鼻内镜辅助切割吸引刀手术在腺样体肥大中应用的对照研究

A Controlled Study of Nasal Endoscopy-Assisted Excisional Suction Knife Surgery in Adenoid Hypertrophy

目的:探讨从鼻阻力、鼻声反射、嗅觉功能及创伤反应指标等层面综合分析鼻内镜辅助切割吸引刀手术治疗腺样体肥大患者的效果。方法:选取2019年2月至2021年2月我院腺样体肥大患者106例,依据治疗术式不同分为鼻内镜组(n=54)、传统组(n=52)。鼻内镜组采取鼻内镜辅助切割吸引刀手术,传统组采取腺样体刮勺盲刮。比较两组疗效、并发症以及术前、术后12h、24h创伤反应指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、细胞间黏附因子-1(ICAM-1)]、术前、术后1周鼻阻力、鼻声反射[鼻腔容积(NCV)、鼻腔最小横截面积(NMCA)、最小横截面距前鼻孔距离(DCAN)]、术前、术后6个月嗅觉功能[气味鉴别(OI)、气味辨别(OD)、气味阈值(OT)、总分(TDI)]。结果:经治疗,鼻内镜组总有效率96.30%显著高于传统组80.77%(P<0.05);两组术后12h、24h血清TNF-α、CRP、ICAM-1水平均较本组术前提高,但鼻内镜组较传统组低(P<0.05);与术前相比,两组术后1周收缩前、收缩后鼻阻力、DCAN水平均降低,NCV、NMCA水平均提高,且鼻内镜组优于传统组(P<0.05);与术前相比,两组术后6个月OI、OD、OT、TDI评分均提高,且鼻内镜组高于传统组(P<0.05);鼻内镜组术后并发症发生率6.25%较传统组29.03%低(P<0.05)。结论:应用鼻内镜辅助切割吸引刀手术治疗腺样体肥大患者可改善鼻阻力及鼻声反射,提升嗅觉功能,减轻手术创伤,减少并发症,有效提高疗效,安全可靠。

Objective:To investigate the effectiveness of nasal endoscopy-assisted excisional suction knife surgery in the treatment of adenoid hypertrophy in patients with nasal resistance,nasal acoustic reflex,olfactory function and trauma response indicators.Methods:From February 2019 to February 2021,106 patients with adenoid hypertrophy in our hospital were selected and divided into nasal endoscopic group(n=54)and traditional group(n=52)according to the different treatment procedures.In the nasal endoscopy group,nasal endoscopy-assisted cutting suction knife surgery was performed,and in the traditional group,blind scraping of the adenoids was performed with an adenoid scraper.Comparison was made on the efficacy,complications and trauma response indicators[tumour necrosis factor-α(TNF-α),C-reactive protein(CRP),intercellular adhesion factor-1(ICAM-1)],nasal resistance,nasal acoustic reflexes[nasal cavity volume(NCV),nasal minimum cross-sectional area(NMCA),minimum cross-sectional distance from the anterior nostril(DCAN)],olfactory function[odour identification(OI),odour discrimination(OD),odour threshold(OT),total score(TDI)]before,at 12h and 24h after surgery,and at 6 months after surgery between the two groups.Results:After treatment,the total effective rate of 96.30%in the nasal endoscopy group was significantly higher than that of 80.77%in the traditional group(P<0.05);the serum TNF-α,CRP and ICAM-1 levels at 12h and 24h after surgery in both groups were higher than those before surgery,but lower in the nasal endoscopy group than in the traditional group(P<0.05);compared with the preoperative period,the pre-systolic and post-systolic nasal resistance and DCAN levels at 1 week after surgery in both groups were lower and NCV and NMCA levels were higher in both groups,and the nasal endoscopy group was better than the traditional group(P<0.05);compared with the preoperative period,OI,OD,OT and TDI scores were higher in both groups at 6 months postoperatively,and the scores in the nasal endoscopy group were higher than those in the traditional group(P<0.05);the postoperative complication rate was lower in the nasal endoscopy group at 6.25%compared with the traditional group at 29.03%(P<0.05).Conclusion:The use of nasal endoscopy-assisted excisional suction knife surgery to treat patients with adenoid hypertrophy can improve nasal resistance and nasal acoustic reflexes,enhance olfactory function,reduce surgical trauma,reduce complications,effectively improve the efficacy,and be safe and reliable.