儿童上颌窦后鼻孔息肉36例临床资料分析

doi:10.6040/j.issn.1673-3770.0.2022.218

摘要/Abstract

摘要： 目的探讨鼻窦载药缓释植入系统在儿童上颌窦后鼻孔息肉手术治疗中的安全性和有效性。方法收集儿童上颌窦后鼻孔息肉36例并随访其预后情况,根据上述病例在手术中是否使用鼻窦载药缓释系统分为研究组(26例)和对照组(10例)。随访时间为术后第1、3、6个月,采用Lund-Kennedy评分法、视觉模拟量表评分进行术后术腔黏膜和症状评估。结果研究组平均(8.51±2.76)岁,对照组平均(7.80±2.76)岁,两者年龄差异无统计学意义(P=0.525)。两组男女比例无统计学意义(P=0.854)。术后1个月、3个月随访,两组间症状评分无统计学意义(P=0.485、P=0.113),但随访至6个月时,研究组病例症状评分较对照组显著改善(P<0.05)。术后1个月随访时研究组术腔Lund-Kennedy评分显著好于对照组(P<0.05),但随访至3、6及12个月时,两者无统计学意义(P=0.158、P=0.087、P=0.555)。研究组和对照组各有1例复发(3.85%/10%),两者无统计学意义(P=0.484)。研究组和对照组病例术后均未出现眶内及颅内并发症。结论儿童上颌窦后鼻孔息肉手术治疗中应用鼻窦载药缓释植入系统能够在一定程度上促进术后症状改善及术腔愈合;利于保持窦口通畅引流,对儿童上颌窦后鼻孔息肉术后恢复有一定积极作用。但复发率结果尚无统计学意义,需更大样本量的临床研究加以验证。鼻窦载药缓释植入系统在本研究中未造成术后并发症的增加。

关键词: 上颌窦后鼻孔息肉, 鼻窦可吸收类固醇缓释植入物, 儿童, 鼻内镜手术, 疗效评价

Abstract: Objective This paper explored the safety and efficacy of sinus absorbable steroid sustained-release implantation system in the treatment of antrochoanal polyp in children. Methods A total of 36 pediatric patients with antrochoanal polyps were divided into study group(26 cases)and control group(10 cases), depending on whether or not a sinus absorbable steroid sustained-release implantation system was implanted into the sinus cavity. All the patients were followed up for half a year. Visual analogue scale and Lund-Kennedy score were used to evaluate the symptoms and mucous membrane of the operative cavity. Results The mean age of the study group was(8.51±2.76)years, and that of the control group was(7.80±2.76)years, with no statistical difference(P=0.525). There was no significant difference in male/female ratio between the two groups(P=0.854). There was no significant difference in the symptom score between the two groups at one and three months of follow-up after the operation(P=0.485; P=0.113, respectively), but the symptom score of the study group was significantly improved compared with the control group at six months after the operation(P<0.05). The Lund-Kennedy score of the study group was significantly better than that of the control group at one month of follow-up(P<0.05), but there was no significant difference at 3, 6, and 12 months of follow-up(P=0.158, P=0.087, and P=0.555, respectively). There was respectively one case of recurrence in the study and control groups(3.85%/10%), with no statistical difference between the two groups(P=0.484). There were no intra-orbital and intra-cranial complications in the study and control groups. Conclusion In the surgical treatment of children with antrochoanal polyps, the application of sinus absorbable steroid sustained-release implantation system can effectively improve postoperative symptoms and operative cavity conditions. However, there was no statistical difference in recurrence rate, which needs to be verified by further clinical studies with a larger sample size. There was no increase in postoperative complications associated with sinus stents in this study.

Key words: Antrochoanal polyp, Bioabsorbable steroid-eluting sinus implants, Children, Nasal endoscopic surgery, Evaluation of therapeutic efficiency

中图分类号:

R765.21

徐宏鸣,范文焱,浦诗磊,李晓艳. 儿童上颌窦后鼻孔息肉36例临床资料分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 159-163.

XU Hongming, FAN Wenyan, PU Shilei, LI Xiaoyan. Clinical data analysis of 36 cases of antrochoanal polyp in Children[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 159-163.

