鼻内镜中鼻甲成形术治疗慢性鼻窦炎伴鼻息肉的效果及术后复发的影响因素

Effect of Endoscopic Middle Turbinoplasty on Chronic Sinusitis with Nasal Polyps and Influencing Factors of Postoperative Recurrence

目的探讨鼻内镜中鼻甲成形术治疗慢性鼻窦炎伴鼻息肉的效果及术后复发的影响因素。方法前瞻性纳入2020年1月至2021年3月驻马店市第一人民医院收治的200例慢性鼻窦炎伴鼻息肉患者,均接受鼻内镜中鼻甲成形术治疗,观察治疗效果。随访12个月,根据复发情况分为复发组(21例)和未复发组(179例),经二元logistic回归分析影响术后复发的因素。结果200例患者接受手术后总有效率为94.50%,术后鼻腔的最小横截面积(NMCA)、鼻腔最小横截面至鼻孔距离(DCAN)、鼻腔容积(NCV)、气道阻力改善情况优于术前,Lund-Kennedy评分、鼻腔鼻窦结局测试-20(SNOT-20)CV评分低于术前(P<0.05)。经二元logistic回归分析,有吸烟史、手术时间≥60 min、钩突不完整切除是导致慢性鼻窦炎伴鼻息肉患者术后复发的独立影响因素。结论鼻内镜中鼻甲成形术治疗慢性鼻窦炎伴鼻息肉患者能够改善嗅觉功能,提高治疗效果。术后复发率受吸烟史、手术时间、切除钩突情况影响,需警惕危险因素,降低术后复发率。

Objective To explore the efficacy of endoscopic middle turbinoplasty in the treatment of chronic sinusitis with nasal polyps and the influencing factors of postoperative recurrence.Methods A total of 200 patients with chronic rhinosinusitis and nasal polyps admitted to the First People’s Hospital of Zhumadian from January 2020 to March 2021 were prospectively included,and all underwent middle turbinoplasty under nasal endoscopy.The therapeutic effect was observed.After 12 months of follow-up,they were divided into recurrence group(21 cases)and the non-recurrence group(179 cases)according to the recurrence situation.The factors affecting postoperative recurrence were analyzed by binary logistic regression.Results After 200 patients underwent surgery,the total effective rate was 94.50%.Postoperative nasal minimum cross-sectional area(NMCA),nasal minimal cross-sectional area to front nostril(DCAN),nasal cavity volume(NCV)and airway resistance were better than those before operation,amd Lund-Kennedy score and(sino-nasal outcome test-20)SNOT-20 score were lower than those before operation(P<0.05).Binary logistic regression analysis showed that smoking history,operation time≥60 minutes and incomplete uncinate excision were independent influencing factors for postoperative recurrence in patients with chronic rhinosinusitis and nasal polyps.Conclusion Endoscopic middle turbinoplasty in the treatment of chronic sinusitis with nasal polyps can improve the olfactory function and improve the therapeutic effect.The postoperative recurrence rate can be affected by smoking history,operation time and resection of uncinate process.It is also necessary to guard against risk factors and reduce the postoperative recurrence rate.