鼻内镜联合低温等离子射频消融术治疗慢性鼻-鼻窦炎的临床效果

Clinical Observation of Nasal Endoscopy Combined with Low-temperature Plasma Radiofrequency Ablation for Chronic Rhinosinusitis

目的 探讨鼻内镜联合低温等离子射频消融术治疗慢性鼻-鼻窦炎(CRS)的临床效果及对鼻黏膜功能和术后复发的影响。方法 回顾性分析2019年1月—2022年3月收治的96例CRS临床资料,根据手术方案不同分为对照组和观察组,每组48例。对照组给予鼻内镜手术治疗,观察组给予鼻内镜联合低温等离子射频消融术治疗。判定2组术后6个月的临床疗效,比较2组手术前后的鼻黏膜功能指标和黏膜组织炎性指标[MUC5AC阳性细胞面积百分率、人软骨糖蛋白-39(YKL-40)、白细胞介素-6(IL-6)]变化,统计2组术后并发症和随访6个月的复发率。结果 观察组临床总有效率高于对照组,术中出血量少于对照组(P<0.05)。术后1周及6个月,2组内镜Lund-Kennedy评分、鼻气道阻力以及黏膜组织MUC5AC阳性表达面积百分率、YKL-40和IL-6含量均较术前下降,鼻黏膜纤毛输送速率较术前提高,且观察组术后6个月上述指标改善效果较对照组更显著(P<0.05)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。观察组随访6个月的复发率低于对照组(P<0.05)。结论 鼻内镜联合低温等离子射频消融术治疗CRS的临床效果显著,能改善鼻黏膜功能,减轻炎症反应,且术后并发症少,复发率低。

Objective To investigate the clinical effect of nasal endoscopy combined with low-temperature plasma radiofrequency ablation(LTPRA)in the treatment of chronic rhinosinusitis(CRS)and the effect on nasal mucosa function and postoperative recurrence.Methods Clinical data of 96 patients with CRS admitted from January 2019 to March 2022 were retrospectively analyzed,and they were divided into control group and observation group according to different surgical protocols,with 48 cases in each group.The control group was treated with nasal endoscopic surgery,and the observation group was treated with nasal endoscopy combined with LTPRA.The clinical efficacy of the two groups at 6 months after surgery was determined,and the changes of nasal mucosal function indicators and mucosal tissue inflammatory indicators[percentage of MUC5AC positive cell area,human chondroglycoprotein-39(YKL-40),interleukin-6(IL-6)]before and after surgery between the two groups were compared,and the postoperative complications and the recurrence rate of postoperative at 6-month follow-up between the two groups were analyzed.Results The total effective rate of the observation group was higher than that of the control group,while the intraoperative blood loss was lower than that of the control group(P<0.05).At 1 week and 6 months after surgery,endoscopic Lund-Kennedy score,nasal airway resistance,percentage of MUC5AC positive expression area,YKL-40 and IL-6 levels in mucosal tissue were significantly decreased in both groups,and the nasal mucosal ciliary delivery rate was increased compared with that before surgery;the improvement of the above indexes in the observation group was more significant than that in the control group 6 months after surgery(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The recurrence rate of observation group was significantly lower than that of control group at 6-month follow-up(P<0.05).Conclusion Nasal endoscopy combined with LTPRA in the treatment of CRS has significant clinical effects,which can improve nasal mucosal function,reduce inflammation,and reduce postoperative complications and recurrence rate.