and processing specification during peri operation period.Analysing the degree of olfactory rehabilitation in chronic sinusitis and nasal polyps with allergic rhinitis.Result：1 Compared with the level of olfactory function,significant improvement was found at first month;however,the olfactory function level 4weeks after operations was significantly statistically different with that 12 weeks and 24 weeks after operations;2 Lund-Mackey sinus CT higher score is related to the worse degree of postoperative nasal olfactory rehabilitation（P〈0.05）.3 The higher scores of endoscopic appearances of Kennedy is related to the worse degree of postoperative nasal olfactory rehabilitation（P〈0.05）.4Allergic rhinitis is one of the factors of olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation,the olfactory rehabilitation of patients with allergic rhinitis is worse than that in the patients with no allergic rhinitis.5 Course of disease is one of the factors of chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation.Longer the course of disease,worse the olfactory rehabilitation.6 Eosinophil count was related to olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation.Higher Eosinophil count,worse the olfactory rehabilitation.Conclusion：FESS plays a positive role in the improvement of olfactory impairment in patients with CRS.It is important to protect the olfactory mucous during surgical removal of sinonasal lesions.The standard intraoperative procedure,treatment on allergic rhinitis and regular follow-up after operation are also very important.