慢性鼻-鼻窦炎伴鼻息肉合并哮喘患者中鼻甲切除的疗效

Efficacy of middle turbinectomy in patients with chronic rhinosinusitis with nasal polyps and asthmatic

目的研究在鼻内镜手术中慢性鼻-鼻窦炎伴鼻息肉合并哮喘患者中鼻甲切除的疗效。方法回顾性分析2012年3月-2014年3月于新疆医科大学第二附属医院住院行鼻内镜手术的慢性鼻-鼻窦炎伴鼻息肉合并哮喘的患者46例,通过对不同病变的中鼻甲采取不同的处理方式,将其分为切除组（24例）和保留组（22例）。于术前及术后6个月分别对两组进行鼻内镜检查Lund-Kennedy评分及嗅觉功能评估,通过鼻内镜及嗅觉功能评分进行疗效的客观及症状的主观评估,并对所有评分结果进行统计学分析。结果①术前切除组Lund-Kennedy评分为（5.96±2.55）分,保留组为（5.45±2.89）分,两组比较差异无统计学意义（t=0.63,P=0.56）;切除组术后LundKennedy评分为（2.79±1.14）分,保留组为（4.27±2.14）分,两组比较差异有统计学意义（t=2.96,P=0.02）。②术后两组嗅觉功能均较术前有所改善,切除组中20例（83.3%）患者自觉嗅觉改善,保留组12例（54.5%）患者自觉嗅觉改善,两组比较差异有统计学意义（χ^2=4.49,P=0.03）。切除组术前评分为（2.68±0.78）分,保留组为（2.57±0.86）分,两组比较差异无统计学意义（t=0.43,P=0.60）;切除组术后评分为（1.07±0.39）分,保留组术后评分为（2.09±0.63）分,两组比较差异有统计学意义（t=6.68,P=0.02）。结论对于慢性鼻-鼻窦炎伴鼻息肉合并哮喘的患者,中鼻甲切除患者术后鼻内镜及嗅觉评分均明显降低,对此类患者主张行鼻内镜下手术切除中鼻甲,并为临床提供一定的理论实践依据。

Objective To investigate the efficacy of middle turbinectomy in patients with chronic rhinosinusitis with nasal polyps and asthma during endoscopic sinus surgery. Methods 46 cases of patients with chronic rhinosinusitis with nasal polyps and asthma for endoscopic sinus surgery admitted to the Second Affiliated Hospital of Xinjiang Medical University from March 2012 to March 2014 were retrospectively analyzed. Based on the different approaches to middle turbinate with different pathological changes, they were divided into resection group（24 cases） and reservation group（22 cases）. An objective assessment of their efficacy was performed using Lund-Kennedy scores by endoscopic examination, while a subjective assessment of symptoms was performed using olfactory function scores before and 6 months after the surgery. All scores were statistically analyzed. Results ①The Lund-Kennedy scores by endoscopic examination of the resection group before surgery was（5.96±2.55） scores, and that of the reservation group was（5.45±2.89） scores, with no statistically significant difference between two groups（t=0.63, P=0.56）. The scores of the resection group after surgery was（2.79±1.14） scores, and that of the reservation group was（4.27±2.14） scores, with statistically significant difference between two groups（t =2.96, P =0.02）. ② According to the assessment of olfactory function, both groups were improved compared with that before surgery. Perception of improvement was found in 20cases（83.3%） in the resection group and 12 cases（54.5%） in the reservation group, the difference was statistically significant（χ^2=4.49, P=0.03）. The scores of the resection group before surgery was（2.68±0.78） scores, and that of the reservation group was（2.57±0.86） scores, with no statistically significant difference between two groups（t=0.43, P=0.60）. The scores of the resection group after surgery was（1.07±0.39） scores, and that of the reservation group was（2.09±0.63） scores, with statistically significant difference between two groups（t=6.68, P=0.02）. Conclusion For patients with chronic rhinosinusitis with nasal polyps and asthma,both of the endoscopic and olfactory scores in patients of the middle turbinectomy group are significantly reduced. It is recommended to perform surgical resection of the middle turbinate under nasal endoscope for these patients, thus providing a theoretical basis for clinical practice.