山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (1): 38-41.doi: 10.6040/j.issn.1673-3770.1.2018.018

• 专家笔谈 • 上一篇    下一篇

合并哮喘的慢性鼻-鼻窦炎的鼻内镜手术治疗

余洪猛*(),刘琢扶,戴琪   

  1. 复旦大学附属眼耳鼻喉科医院耳鼻喉科研究院，上海 200031
  • 收稿日期:2018-09-21 出版日期:2019-01-20 发布日期:2019-01-28
  • 通讯作者: 余洪猛 E-mail:hongmengyush@163.com
  • 作者简介:余洪猛，主任医师，博士生导师。复旦大学眼耳鼻喉科医院耳鼻喉科研究院副院长，耳鼻喉科副主任，鼻科主任，鼻颅底外科主任。主要学术任职：中国医师协会耳鼻咽喉科医师分会鼻科学组副组长，中国中西医结合学会耳鼻咽喉科专业委员会鼻颅底肿瘤及嗅觉专病专家委员会主任，中国医师协会耳鼻咽喉科医师分会委员，国家卫生计生委能力建设和继续教育耳鼻喉科专家委员会委员(鼻颅底外科学组)，中国中西医结合学会耳鼻咽喉科专业委员会委员，上海市医师协会耳鼻喉科医师分会委员，上海市中西医结合学会耳鼻咽喉科专业委员会副主任委员。担任《国际耳鼻咽喉头颈外科杂志》等多家杂志编委。曾赴德国Fulda医院世界著名鼻颅底外科Wolfgang Draf教授处和美国匹兹堡颅底外科中心学习鼻颅底外科技术

Endoscopic sinus surgery for chronic sinusitis with asthma

Hongmeng YU*(),Zhuofu LIU,Qi DAI   

  1. Institute of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
  • Received:2018-09-21 Online:2019-01-20 Published:2019-01-28
  • Contact: Hongmeng YU E-mail:hongmengyush@163.com

RichHTML

117

PDF (PC)

1126

摘要：

慢性鼻-鼻窦炎(CRS)是一种异质性的疾病，其中合并哮喘的患者占到10%~40%，且在全球范围内呈上升趋势。在哮喘患者中，CRS的发病率也高于一般人群。目前大部分的研究认为鼻内镜手术结合药物治疗对合并哮喘的CRS患者的鼻部症状有明显的改善作用，且有利于哮喘的长期管理。但是此类患者术后易复发，围手术期手术风险也较高。将重点论述合并哮喘的CRS患者的术前评估和围手术期管理、手术方式的选择及鼻内镜手术术后对哮喘的影响等。

关键词: 慢性鼻-鼻窦炎, 哮喘, 鼻内镜外科手术

Abstract:

Chronic rhinosinusitis (CRS) is a heterogeneous disease, and patients with asthma account for 10%-40% of the CRS cases and this number is increasing worldwide. In addition, the incidence of CRS is higher in patients with asthma than in the general population. At present, most of the studies suggest that endoscopic surgery combined with drug therapy can significantly improve the nasal symptoms of patients with CRS accompanied by asthma, and is conducive to long-term management of asthma. However, such patients are prone to recurrence after surgery and the risk for perioperative surgery is also high. This article focuses on the preoperative evaluation and perioperative management of patients with CRS accompanied by asthma, choice of surgical methods, and impact of endoscopic surgery on asthma.

Key words: Chronic rhinosinusitis, Asthma, Endoscopic surgical procedures, operative

中图分类号: 

