改良鼻丘径路额窦鼻内镜修正手术在难治性鼻-鼻窦炎治疗中的应用

Application of modified Nasal-thalamic Approach to frontal Sinus endoscopic Revision Surgery in the Treatment of refractory Rhinosinusitis

目的探讨难治性鼻—鼻窦炎患者采用改良鼻丘径路额窦鼻内镜修正术治疗的临床效果。方法对濮阳市油田总医院2019年1月至2021年6月收治的难治性鼻—鼻窦炎患者展开研究,选取212例拟行手术治疗的患者为研究对象,采用随机排列法将其中106例采用鼻窦开放手术治疗的患者纳入参照组,其余106例采用改良鼻丘径路额窦鼻内镜修正术治疗的患者纳入试验组,比较两组手术前和手术后3个月嗅觉功能、鼻黏膜纤毛运动速率,观察患者临床疗效和并发症情况;统计两组患者术后12个月内的复发情况;采用鼻腔鼻窦结局测试-20(SNOT-20)量表评价患者手术前后的生活质量。结果两组手术前嗅觉功能比较,差异无统计学意义(P>0.05);试验组手术后嗅觉功能优于参照组,差异有统计学意义(P<0.05)。两组手术前鼻黏膜纤毛运动速度比较,差异无统计学意义(P>0.05);试验组术后1个月和3个月鼻黏膜纤毛运动速率均快于参照组,差异有统计学意义(P<0.05)。试验组有效率(90.57%)高于参照组(76.42%),差异有统计学意义(P<0.05)。试验组治疗有效患者术后1年复发率1.04%低于参照组13.58%,差异有统计学意义(P<0.05)。试验组并发症发生率(1.89%)低于(11.32%),差异有统计学意义(P<0.05)。两组手术前鼻腔鼻窦结局测试-20(SNOT-20)量表两项评分比较,差异无统计学意义(P>0.05);手术后,两组SNOT-20量表两项评分均低于本组手术前,差异有统计学意义(P<0.05),且试验组手术后评分低于参照组,差异有统计学意义(P<0.05)。结论难治性鼻—鼻窦炎患者采用改良鼻丘径路额窦鼻内镜修正术治疗不仅可以促进其嗅觉功能的恢复,改善鼻黏膜纤毛运动速率,还可以在减少疾病的复发的同时提高患者的生活质量,治疗优势显著,值得临床应用。

Objective To investigate the clinical effect of frontal sinus endoscopic correction via modified nasal colliculus approach in patients with refractory rhinosinusitis.Methods The patients with refractory rhinosinusitis treated in Puyang Oilfield General Hospital from January 2019 to June 2021 were studied.212 patients who planned to undergo surgery were selected as the research objects.106 patients who underwent sinus surgery were included in the reference group by random arrangement method,and the remaining 106 patients who underwent frontal sinus endoscopic correction via the modified sinus approach were included in the experimental group,The olfactory function and ciliary movement rate of nasal mucosa were compared between the two groups before and 3 months after operation,and the clinical efficacy and complications were observed;The recurrence of the two groups within 12 months after operation was counted;The quality of life of patients before and after surgery was evaluated by nasal and paranasal sinus outcome Test-20(SNOT-20).Results There was no significant difference in olfactory function between the two groups before operation(P>0.05);The olfactory function of the experimental group was better than that of the reference group after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the ciliary movement speed of nasal mucosa between the two groups before operation(P>0.05);The ciliary movement rate of nasal mucosa in the experimental group was faster than that in the reference group at 1 and 3 months after operation,and the difference was statistically significant(P<0.05).The effective rate of the experimental group(90.57%)was higher than that of the reference group(76.42%),and the difference was statistically significant(P<0.05).The recurrence rate of 1 year after operation in the experimental group was 1.04%lower than that in the reference group(13.58%),and the difference was statistically significant(P<0.05).The incidence of complications in the experimental group(1.89%)was lower than that in the control group(11.32%),and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the scores of nasal cavity and paranasal sinus outcome Test-20(SNOT-20)before operation(P>0.05);After operation,the scores of two items of SNOT-20 scale in the two groups were lower than that before operation,and the difference was statistically significant(P<0.05),and the score of the experimental group was lower than that of the reference group,and the difference was statistically significant(P<0.05).Conclusion The treatment of refractory rhinosinusitis patients with modified frontal sinus endoscopic correction via the nasal colliculus approach can not only promote the recovery of their olfactory function and improve the ciliary movement rate of nasal mucosa,but also reduce the recurrence of the disease and improve the quality of life of patients.The treatment has a significant advantage and is worthy of clinical application.