鼻内镜Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎伴鼻息肉患者鼻腔功能及炎性应激反应的影响

Effect of nasal endoscopic Messerklinger′s turbinoplasty on nasal function and inflammatory stress in patients with chronic rhinosinusitis and nasal polyps

目的探究鼻内镜Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者鼻腔功能及炎性应激反应的影响。方法选取CRSwNP患者117例作为研究对象,按照随机数字表法分为观察组(59例)、对照组(58例)。观察组采取鼻内镜Messerklinger中鼻甲成形术,对照组采取鼻内镜中鼻甲部分切除术。比较两组临床疗效、手术前后症状改善情况、鼻腔功能[鼻腔容积(NCV)、鼻腔最小横截面积(NMCA)、鼻腔最小横截面至前鼻孔距离(DCAN)、气道阻力]、嗅觉功能、鼻黏膜形态、炎性应激反应[鼻黏膜白细胞介素-5(IL-5)、人软骨糖蛋白-39(YKL-40)、转化生长因子-β1(TGF-β1)]水平。并随访6个月,统计对比两组复发率。结果观察组总有效率94.92%(56/59)高于对照组79.31%(46/58)(P<0.05);术后3个月,观察组流脓涕、鼻塞、咳嗽、头晕评分低于对照组(P<0.05);观察组术后3个月NCV、NMCA高于对照组,DCAN、气道阻力低于对照组(P<0.05);术后3个月,观察组嗅觉功能、Lund-Kennedy评分低于对照组(P<0.05);观察组术后3个月鼻黏膜IL-5、YKL-40、TGF-β1低于对照组(P<0.05);随访6个月,观察组脱落3例,对照组脱落2例。观察组复发率7.14%(4/56)与对照组4.35%(2/46)相比,差异无统计学意义(P>0.05)。结论鼻内镜Messerklinger中鼻甲成形术治疗CRSwNP患者疗效显著,可明显减轻临床症状,改善鼻腔功能、嗅觉功能及鼻黏膜形态,还可降低鼻黏膜炎性应激反应程度,且不增加复发风险。

Objective To investigate the effects of nasal endoscopic Messerklinger turbinate angioplasty on nasal function and inflammatory stress response in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods A total of 117 patients with CRSwNP were selected and divided into observation group(59 cases)and control group(58 cases)according to the random number table method.The observation group received nasal endoscopic Messerklinger turbinate angioplasty,and the control group received nasal endoscopic turbinate excision.The clinical efficacy,improvement of symptoms before and after surgery,nasal function[nasal cavity volume(NCV),nasal cavity minimum cross-sectional area(NMCA),nasal cavity cross-section to anterior nostril(DCAN),airway resistance],olfactory function,nasal morphology,and inflammatory stress response[nasal mucosal interleukin-5(IL-5),human cartilage glycoprotein-39(YKL-40),transforming growth factor-β1(TGF-β1)].Were compared between the two groups.Results The total effective rate in the observation group was 94.92%(56/59),significantly higher than the control group(79.31%,46/58)(P<0.05).Three months after operation,the scores of purulent snot,nasal congestion,cough and dizziness in the observation group were significantly lower than those in the control group(P<0.05).The NCV and NMCA of the observation group 3 months after operation were significantly higher than those of the control group,and the DCAN and airway resistance were significantly lower than those of the control group(P<0.05).Three months after operation,the olfactory function and Lund-Kennedy score of the observation group were significantly lower than those of the control group(P<0.05).The nasal mucosa IL-5,YKL-40,and TGF-β1 were significantly lower in the observation group 3 months after operation(P<0.05).During a follow-up of 6 months,3 cases of shedding in the observation group and 2 cases of shedding in the control group were reported,with no significant difference between the 2 groups(P>0.05).Conclusion Nasal endoscopic Messerklinger′s turbinate angioplasty is effective in treating patients with CRSwNP,which can significantly reduce clinical symptoms,improve nasal function,olfactory function and nasal mucosa morphology.It can also reduce the inflammatory response of nasal mucosa without increasing the risk of recurrence.