鼻内镜下中鼻甲不同术式对慢性鼻-鼻窦炎合并鼻息肉患者的影响分析

Analysis of postoperative effect of endoscopic middle turbinate resection versus preservation on patients with chronic rhinosinusitis accompanying nasal polyps

目的分析鼻内镜下中鼻甲不同术式对慢性鼻-鼻窦炎合并鼻息肉患者的影响。方法选取2012年3月~2014年4月在我院择期鼻内镜下行鼻窦手术的慢性鼻-鼻窦炎合并鼻息肉患者60例（94侧）,根据术中对中鼻甲处理情况分为保留组和切除组,保留组38例（56侧）行中鼻甲成形术,切除组22例（38侧）行中鼻甲切除术。利用Lund-Kennedy评分法对鼻内镜检查结果进行量化,采用视觉模拟量表（VAS）对鼻塞、脓涕等主观症状进行评价。结果术后12个月复查,保留组35例（51侧）患者中鼻甲颜色和形态恢复较好,32例患者嗅觉出现不同程度恢复;切除组18例（28侧）患者原中鼻甲的位置鼻中隔出现增厚,并出现中隔鼻甲,仅12例患者嗅觉出现不同程度恢复。术后两组患者Lund-Kennedy评分均较术前降低（P〈0.05）,保留组患者Lund-Kennedy评分低于切除组（P〈0.05）;术后两组患者鼻塞和流浓涕症状VAS评分分布均好于治疗前（P〈0.05）,保留组患者流浓涕症状轻度和中度比例显著高于切除组（P〈0.05）。结论鼻内镜下行中鼻甲成形术有助于术后鼻腔正常功能恢复,提高临床治疗效果,减少并发症的发生,改善鼻塞、流脓涕等主观症状,建议术中予以保留中鼻甲。

Objective To investigate the postoperative effect of endoscopic middle turbinate resection versus preservation in patients with chronic rhinosinusitis（ CRS） accompanying nasal polyps.Methods 60 cases（ 94 sides） with CRS accompanying nasal polyps undergoing endoscopic sinus surgery in our department from March 2012 to April 2014 were included.They were divided into preservation group and resection group according to the preservation and resection middle turbinate.38 cases（ 56 sides） in the preservation group received middle conchoplasty while the middle turbinates were resected in 22 cases（ 38 sides） in the resection group.The results of endoscopic examination were scored with LundKennedy method.Visual analog scale（ VAS） was used for evaluating the nasal obstruction,purulent nasal discharge and other subjective symptoms.Results In the preservation group,color and morphology of the middle turbinate got recovered in 35 cases（ 91.1%） and olfaction was improved to different degrees in 32（ 84.2%）.In the control group,septal turbinate due to hyperplasia occurred in 18 cases（ 73.7%）,olfactory function improvement was achieved in only 12（ 54.5%）.The postoperative Lund-Kennedy scores of both groups were lower than the preoperative ones（ both P〈0.05）.The postoperative Lund-Kennedy score of the preservation group was lower than that of the resection group（ P〈0.05）.The VAS scores of postoperative nasal congestion and nasal discharge in both groups were better than the preoperative ones（ P〈0.05）.The ratio of patients with mild to moderate nasal discharge in the preservation group was significantly higher than that of the resection group（ P〈0.05）.Conclusion Nasal endoscopic middle conchoplasty can facilitate postoperative recovery of nasal function,improve therapeutic effect,reduce incidence of complications and relieve nasal obstruction,purulent nasal discharge and other subjective symptoms.It is therefore recommended that middle turbinate should be reserved during operation in patients with CRS accompanying nasal polyps.