不保留中上鼻甲的内镜鼻窦手术对慢性鼻-鼻窦炎伴鼻息肉患者生存质量及嗅觉功能的影响

The impacts of endoscopic sinus surgery with middle turbinate and superior turbinate resection on quality of life and olfactory function in patients with chronic rhinosinusitis with nasal polyps

目的:探讨不保留中、上鼻甲的内镜鼻窦手术对伴有嗅觉功能障碍的慢性全组鼻-鼻窦炎伴鼻息肉患者的生存质量以及嗅觉功能的影响。方法:81例伴嗅觉功能障碍的慢性全组鼻-鼻窦炎伴鼻息肉患者,均在全身麻醉下施行不保留中、上鼻甲的内镜鼻窦手术,围手术期给予鼻腔冲洗、局部激素喷鼻、口服黏液促排剂、酌情应用大环内酯类药物等规范化药物治疗。使用鼻腔鼻窦结局测试20(SNOT-20)中文版量表评估患者术前、术后的生存质量;使用T&T嗅觉功能检测法及视觉模拟量表(VAS)评估患者的嗅觉功能。结果:通过SNOT-20量表评估,术前必须擤鼻涕、缺乏高质量睡眠、流黏稠鼻涕、难以进入睡眠、尴尬5个条目对患者生存质量的影响较为突出,术后第2周、术后1个月及术后3个月各项评分均较术前呈下降趋势(P<0.05)。嗅觉情况:术前81例(162侧)患者中54例(108侧)嗅觉完全丧失,27例不同程度嗅觉减退(10例为双侧对称性嗅觉减退,17例为双侧不对称性嗅觉减退)。术后3个月嗅觉功能较术前改善者70例(86.4%),其中双侧嗅觉功能完全恢复者43例(53.1%),未完全恢复但有不同程度改善者27例(33.3%);嗅觉功能无改善者11例(13.6%)。术后随访1年以上者61例,术后1年嗅觉功能较术前改善者53例(86.9%),其中双侧嗅觉功能完全恢复者31例(50.8%),未完全恢复但有不同程度改善者22例(36.1%);嗅觉功能无改善者8例(13.1%);余20例正在随访中。T&T嗅觉功能检测法术前与术后3个月比较差异有统计学意义(P<0.05);VAS评分术前与术后3个月比较差异亦有统计学意义(P<0.05)。结论:对于伴有嗅觉功能障碍的双侧慢性全组鼻-鼻窦炎伴鼻息肉患者,采用不保留中、上鼻甲的内镜鼻窦手术、结合围手术期规范的药物治疗,可以有效改善患者的生存质量和嗅觉功能。未发现因切除组织较多导致的过度通气及鼻干等症状。

Objective：The aim of this study is to investigate the impacts of endoscopic sinus surgery（ESS）with middle turbinate and superior turbinate resection on quality of life and olfactory function in patients with chronic rhinosinusitis with nasal polyps（CRSwNP） and with dysosmia.Method：All of the 81 patients with CRSwNP and with dysosmia recieved ESS with middle turbinate and superior turbinate resection.The patients were given standardized drug treatments during the preoperative period,such as nasal irrigation,using local hormone spray,mucus decorporation agent by oral,using macrolide antibiotics according to the circumstances and so on.We used SNOT-20 to evaluate the quality of life preoperatively and postoperatively in patients;and used the TT olfactory testing and VAS to evaluate the olfactory function of the patients.Result：The SNOT-20 test showed that＂ need to blow nose＂,＂ lack of a good sleep＂,＂ thick nasal discharge＂,＂ difficult to go to sleep＂,and＂ awkward＇ influence on the quality of life severely.The scores of all items showed decreasing tread in 2 weeks,1 month and 3 months after operation（P0.05）.Olfactory：Among the 81 patients（162 side）,54 patients（108 sides） lost sense of smell completely in preoperative period and 27 patients＇ olfaction lost in varying degrees（10 patients are bilateral symmetry hyposmia and 17 patients are bilateral asymmetry hyposmia）.Compared with the preoperative period,70 patients＇（86.4%） olfactory function were improved at 3 months after the operation,in which 43 patients＇（53.1%） olfactory function recovered to normal,and 27 patients＇（33.3%） olfactory function improved in varying degrees;however,11patients＇（13.6%） olfactory function had not improvement at all.Sixty-one patients were followed up for more than one year.One year after operation,53 patients＇（86.9%） olfactory function were improved,in which the 31 patients＇（50.8%）olfactory function recovered to normal and 22 patients＇（36.l%）olfactory function improved in varying degrees;8 patients＇（13.1%） olfactory function had no improvement;the remaining 20 patients are being followed up.There was a significant difference between preoperative TT olfactory testing and postoperative＇s（P0.05）;and so was VAS assessment（P0.05）.Conclusion;For the patients with CRSwNP and with dysosmia,the operation of ESS with middle turbinate and superior turbinate resection combined with standardized drug treatment in preoperative period can effectively improve the patients＇ quality of life and olfactory function.Hyperventilation and nasal dryness caused by excessive resection were not found.