轮廓化鼻窦内镜技术对鼻息肉复发的影响

The influence of contoured sinus endoscopy on the recurrence of nasal polyps

目的:研究内镜手术质量对鼻息肉术后复发的影响。方法:收集2016年12月-2018年6月收治的复发性鼻息肉患者32例(64侧),均为Ⅱ型3期,双侧弥漫性鼻息肉,依据术后病理结果分为嗜酸粒细胞(EOS)组和非嗜酸粒细胞(NEOS)组。所有患者行鼻窦CT扫描并三维重建,结合鼻窦CT影像表现以及术中所见,对患者既往所经历的鼻内镜手术质量进行分析,并比较两组患者再次手术前后的鼻窦CT L-M评分、鼻内镜L-K评分、鼻部症状VAS评分和生活质量Snot-20评分。结果:32例复发性鼻息肉患者中,术后病理证实EOS鼻息肉17例(53.1%),NEOS鼻息肉15例(46.9%)。经历既往手术后患者仍有筛房或筛房间隔残留60侧(93.8%),骨质增生56侧(87.5%),额隐窝气房或气房骨骼残留50侧(78.1%),鼻腔黏连10侧(15.6%),残余钩突8侧(12.5%),上颌窦口处理不当或闭锁6侧(9.4%),蝶窦未开放或闭锁8侧(12.5%),鼻中隔偏曲未处理4例(12.5%),前次手术操作规范无筛房及骨间隔残留仍复发1例(3.1%)。EOS组和NEOS组患者再次手术后随访1.5~3年,L-M评分、L-K评分、VAS评分、Snot-20评分均较术前显著改善;息肉完全控制25例,部分控制7例,其中2例EOS鼻息肉伴哮喘患者术后1年局部黏膜仍有较多息肉样变,目前用药治疗控制中。结论:虽然鼻息肉复发与其内在型密切相关,但内镜手术的技术也是影响鼻息肉复发的重要因素,对于双侧对称弥漫性鼻息肉患者,高质量的首次鼻窦内镜手术结合术后规范随访用药可降低鼻息肉的复发率,延长复发时间。

Objective:The aim of this stusy is to study the effect of endoscopic surgery quality on the recurrence of nasal polyps.Methods:A total of 32 patients(64 sides)with recurrent nasal polyps were collected from December 2016 to June 2018,all of which were bilateral typeⅡdiffuse nasal polyps in stage 3.According to the post-operative pathological results,patients were divided into eosinophilic nasal polyps group(EOS)and non-eosinophilic nasal polyps group(NEOS).All patients underwent sinus CT scan and three-dimensional reconstruction,combined with the sinus CT image performance and intraoperative findings,the quality of the patients’previous endoscopic sinus surgery was analyzed,and the CT L-M scores of sinuses before and after reoperation were compared between the two groups.Endoscopic L-K score,nasal symptoms VAS score,quality of life Snot-20 score.Results:Among 32 patients with recurrent nasal polyps,17 cases(53.1%)of EOS nasal polyps were confirmed pathologically after surgery,and 15 cases(46.9%)of NEOS nasal polyps were confirmed.After the previous operation,the patient still has 60 sides(93.8%)of ethmoidal cells or ethmoidal septum,56 sides(87.5%)of bone hyperplasia,50 sides(78.1%)of bones in frontal recess air-cell or bone air-cell,and nasal cavity adhesion there were 10 sides(15.6%),residual uncinate process 8(12.5%),improper treatment of maxillary sinus ostia or atresia were 6(9.4%),sphenoid sinus not open or atresia were 8(12.5%),nasal septal deviation untreated were 4 cases(12.5%),1 case(3.1%)had recurrence without ethmoidal cells and residual bone interval.Patients both in the EOS group or the NEOS group were followed up with L-M score,L-K score,VAS score,and Snot-20 score after surgery,the result were significantly improved compared with the preoperative results.After follow-up of 1.5-3 years,25 cases of polyps were completely controlled and 7 cases were partially controlled.Among them,2 cases of EOS nasal polyps and asthma patients still had some polypoid changes in local mucosa one year after operation and was currently under medication control.Conclusion:Although the recurrence of nasal polyps is closely related to its intrinsic type,the technique of endoscopic surgery is also an important factor affecting the recurrence of nasal polyps.For patients with bilateral symmetric diffuse nasal polyps,high-quality sinus surgery of first time combined with standardized follow-up can reduce the recurrence rate of nasal polyps and prolong the relapse time.