中鼻甲不同处理方式对合并哮喘的慢性鼻-鼻窦炎术后疗效的影响

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

目的探讨中鼻甲不同处理方式对合并哮喘的慢性鼻-鼻窦炎患者鼻内镜术后疗效的影响。方法回顾性分析2012年3月～2014年10月收治的44例合并哮喘的慢性鼻-鼻窦炎患者的临床资料。所有患者实施以鼻内镜手术为主的综合治疗,根据对病变中鼻甲采取不同的处理方式,将其分为切除组（23例）和保留组（21例）,于术前和术后1年分别进行VAS评分和Lund-Kennedy评分,评估并比较两组患者的临床治疗效果。结果两组患者术后VAS评分与Lund-Kennedy评分均明显低于术前,差异有统计学意义（P均〈0.01）。术前VAS评分和Lund-Kennedy评分两组间比较,差异均无统计学意义（P均〉0.05）。术后VAS评分和Lund-Kennedy评分两组间比较,差异均有统计学意义（P均〈0.05）。切除组的病情完全控制率、部分控制率、未控制率分别为43.5%（10例）、39.1%（9例）、17.4%（4例）,而保留组的病情完全控制率、部分控制率、未控制率分别为9.5%（2例）、57.2%（12例）、33.3%（7例）,两组患者术后1年的治疗总有效率分别为82.6%、66.7%,差异有统计学意义（P〈0.05）。结论对于合并哮喘的慢性鼻-鼻窦炎患者应采用鼻内镜手术为主的综合治疗,术中切除中鼻甲能取得更好的疗效,值得临床借鉴和推广。

Objective To investigate the postoperative effects of endoscopic middle turbinate resection versus preservation in patients with chronic rhinosinusitis（CRS） accompanying asthma. Methods Retrospectively analyzed the clinical data of 44 patients with CRS and asthma were analyzed From March 2012 to October 2014, All patients experienced endoscopic sinus surgery（ESS）-based multidisciplinary treatments. The patients were divided into the resection group（n=23） and preservation group（n=21） according to intraoperative resection or preservation of the middle turbinate. Investigations were performed before and 1-year after ESS. Evaluation index included the visual analogue scale（VAS） and endoscopy Lund-Kennedy assessment. The clinical effects in two groups were observed 1-year following ESS. Results In both groups, the VAS scores and Lund-Kennedy scores post-operation were less than those of pre-operation, with statistically significant difference（P〈0.01）. Moreover, the VAS and Lund-Kennedy scores presented significant differences（P〈0.05） between two groups postoperavely, although both scores were not statistical significant（P〈0.05） preoperavely. Furthermore, 10 of 23 patients（43.5%） were cured and 9 of 23 patients（39.1%） were improved in the resection group, while 4 of 23 patients（17.4%） were ineffective. By contrast, in the preservation group, only 2 of 21 patients（9.5%） were cured and 12 of 21 patients（57.2%） were improved, with 7 of 21 patients（33.3%） being ineffective. Thus,the effective rates were 82.6% and 66.7% in the resection and preservation groups respectively, which was statistically significant（P〈0.05）. Conclusion The patients with CRS and asthma should be treated with the ESS –based multidisciplinary treatments, and middle turbinate resection can improve the surgical outcomes postoperatively.