  • R765.4
1 Cao PP , Li HB , Wang BF , et al. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese[J]. J Allergy Clin Immunol, 2009, 124 (3): 478- 2. 478-484, 484.e1-2
doi: 10.1016/j.jaci.2009.05.017
2 Bachert C , Gevaert P , Holtappels G , et al. Total and specific IgE in nasal polyps is related to local eosinophilic inflammation[J]. J Allergy Clin Immunol, 2001, 107 (4): 607- 614.
doi: 10.1067/mai.2001.112374
3 Al Badaai Y , Samaha M . Outcome of endoscopic sinus surgery for chronic rhinosinusitis patients: a Canadian experience[J]. J Laryngol Otol, 2010, 124 (10): 1095- 1099.
doi: 10.1017/S0022215110001003
4 Kim HY , So YK , Dhong HJ , et al. Prevalence of lower airway diseases in patients with chronic rhinosinusitis[J]. Acta Otolaryngol Suppl, 2007, (558): 110- 114.
doi: 10.1080/03655230701624988
5 Rosati MG , Peters AT . Relationships among allergic rhinitis, asthma, and chronic rhinosinusitis[J]. Am J Rhinol Allergy, 2016, 30 (1): 44- 47.
doi: 10.2500/ajra.2016.30.4252
6 Fasano MB . Combined airways: impact of upper airway on lower airway[J]. Curr Opin Otolaryngol Head Neck Surg, 2010, 18 (1): 15- 20.
doi: 10.1097/MOO.0b013e328334aa0e
7 Hopkins C , Browne JP , Slack R , et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis[J]. Clin Otolaryngol, 2006, 31 (5): 390- 398.
doi: 10.1111/j.1749-4486.2006.01275.x
8 Hamizan AW , Loftus PA , Alvarado R , et al. Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease[J]. Laryngoscope, 2018, 128 (9): 2015- 2021.
doi: 10.1002/lary.27180
9 Rajan JP , Wineinger NE , Stevenson DD , et al. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: a meta-analysis of the literature[J]. J Allergy Clin Immunol, 2015, 135 (3): 676- 681.e1.
doi: 10.1016/j.jaci.2014.08.020
10 韩传宝, 周钦海, 孙培莉, 等. 哮喘患者围术期麻醉管理[J]. 临床麻醉学杂志, 2013, 29 (8): 820- 822.
11 Woods BD , Sladen RN . Perioperative considerations for the patient with asthma and bronchospasm[J]. Br J Anaesth, 2009, 103 (Suppl 1): i57- i65.
doi: 10.1093/bja/aep271
12 陈国静, 蔡晓岚, 李学忠, 等. 慢性鼻-鼻窦炎-鼻息肉伴哮喘患者鼻内镜围手术期药物治疗[J]. 山东大学耳鼻喉眼学报, 2015, 29 (3): 35- 38.
doi: 10.6040/j.issn.1673-3770.0.2015.125
CHEN Guojing , CAI Xiaolan , LI Xuezhong , et al. Perioperative treatment in endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps and asthma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015, 29 (3): 35- 38.
doi: 10.6040/j.issn.1673-3770.0.2015.125
13 Liccardi G , Salzillo A , Sofia M , et al. Bronchial asthma[J]. Curr Opin Anaesthesiol, 2012, 25 (1): 30- 37.
doi: 10.1097/ACO.0b013e32834e7b2e
14 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2016年版)[J]. 中华结核和呼吸杂志, 2016, 39 (9): 675- 697.
doi: 10.3760/cma.j.issn.1001-0939.2016.09.007
15 Fokkens WJ , Lund VJ , Mullol J , et al. European position paper on rhinosinusitis and nasal polyps 2012[J]. Rhinology, 2012, 50 (1): 1- 12.
doi: 10.4193/rhin050e2
16 McCoul ED , Tabaee A . A practical approach to refractory chronic rhinosinusitis[J]. Otolaryngol Clin North Am, 2017, 50 (1): 183- 198.
doi: 10.1016/j.otc.2016.08.014
17 Dinis PB , Gomes A . Sinusitis and asthma: how do they interrelate in sinus surgery?[J]. Am J Rhinol, 1997, 11 (6): 421- 428.
doi: 10.2500/105065897780914992
