慢性肥厚性鼻炎鼻内镜下不同术式临床疗效观察及术后相关因素分析

The clinical efficacy of nasal endoscope surgery for patients with chronic hypertrophic rhinitis and the related factors for the postoperative olfactory recovery

目的探讨鼻内镜手术治疗慢性肥厚性鼻炎临床疗效观察及影响术后嗅觉恢复相关因素。方法回顾性分析268例慢性肥厚性鼻炎患者的临床资料及手术效果,根据鼻内镜下手术方式不同分为A组(低温等离子射频消融术)75例,B组(改良下鼻甲成形术)78例,C组(下鼻甲黏膜下微波治疗术)70例,D组(行下鼻甲部分切除术)45例,观察其临床疗效及术后影响嗅觉恢复的相关因素。结果 A组总的有效率为97.06%,明显高于B组(82.80%)(P<0.05)。A组并发症发生率为3.9%,明显优于B和D组(P<0.05)。A组的手术时间、术中出血量、恢复通气时间、黏膜恢复时间及VAS评分均明显高于B和D组(P<0.05);A组手术时间、恢复通气时间、黏膜恢复时间及VAS评分明显高于C组(P<0.05),但术中出血量与C组差异无显著性(P>0.05)。多因素logistic回归分析结果显示过敏因素是影响嗅觉恢复的独立危险因素。结论慢性肥厚性鼻炎手术方式众多,鼻内镜下低温等离子射频消融术效果优于其余3种治疗方法,具有有效率高、并发症少及术后恢复快等优点,可以作为目前相对有效和安全的治疗方法。

[ Objective ] To explore the clinical efficacy of endoscopic sinus surgery for patients with chronic hy- pertrophic rhinitis, and analyze the related factors for the postoperative olfactory recovery. [ Methods ] 268 patients with chronic hypertrophic rhinitis were divided into A group （ radiofrequeney ablation group） of 75 patients and B group （improved inferior tnrbinate plasty group） of 93 patients, C group（inferior turbinate mucosa micro wave therapy） of 70 patients, D group （partial inferior turbineetomy） of 45 patients, the clinical efficacy and the related factors for the postoperative olfactory recovery were analyzed. [ Results ] The total effective rate of A group was 97.06%, which was significantly higher than B, C, D group（P =〈0.05）. The complication rate of A group was 3.9%, which was significantly lower than B, C, D group（P 〈0.05）. The blood loss, operative time, mucosal recovery time, ventilation recovery time and postoperative ventilation VAS scores of A group were significantly better than B, D group （P 〈0.05）, The operative time, mucosal recovery time, ventilation recovery time of A group were significantly better than C group, but the the blood loss showed no significant differences. Multivariate logistic regression analysis showed that allergic factor was an independent risk factor affectting the olfactory recovery. [ Conclusion ] There are many surgical procedures for chronic hypertrophic rhinitis, nasal endoscope surgery for patients with chronic hypertrophic rhinitis is simply operated, it could significantly reduced the volume with minimal damage to the nasal turbinate and it can effectively improve the nasal ventilation recovery and olfactory recovery. It is relatively safe and effective method to treat chronic hypertrophic rhinitis.