布地奈德联合鼻内镜手术治疗难治性鼻窦炎的疗效及对黏膜组织重塑的影响

Efficacy of Budesonide Combined with Nasal Endoscopic Surgery in the Treatment of Refractory Rhinosinusitis and the Effect on Mucosal Tissue Remodeling

【目的】研究布地奈德联合鼻内镜手术治疗难治性鼻-鼻窦炎（RRS）的疗效及对黏膜组织重塑的影响。【方法】选择2013年11月至2016年11月于本院接受治疗的68例RRS患者，随机分为对照组及观察组各34例。对照组行修正性鼻内镜手术治疗，观察组加用布地奈德治疗，比较两组疗效及对黏膜组织重塑的影响。【结果】观察组手术时间、术中出血量、术野出血评分均显著少于对照组（P〈0．05）；观察组治疗总有效率为94．12％，显著高于对照组的76．47％（P〈0．05）；治疗后两组鼻塞、流涕、嗅觉损伤、头面疼痛视觉模拟疼痛（VAS）评分显著降低（P〈0．05），Lund—Kennedy评分显著降低（P〈0．05），鼻腔黏膜损伤得到明显改善（P〈0．05），TGF-β1阳性率和胶原Ⅲ阳性基底膜厚度〉20μm构成比显著降低（P〈0．05），且观察组改善幅度大于对照组（P〈0．05）；术后6个月，观察组并发症总发生率11．76％，复发率5．88％，显著低于对照组的26．47％和23．53％（P〈0．05）。【结论】布地奈德联合鼻内镜手术治疗难治性鼻窦炎，可明显缩短手术时间，减少出血量，抑制鼻腔黏膜重塑，降低术后并发症和复发风险，改善预后。

[Objective]To study the efficacy of budesonide combined with nasal endoscopic surgery in the treatment of refractory rhinosinusitis （RRS） and the effect on mucosal tissue remodeling. [Methods] Sixty-eight patients with RRS treated in our hospital during November 2013 - November 2016 were randomly divided into the control group and the observation group, 34 cases in each group. The control group was treated by corrective nasal endoscopic surgery while the observation group was additionally treated with budesonide. The efficacy and effect on mucosal tissue remodeling were compared between the two groups. [Results] The operation time, intraoperative blood loss and operative field bleeding score of the observation group were significantly shorter, less and lower than those of the control group （ P 〈 0.05）. The total effective rate in the observation group was significantly higher than that in control group （94.12% vs 76.47%） （ P 〈0.05）. After treatment, the scores of nasal obstruction, runny nose, olfactory injury, head pain and visual simulated pain were significantly decreased in the two groups （ P 〈0.05）. Lund-Kennedy score decreased significantly （ P 〈0.05）. Nasal mucosal injury was significantly improved （ P 〈0.05）. The positive ratio of TGF- β1 and the proportion of collagen Ⅲ positive basement membrane thickness〉20μm were significantly reduced （ P 〈0.05 ）, and the improvement amplitude of the observation group was greater than that of the control group （ P 〈0.05 ） ; 6 months after operation, the total incidence of complications in the observation group was 11.76% and the recurrence rate was 5.88%, which was significantly lower than that in the control group （26.47% and 23.53%, P 〈0.05）.[Conclusion] Application of budesonide in corrective nasal endoscopic surgery for RRS can significantly shorten the operation time, reduce blood loss, inhibit the nasal mucosa remodeling, decrease postoperative complications and recurrence, and improve the prognosis.