18 Guerrero J , Molina B , Echeverría L , et al. Endoscopic sinonasal surgery: study of 110 patients with nasal polyposis and chronic rhinosinusitis[J]. Acta Otorrinolaringol Esp, 2007, 58 (6): 252- 256.
doi: 10.1016/S0001-6519(07)74922-1
19 Vashishta R , Soler ZM , Nguyen SA , et al. A systematic review and meta-analysis of asthma outcomes following endoscopic sinus surgery for chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2013, 3 (10): 788- 794.
doi: 10.1002/alr.21182
20 Corren J , Adinoff AD , Buchmeier AD , et al. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma[J]. J Allergy Clin Immunol, 1992, 90 (2): 250- 256.
doi: 10.1016/0091-6749(92)90079-H
21 Foresi A , Pelucchi A , Gherson G , et al. Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis[J]. J Allergy Clin Immunol, 1996, 98 (2): 274- 282.
doi: 10.1016/S0091-6749(96)70150-1
22 Lohia S , Schlosser RJ , Soler ZM . Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis[J]. Allergy, 2013, 68 (5): 569- 579.
doi: 10.1111/all.12124
23 Ragab S , Scadding GK , Lund VJ , et al. Treatment of chronic rhinosinusitis and its effects on asthma[J]. Eur Respir J, 2006, 28 (1): 68- 74.
doi: 10.1183/09031936.06.00043305
24 Dunlop G , Scadding GK , Lund VJ . The effect of endoscopic sinus surgery on asthma: management of patients with chronic rhinosinusitis, nasal polyposis, and asthma[J]. Am J Rhinol, 1999, 13 (4): 261- 265.
doi: 10.2500/105065899782102809
25 LeP T , Soler ZM , Jones R , et al. Systematic review and meta-analysis of SNOT-22 outcomes after surgery for chronic rhinosinusitis with nasal polyposis[J]. Otolaryngol Head Neck Surg, 2018, 159 (3): 414- 423.
doi: 10.1177/0194599818773065
26 Fokkens W , Lund V , Mullol J , et al. European position paper on rhinosinusitis and nasal polyps 2007[J]. Rhinol Suppl, 2007, 20: 1- 136.
[1] 冯思聪,于晓岚,娄丹. 基于囊泡组织Ki67、GM-CSF表达评估Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 31-39.
[2] 曹正勇,李小波. 慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 43-50.
[3] 崇维琨,王娟. 联合应用奥马珠单抗在儿童中重度变应性哮喘合并慢性鼻窦炎中的疗效观察[J]. 山东大学耳鼻喉眼学报, 2024, 38(1): 21-26.
[4] 孙汐文,骆春雨,李志鹏,张维天. 铁死亡在呼吸道炎症性疾病中的作用及研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 24-32.
[5] 卢淦,邓玉琴,陶泽璋. 过敏性疾病与糖尿病的相关性及潜在关联机制[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 215-222.
[6] 袁玥,付圣尧,姜彦,陈敏. 细胞焦亡在慢性气道炎症性疾病中的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 166-171.
[7] 王娜,柴向斌. 前列腺源性ETS因子在哮喘及鼻黏膜炎性疾病中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 136-141.
[8] 陈世琴,卫平存,胡云龙,胡金旺. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201.
[9] 李孟辉,郅莉莉,戚凯文,王珊珊,高倩,步美玲,姜荷云,冯绛楠,王金荣. 皮下免疫治疗对单一尘螨和合并霉菌过敏儿童哮喘的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 75-80.
[10] 陶丹丹,董红军,褚云锋,黄超,胡磊. 慢性鼻-鼻窦炎伴鼻息肉患者组织嗜酸性粒细胞与嗅觉功能障碍的相关性研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 16-20.
[11] 杨一帆, 程雷. 儿童鼻窦炎与哮喘:统一气道疾病[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 10-15.
[12] 王海英. 鼻内镜下二线减张鼻中隔矫正术43例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 166-168.
[13] 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.
[14] 李强,刘志元,周涵. 鼻内镜下蝶腭动脉阻断术治疗老年难治性鼻出血[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 92-95.
[15] 邱前辉,陈卓. 鼻内镜手术治疗首诊局部晚期鼻咽癌及放疗后严重并发症的作用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 17-20.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发