鼻内镜鼻窦手术联合低温等离子下鼻甲射频消融术治疗慢性鼻-鼻窦炎疗效观察

Curative effect observation of endoscopic sinus surgery combined with low temperature plasma radiofrequency ablation of inferior turbinate for chronic rhinosinusitis

目的观察鼻内镜鼻窦手术联合低温等离子下鼻甲射频消融术治疗慢性鼻-鼻窦炎的临床疗效。方法选择2016年7月至2018年2月新乡医学院第一附属医院耳鼻喉科收治的96例慢性鼻-鼻窦炎患者为研究对象,按照随机数字表法将患者分为观察组和对照组,每组48例。对照组患者行鼻内镜鼻窦手术,观察组患者行鼻内镜鼻窦手术联合低温等离子下鼻甲射频消融术。采用视觉模拟评分法(VAS)对患者术前和术后3个月的主观症状进行评估,采用Lund-Kennedy量表评价患者术后3个月恢复情况,观察2组患者手术前后鼻腔黏膜结构及鼻道黏液纤毛清除速率(MTR)。比较2组患者手术相关指标及术后3、6个月的临床疗效和并发症发生情况。结果观察组患者手术时间、住院时间短于对照组,术中出血量少于对照组(P<0.05)。对照组患者术后3、6个月总有效率分别为83.33%(40/48)和81.25%(39/48),观察组患者术后3、6个月总有效率分别为97.92%(47/48)和95.83%(46/48),观察组患者术后3、6个月总有效率均高于对照组(χ~2=6.008、5.051,P<0.05)。2组患者术前VAS评分比较差异无统计学意义(P>0.05),2组患者术后VAS评分均低于术前(P<0.05),且术后观察组患者VAS评分低于对照组(P<0.05)。术后观察组患者Lund-Kennedy评分低于对照组(P<0.05)。术后3个月,2组患者上颌窦鼻黏膜结构完整,表面覆有假复层柱状纤毛上皮,上皮间有大量分泌黏液的杯状细胞,炎性细胞较少;且观察组患者的黏膜上皮恢复好于对照组。术前2组患者MTR比较差异无统计学意义(P>0.05);观察组患者术后6个月MTR显著高于术前,对照组患者术后6个月MTR与术前比较差异无统计学意义(P>0.05);术后6个月,观察组患者MTR显著高于对照组(P<0.05)。观察组和对照组患者并发症发生率分别为4.16%(2/48)、16.65%(8/48),观察组患者术后并发症发生率显著低于对照组(χ~2=4.018,P<0.05)。结论鼻内镜鼻窦手术联合低温等离子下鼻甲射频消融术能够减少对患者的创伤,提高了慢性鼻-鼻窦炎的临床疗效。

Objective To observe the clinical efficacy of endoscopic sinus surgery combined with low temperature plasma radiofrequency ablation of inferior turbinate for chronic rhinosinusitis.Methods Ninty-six patients with chronic rhinosinusitis in the Department of Otolaryngology,the First Affiliated Hospital of Xinxiang Medical University from July 2016 to February 2018 were selected and divided into observation group and control group according to the random number table method,with 48 cases in each group.The patients in the control group were treated with endoscopic sinus surgery,the patients in the observation group were treated with endoscopic sinus surgery combined with low temperature plasma radiofrequency ablation of inferior turbinate.The subjective symptoms of all patients were evaluated by visual analogue scale(VAS)before and 3 months after surgery;the recovery condition of all patients were evaluated by Lund-Kennedy scale at 3 months after surgery.The nasal mucosa structure and nasal mucociliary clearance rate(MTR)of all patients were observed before and after surgery.The surgical related indicators,clinical efficacy at 3,6 months after operation and complications after operation were compared between the two groups.Results The operation time,intraoperative blood loss and hospital stays of patients in the observation group were lower than those in the control group(P<0.05).The total effective rate of patients in the control group at 3,6 months after operation was 83.33%(40/48)81.25%(39/48),respectively;the total effective rate of patients in the observation group at 3,6 months after operation was 97.92%(47/48),95.83%(46/48),respectively;the total effective rate of patients in the observation group was higher than that in the control group at 3,6 months after operation(χ~2=6.008,5.051;P<0.05).There was no significant difference in the VAS scores between the two groups before operation(P>0.05),the VAS scores of patients after operation were lower than those before operation in the two groups(P<0.05),and the VAS score of patients in the observation group was lower than that in the control group after operation(P<0.05).The Lund-Kennedy score of patients in the observation group was lower than that in the control group after operation(P<0.05).At 3 months after operation,the structure of nasal mucosa of maxillary sinus was complete,with pseudostratified columnar ciliary epithelium on the surface of nasal mucosa;there were a large number of mucus-secreting goblet cells and fewer inflammatory cells in the epithelial cells.The recovery condition of mucosal epithelium of patients in the observation group was better than that in the control group.There was no significant difference in the MTR between the two groups before operation(P>0.05);the MTR of patients at 6 months after operation was higher than that before operation in the observation group(P<0.05),but there was no significant difference in the MTR at 6 months after operation and before operation in the control group(P>0.05);the MTR of patients in the observation group was significantly higher than that in the control group at 6 months after operation(P<0.05).The incidence of complications in the observation group and the control group were 4.16%(2/48)and 16.65%(8/48),respectively;the incidence of complications of patients in the observation group was significantly lower than that in the control group(χ~2=4.01,P<0.05).Conclusion Endoscopic sinus surgery combined with low-temperature plasma radiofrequency ablation of inferior turbinate can reduce the trauma of patients and improve the clinical efficacy of chronic rhinosinusitis.