鼻内镜下经泪前隐窝入路成人上颌窦后鼻孔息肉切除术的应用分析

Application analysis of nasal endoscopic resection of antrochoanal polypsvia prelacrimal recess approach in adults

目的评价鼻内镜下经泪前隐窝入路成人上颌窦后鼻孔息肉(ACP)切除术的应用价值。方法回顾性分析2017年7月至2022年5月南京鼓楼医院耳鼻咽喉科收治的22例上颌窦后鼻孔息肉患者的临床资料。行鼻内镜下经泪前隐窝入路上颌窦后鼻孔息肉切除术,其中10例保留中鼻道上颌窦自然引流口结构,12例联合经中鼻道上颌窦口扩大。比较术前、术后1个月及术后12个月视觉模拟量表评分(VAS)、鼻腔鼻窦结局测试22量表(SNOT-22)、鼻内镜检查及鼻窦CT检查结果。结果患者术后1个月及术后12个月VAS、SNOT-22症状评分较术前明显降低(P<0.001),术后12个月VAS、SNOT-22症状评分较术后1个月明显降低(P<0.001)。随访12个月后,内镜结果显示所有患者均未出现鼻泪管损伤、鼻腔粘连等并发症。10例保留中鼻道上颌窦自然引流口结构的患者与12例联合经中鼻道上颌窦口扩大患者术前及术后12个月复查CT显示,上颌窦腔内壁光滑,无炎症或息肉潴留,恢复好,均无复发。结论应用鼻内镜下经泪前隐窝入路可安全有效地清除ACP,术后并发症少,随访期内无复发,并且保留中鼻道上颌窦自然引流口结构能够获得与联合切除钩突并开放扩大上颌窦口同样的疗效。

Objective To assess the clinical value of nasal endoscopic resection of antrochoanal polyps(ACP)using the prelacrimal recess approach in adults.Methods Between July 2017 and May 2022,22 patients with ACP at the Department of Otorhinolaryngology,Nanjing Drum Tower Hospital were enrolled.All patients underwent nasal endoscopic resection of ACP via the prelacrimal recess approach.Ten cases preserved the natural drainage structure of the middle meatus,while 12 cases had an enlarged ostium of the maxillary sinus.Visual Analogue Scale(VAS),sino-nasal outcome test 22(SNOT-22),nasal endoscopy and sinus CT were compared before surgery,1 month and 12 months after surgery.We compared preoperative and postoperative(at 1 month and 12 months)results of the VAS,the SNOT-22,nasal endoscopy,and sinus CT scans.Results The VAS and SNOT-22 scores of patients 1 month and 12 months after surgery were significantly lower than those before surgery(P<0.001),and the VAS and SNOT-22 scores of patients 12 months after surgery were significantly lower than those 1 month after surgery(P<0.001).At the 12month follow-up,endoscopic results indicated no complications such as nasolacrimal duct damage or nasal adhesions in any patient.CT reexamination before and 12 months after operation showed that the inner wall of the maxillary sinus cavity was smooth,without inflammation or polyp retention,and no recurrence in 10 patients with the natural drainage of maxillary sinus in the middle nasal canal and 12 patients with combined expansion of maxillary sinus through the middle nasal canal.Conclusion The application of nasal endoscopic resection of antrochoanal polypsvia prelacrimal recess approach can safely and effectively remove ACP,with fewer postoperative complications and no recurrence during the follow-up period.In addition,retaining the structure of the natural maxillary sinus drainage in the middle nasal canal can achieve the same curative effect as the combined removal of the uncinate process and opening and expanding the maxillary sinus opening.