鼻内窥镜鼻窦开放手术中切除与保留中鼻甲对手术效果的影响

Effect of Removal and Preservation of Middle Turbinate During Open Sinus SurgeryUnder Nasal Endoscopic Sinus Surgery

目的观察鼻内窥镜鼻窦开放手术中鼻甲不同的处理方式对手术效果的影响。方法选取2018年1~12月在乐山市人民医院诊断为慢性鼻-鼻窦炎的165例(232侧)患者,采用随机数字表法分为保留中鼻甲组82例和切除中鼻甲组83例,术后随访6个月以上,采用Lund-Kennedy鼻内镜评分法,视觉模拟量表(VAS)评分和鼻腔鼻窦结局测试-20中文版(SNOT-20CV)比较两组的疗效。结果保留中鼻甲组手术治疗总有效率86.58%,切除中鼻甲组手术治疗总有效率83.13%,两组疗效比较,差异无统计学意义(P>0.05),两组术后VAS评分、SNOT-20CV评分比较,差异无统计学意义(P>0.05)。结论鼻内窥镜鼻窦开放手术中切除与保留中鼻甲两种不同术式对患者的治疗效果的影响无明显差异,提示切除大部分中鼻甲并不会降低手术疗效及患者主观症状,临床工作中应该根据患者的具体情况对中鼻甲进行处理,尽可能切除中鼻甲的病变组织,解除中鼻道阻塞因素,提高手术效果。

Objective To observe the effect of different treatments of the turbinate in the open sinus surgery under nasal endoscopic sinus surgery.Methods 165 patients(232 sides)diagnosed with chronic rhinosinusitis in Leshan People's Hospital from January to December 2018 were selected and divided into 82 cases in the middle turbinate retention group and 83 cases in the middle turbinate removal group by random number table method.Follow-up for more than 6 months after operation,Lund-Kennedy nasal endoscopy score,visual analog scale(VAS)score and nasal cavity and sinus outcome test-20 Chinese version(SNOT-20CV)were used to compare the efficacy of the two groups.Results The total effective rate of surgical treatment in the middle turbinate-preserving group was 86.58%,and the total effective rate of surgical treatment in the middle turbinate-removing group was 83.13%,there was no significant difference in curative effect between the two groups(P>0.05).The postoperative VAS score and SNOT-20CV of the two groups the score comparison showed no statistically significant difference(P>0.05).Conclusion There was no significant difference in the effect of the two different surgical methods of removal and preservation of the middle turbinate during open sinus surgery under nasal endoscopic sinus surgery.It suggested that removing most of the middle turbinate would not reduce the surgical efficacy and subjective symptoms of patients.The middle turbinate should be treated according to the specific conditions of the patient,and the diseased tissue of the middle turbinate should be removed as much as possible to remove the obstructive factors of the middle nasal passage and improve the surgical effect.