上鼻道开放在慢性鼻-鼻窦炎伴鼻息肉患者术后嗅觉改善中的作用

Effect of superior meatus approach on the improvement of olfactory function after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps

目的探讨鼻内镜手术对有嗅觉障碍的慢性鼻-鼻窦炎伴鼻息肉患者的治疗效果及上鼻道开放术在嗅觉改善中所起的作用。方法对2012年3月～2013年5月收治的有嗅觉减退的慢性鼻-鼻窦炎伴鼻息肉病例（41例,其中79侧有嗅觉障碍）进行回顾性研究。住院前均在门诊给予保守治疗2个月,症状无明显改善而住院手术。术后2、4、8、12周及6个月进行鼻内镜复查及视觉模拟评分,并用SPSS18.0统计软件进行统计学分析,术后6个月复查嗅觉功能。结果 41例（79侧）嗅觉障碍患者通过6个月的回访,嗅觉恢复正常51侧（64.6%）、好转17侧（21.5%）,总有效率为86.1%;无效9侧（11.4%）、加重2侧（2.5%）。结论鼻内镜手术是改善甚至恢复有嗅觉障碍的慢性鼻-鼻窦炎伴鼻息肉患者嗅觉的有效手段。上鼻道开放术改善了鼻腔通气引流,使空气更容易接触嗅区,并防止了手术中遗漏病变清除不彻底,对于嗅觉的改善起到重要的作用。

Objective To discuss the effect of superior meatus approach in the endoscopic sinus surgery on olfactory dysfunction in patients of chronic rhinosinusitis combined with nasal polyps. Methods Superior meatus approach for ethmoidectomy was performed in 41 patients（ 79 sides with dysosmia） of chronic rhinosinusitis combmed with nasal polyps from March 2012 to May 2013. All patients were treated with maximal medical therapy for at least two months before surgery but failed. The endoscopic examination and visual analog scale for the olfactory function was done2,4,8,12 weeks and 6 months after the operation respectively. Statistical analysis was performed by using SPSS18. 0software. Results Forty-one patients（ 79 sides） with olfactory dysfunction were followed up for 6 months,in which 51sides（ 64. 6%） got to normal,17 sides（ 21. 5%） got improved,with the total effective rate being 86. 1%,9 sides got invalid and 2 sides（ 2. 5%） got worse. Conclusions Proper endoscopic sinus surgery is an effective way to recover the olfactory function for the patients suffering from olfactory dysfunction combined with chronic rhino sinusitis and nasal polyps. Effective opening of superior meatus could increase the effective ventilation of olfactory area and remove the polyps in the superior meatus,ethmoid maxillary sinus and sphenoethmoidal recess and is a better way to prevent the recurrence of the nasal polyps.