鼻息肉患者鼻内镜术后复发的危险因素分析及防治策略

Analysis of risk factors for recurrence of nasal polyps in patients with nasal endoscopy and its prevention and treatment strategies

目的分析鼻息肉患者鼻内镜术后复发的危险因素及其防治策略。方法选取2015年6月至2018年6月我院耳鼻咽喉科行鼻内镜手术治疗鼻息肉的患者127例,术后随访1年,根据是否复发分为复发组和非复发组,采用单因素及多因素logistic回归分析筛选术后复发的独立危险因素,并分析其防治策略。结果术后复发率为26.77%。单因素分析结果显示:2组患者的年龄、病程、吸烟史、糖尿病、合并变应性鼻炎、ENP、Lund-Mackay评分及术后综合治疗等指标有显著差异(P<0.05);多因素Logistic回归分析结果显示:吸烟史(OR=3.061,95%CI:1.124~9.341)、ENP(OR=3.264,95%CI:1.263~9.465)、PE积分(OR=3.742,95%CI:1.876~8.822)、术后综合治疗(OR=2.068,95%CI:0.729~5.489)是鼻息肉患者鼻内镜术后复发的独立危险因素。结论长期吸烟史、为嗜酸性粒细胞型鼻息肉、PE积分明显升高以及术后未采取综合治疗的鼻息肉患者术后易复发。对于长期吸烟、病理类型为嗜酸性粒细胞型及术前PE积分明显升高的鼻息肉患者,术前制定详细手术方案、术后严格戒烟以及采取综合治疗可以有效防治复发。

Objective To analyze the risk factors and prevention strategies of nasal endoscopic recurrence in patients with nasal polyps.Methods A total of 127 patients with nasal polyps treated by endoscopic sinus surgery from June 2015 to June 2018 were enrolled.All patients were followed up for 1 year.They were divided into recurrent group and non-recurrent group according to whether they relapsed.Factors and multivariate logistic regression analysis were used to screen for independent risk factors for postoperative recurrence and to analyze their prevention strategies.Results The postoperative recurrence rate was 26.77%.Univariate analysis showed that there were significant differences in age,duration of disease,smoking history,diabetes,combined allergic rhinitis,ENP,Lund-Mackay score,and postoperative comprehensive treatment in the two groups(P<0.05);multivariate logistic The results of regression analysis showed:smoking history(OR=3.061,95%CI:1.124~9.341),ENP(OR=3.264,95%CI:1.263~9.465),PE score(OR=3.742,95%CI:1.876~8.822),postoperative comprehensive treatment(OR=2.068,95%CI:0.729~5.489)is an independent risk factor for recurrence after nasal endoscopic surgery in patients with nasal polyps.Conclusions Long-term smoking history,eosinophilic nasal polyps,PE scores significantly increased,and patients with nasal polyps who did not receive comprehensive treatment after surgery,were prone to recurrence.For patients with long-term smoking,pathological types of eosinophils and preoperative PE scores significantly increased,preoperative surgical planning,strict smoking cessation after surgery and comprehensive treatment can effectively prevent recurrence.