轮廓化鼻内镜手术治疗难治性鼻窦炎的价值探讨

Value discussion of radical sinus surgery for difficult-to-treat rhinosinusitis

目的:探讨轮廓化鼻内镜手术(RSS)对伴息肉难治性鼻窦炎(DTRS)的临床疗效。方法:回顾性分析2013-08-2017-06期间就诊于南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科的26例接受RSS术式的DTRS患者临床资料,与同期入院手术但未接受RSS术式的复发型慢性鼻窦炎伴鼻息肉(CRSwNP)患者相比较。同时比较接受RSS术式DTRS患者术前及术后6个月时的内镜Lund-Kennedy评分、整体症状VAS评分和嗅觉障碍VAS评分。结果:RSS组在CT Lund-Mackay评分、内镜Lund-Kennedy评分、整体症状VAS评分和嗅觉障碍VAS评分等方面均要重于非RSS组,也有着更多的既往手术次数和更多的嗅裂区息肉生长比例,伴发哮喘和AR的比例也更高,但伴有脓性涕比例反倒低于非RSS组,外周血嗜酸粒细胞计数两组之间差异无统计学意义。接受RSS术后6个月,患者的内镜Lund-Kennedy评分、整体症状VAS评分和嗅觉障碍VAS评分均得到明显降低,治愈14例(53.8%),有效12例(46.2%),无效0例。结论:RSS术式结合个体化的围手术期药物治疗,能够缓解DTRS患者整体症状和改善嗅觉,是值得推荐的手术方式。

Objective：To investigate the efficacy of radical sinus surgery（RSS）on difficult-to-treat rhinosinusitis（DTRS）with nasal polyps.Method：We retrospectively analyzed the clinical data of 26 patients with DTRS that treated with RSS and patients who were not treated with RSS in our hospital from August 2013 to June 2017.The effect of RSS were evaluated by comparing the CT Lund-Kennery score,endoscope Lund-Kennery score,global VAS score and dysosmia VAS score before operation and 6 months after operation.Result：RSS group had more severe Lund-Kennery score,global VAS score and dysosmia VAS score than non-RSS group,and also had more previous surgeries,higher ratio of olfactory region polyps,and higher ratio of co-existing asthma and allergic rhinitis.However RSS group had a lower ratio with pus anot than non-RSS group.The eosinophil count in periheral blood between two groups had no statistical significance.Six months after RSS,the score of endoscope Lund-Kennery,global VAS and dysosmia VAS dependence.14 patients were successfully cured（53.8%）,12 patients showed improvement（46.2%）,no invalid cases.Conclusion：The global symptoms and olfaction of DTRS patients can be improved by RSS combine individual perioperative drug therapy.