鼻内镜手术对慢性鼻-鼻窦炎患者鼻黏膜纤毛功能、嗅觉功能及术后并发症的影响

Effect of nasal endoscopic surgery on changes of nasal mucociliary function,olfactory function and postoperative complications in patients with chronic rhinosinusitis

目的研究鼻内镜手术(NES)对慢性鼻-鼻窦炎(CR)患者鼻黏膜纤毛功能、嗅觉功能及术后并发症的影响。方法前瞻性选取2020年10月至2022年10月于广州中医药大学附属中山中医院行手术治疗的CR患者196例,按照随机数字表法将其分为实验组(n=98)、对照组(n=98)。对照组行上颌窦鼻内开窗术,实验组行NES。观察两组术前、术后1个月的鼻腔通气功能指标[鼻腔容积(NCV)、鼻腔最小横截面积(NMCA)、鼻气道阻力(NAR)]、鼻黏膜纤毛功能指标(纤毛清除速度、纤毛清除率)、嗅觉功能改变情况、生活质量[鼻腔鼻窦结局测试20量表(SNOT20)],并比较两组的临床疗效及术后并发症。结果术后1个月,两组NCV、NMCA均大于术前,NAR均小于术前,差异均有统计学意义(P<0.05);术后1个月,两组NCV、NMCA、NAR比较,差异均无统计学意义(P>0.05)。术后1个月,两组纤毛清除速度、纤毛清除率均大于术前,且实验组纤毛清除速度、纤毛清除率分别为(5.74±0.59)mm/min、(75.95±7.83)%,均大于对照组[(4.98±0.52)mm/min、(64.21±6.75)%],差异均有统计学意义(P<0.05)。术后1个月,两组嗅觉评分、SNOT20评分均小于术前,且实验组嗅觉评分、SNOT20评分分别为(2.67±0.29)、(15.18±1.83)分,均小于对照组[(3.18±0.34)、(17.59±1.94)分],差异均有统计学意义(P<0.05)。两组总有效率比较差异无统计学意义(96.94%vs.97.96%)(P>0.05)。实验组术后并发症发生率为1.02%,低于对照组(8.16%),差异有统计学意义(P<0.05)。结论NES治疗CR可有效减少鼻、鼻窦黏膜损伤,促进术后鼻腔通气功能、鼻黏膜纤毛功能恢复,纠正嗅觉功能异常改变,减少术后并发症,且其临床疗效与传统术式较为一致。

Objective To study the effects of nasal endoscopic surgery(NES)on nasal mucociliary function,olfactory function and postoperative complications in patients with chronic rhinosinusitis(CR).Methods A total of 196 patients with CR who underwent surgical treatment in Zhongshan Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine from October 2020 to October 2022 were prospective selected and divided into the experimental group(n=98)and the control group(n=98)according to the random number table method.The control group received maxillary sinus intranasal fenestration,and the experimental group received NES.Rhe nasal ventilation function indicators[nasal cavity volume(NCV),nasal minimum cross-sectional area(NMCA),nasal airway resistance(NAR)],nasal mucosal ciliary function indicators(ciliary clearance speed,ciliary clearance rate),changes in olfactory function,and quality of life[Nasal and Sinus Outcome Test 20 Scale(SNOT20)]in two groups were observed before and 1 month after surgery.The clinical efficacy and postoperative complications of the two groups were compared.Results At 1 month after surgery,NCV and NMCA in two groups were higher than those before surgery,while NAR was lower than that before surgery,and the differences were statistically significant(P<0.05);there were no statistically significant differences in NCV,NMCA,and NAR at 1 month after surgery between the two groups(P>0.05).At 1 month after surgery,the ciliary clearance rate and ciliary clearance rate in two groups were higher than those before surgery,the ciliary clearance rate and ciliary clearance rate of the experimental group were(5.74±0.59)mm/min,(75.95±7.83)%,which were higher than those of the control group[(4.98±0.52)mm/min,(64.21±6.75)%],and the differences were statistically significant(P<0.05).At 1 month after surgery,the olfactory scores and SNOT20 scores in two groups were lower than those before surgery,the olfactory scores and SNOT20 scores of the experimental group were(2.67±0.29),(15.18±1.83)points,which were lower than those of the control group[(3.18±0.34),(17.59±1.94)points],and the differences were statistically significant(P<0.05).There was no statistically significant difference in total effective rate between the two groups(96.94%vs.97.96%)(P>0.05).The incidence of postoperative complications in the experimental group was 1.02%,which was lower than that in the control group(8.16%),and the difference was statistically significant(P<0.05).Conclusion NES treatment of CR can effectively reduce nasal and sinus mucosal injuries,promote postoperative recovery of nasal ventilation function and nasal mucociliary function,correct abnormal changes in olfactory function,and reduce postoperative complications,and its clinical efficacy is relatively consistent with that of traditional surgery.