鼻内镜术中不同中鼻甲处理方式治疗慢性鼻-鼻窦炎伴鼻息肉效果比较

doi:10.6040/j.issn.1673-3770.0.2018.447

摘要/Abstract

摘要： 目的

探讨慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者鼻内镜术中不同中鼻甲处理方式的临床效果。

方法

选取115例CRSwNP患者，均接受鼻内镜手术治疗，根据术中中鼻甲处理方式分为观察组60例及对照组55例，观察组行鼻内镜Messerklinger中鼻甲成形术，对照组行中鼻甲部分切除术，术后随访3个月，比较两组手术前后临床症状的改善、鼻腔功能及嗅觉功能变化，并进行Lund-Kennedy和SNOT-20量表评定。

结果

与术前比较，术后1个月两组头晕、咳嗽、鼻塞及流脓涕等临床症状评分降低，且观察组头晕、咳嗽及流脓涕等评分低于对照组（t分别为12.979、13.298、9.216，P均<0.001）；术后3个月两组鼻腔功能指标气道阻力、DCAN及嗅觉功能评分均有所降低，且观察组低于对照组（t分别为14.999、3.611、3.798，P均<0.001）；两组鼻腔功能指标NMCA、NCV升高，且观察组高于对照组（t分别为2.216、11.379，P均<0.001）；术后3个月两组Lund-Kennedy评分、SNOT-20评分均降低，且观察组低于对照组（t=17.025、11.822，P均<0.001）。

结论

CRSwNP患者在鼻内镜术应用中鼻甲成形术治疗效果确切，可促进鼻腔功能及嗅觉功能的恢复，同时提高患者的生活质量。

关键词: 鼻窦炎, 鼻息肉, 鼻内镜外科手术, 中鼻甲成形术, 治疗结局

Abstract: Objective

To explore the clinical effects of different middle turbinate treatments on on chronic rhinosinusitis with nasal polyps (CRSwNP) during endoscopic sinusitis.

Methods

115 patients with CRSwNP were selected and treated with endoscopic sinus surgery, the patients were divided into study group (n=60, Middle conchoplasty) and control group (n=55, excision) according to the treatment of middle turbinate during operation, after operation they had follow-up for 3 months, the improvement of clinical symptoms, the changes of nasal function and olfactory function before and after operation of the 2 groups were compared, and the assessment of the Lund-Mackay and SNOT-20 scales was carried out.

Results

Compared with the preoperative group, the scores of dizziness, cough, nasal obstruction and purulent discharge in the 2 groups were lower, and the scores of dizziness, cough and purulent discharge in the study group were lower than those in the control group (t=12.979、13.298、9.216；P<0.001); 3 months after operation, the airway resistance, DCAN and olfactory function scores of the 2 groups decreased, and the nasal function indexes of the study group were lower than those of the control group (t=14.999, 3.611, 3.798;P<0.001); the nasal function indexes of the 2 groups increased, and the study group was higher than the control group (t=2.216, 11.379; P<0.001); Lund-Kennedy score and SNOT-20 score of the 2 groups decreased 3 months after operation, and that of the study group was lower than that of the control group (t=17.025,11.822; P<0.001).

Conclusion

The application of middle turbinate in endoscopic sinusitis. for CRSwNP patients is more effective, which can promote the recovery of nasal function and olfactory function and improve the quality of life of the patients.

Key words: Rhinosinusitis, Nasal polyps, Endoscopic surgical procedures, operative, Middle conchoplasty, Treatment outcome

中图分类号:

R765.41

陈国辉,和守睆,孙青,高天乐,白广平. 鼻内镜术中不同中鼻甲处理方式治疗慢性鼻-鼻窦炎伴鼻息肉效果比较[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 82-86.

Guohui CHEN,Shouhuan HE,Qing SUN,Tianle GAO,Guangping BAI. Clinical effects of different middle turbinate treatments on chronic rhinosinusitis with nasal polyps during endoscopic sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 82-86.

图/表 3

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组别	n	头晕	咳嗽	鼻塞	流脓涕
对照组	55
术前		2.16±0.36	4.26±1.21	5.56±1.36	5.29±1.36
术后1个月		0.78±0.16^Δ	1.36±0.25^Δ	1.68±0.34^Δ	1.54±0.34^Δ
观察组	60
术前		2.21±0.42	4.33±1.25	5.68±1.42	5.36±1.42
术后1个月		0.45±0.11^Δa	0.88±0.12^Δa	1.59±0.22^Δ	1.03±0.25^Δa

组别	n	鼻腔功能				嗅觉功能(分)
组别	n	气道阻力[kPa/(s·L)]	DCAN(cm)	NMCA(cm²)	NCV(cm³)	嗅觉功能(分)
对照组	55
术前		2.96±0.36	1.86±0.26	0.45±0.06	11.63±1.21	4.85±0.45
术后3个月		0.78±0.15^Δ	1.77±0.20^Δ	0.51±0.11^Δ	14.26±1.93^Δ	0.99±0.25^Δ
观察组	60
术前		2.89±0.41	1.82±0.31	0.48±0.05	11.86±1.52	4.92±0.41
术后3个月		0.36±0.15^Δa	1.66±0.12^Δa	0.56±0.13^Δa	18.92±2.41^Δa	0.82±0.23^Δa