参考文献

[1] Bakshi SS, Vaithy K A. Antrochoanal polyp[J]. J Allergy Clin Immunol Pract, 2017, 5(3): 806-807. doi:10.1016/j.jaip.2016.10.005
[2] Yuca K, Bayram I, A Faruk Kirolu, et al. Evaluation and treatment of antrochoanal polyps[J]. J Otolaryngol, 2006, 35(6): 420-423. doi: 10.2310/7070.2005.0039
[3] Yaman H, Yilmaz S, Karali E, et al. Evaluation and management of antrochoanal polyps[J]. Clin Exp Otorhinolaryngol, 2010, 3(2): 110-114. doi:10.3342/ceo.2010.3.2.110
[4] Bakheet M, Althawadi N, Albinali S, et al. Day case endoscopic excision of an antrochoanal polyp in a paediatric patient[J]. J Surg Case Rep, 2021,(6): 1-3. doi:10.1093/jscr/rjab234
[5] Comoglu S, Celik M, Enver N, et al. Transnasal prelacrimal recess approach for recurrent antrachoanal polyp[J]. J Craniofac Surg, 2016, 27(4): 1025-1027. doi:10.1097/SCS.0000000000002699
[6] Alekseenko S, Karpishchenko S. Comparison of the efficiency and safety of endonasal and open rhinosurgery in children[J]. Laryngoscope, 2020, 130(4): 1056-1063. doi:10.1002/lary.28145
[7] 陶泽璋, 任杰, 陈始明. 儿童慢性鼻-鼻窦炎再次鼻内镜手术的若干问题[J]. 山东大学耳鼻喉眼学报, 2011, 25(5): 36-37
[8] 许庚, 史剑波, 文卫平. 儿童鼻窦炎规范化诊断和治疗[J]. 中国耳鼻咽喉头颈外科, 2005, 12(7): 407-410
[9] 范文焱, 李晓艳, 赵利敏, 等. 鼻窦可吸收类固醇缓释植入系统在儿童鼻内镜手术中的初步应用[J]. 中国眼耳鼻喉科杂志, 2021, 21(1): 16-20, 24. doi:10.14166/j.issn.1671-2420.2021.01.005 FAN Wenyan, LI Xiaoyan, ZHAO Limin, et al. Preliminary application of bioabsorbable steroid-eluting sinus implants in functional endoscopic sinus surgery in children[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2021, 21(1): 16-20, 24. doi:10.14166/j.issn.1671-2420.2021.01.005
[10] Lim M, Lew-Gor S, Darby Y, et al. The relationship between subjective assessment instruments in chronic rhinosinusitis[J]. Rhinology, 2007, 45(2): 144-147
[11] Lund VJ, Kennedy DW. Staging for rhinosinusitis[J]. Otolaryngol Head Neck Surg, 1997, 117(3 Pt 2): S35-S40. doi:10.1016/s0194-5998(97)70005-6
[12] Aksakal C. Bilateral antrochoanal polyp in a child[J]. J Craniofacial Surg, 2018, 29(8): 2368-2369. doi:10.1097/scs.0000000000004947
[13] Galluzzi F, Pignataro L, Maddalone M, et al. Recurrences of surgery for antrochoanal polyps in children: a systematic review[J]. Int J Pediatr Otorhinolaryngol, 2018, 106: 26-30. doi:10.1016/j.ijporl.2017.12.035
[14] Chaiyasate S, Roongrotwattanasiri K, Patumanond J, et al. Antrochoanal polyps: how long should follow-up be after surgery? [J]. Int J Otolaryngol, 2015, 8(3):297417. doi:10.1155/2015/297417
[15] Choudhury N, Hariri A, Saleh H, et al. Diagnostic challenges of antrochoanal polyps: a review of sixty-one cases[J]. Clin Otolaryngol, 2018, 43(2): 670-674. doi:10.1111/coa.12993
[16] Jin P, Zi X, Charn TC, et al. Histopathological features of antrochoanal polyps in Chinese patients[J]. Rhinology, 2018, 56(4): 378-385. doi:10.4193/Rhin18.057
[17] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(S29): 1-464. doi:10.4193/Rhin20.600
[18] 李树华, 石洪金, 吴大海, 等. 上颌窦后鼻孔息肉起源临床观察[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(9): 764-766. doi:10.3760/cma.j.issn.1673-0860.2012.09.014 LI Shuhua, SHI Hongjin, WU Dahai, et al. Clinical observation on the origin of antrochoanal polyp[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2012, 47(9): 764-766. doi:10.3760/cma.j.issn.1673-0860.2012.09.014
[19] Amedee RG. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis[J]. Am J Rhinol Allergy, 2017, 31(4): 278. doi:10.2500/194589217821335822
[20] Adriaensen GFJPM, Lim KH, Fokkens WJ. Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial[J]. Int Forum Allergy Rhinol, 2017, 7(8): 813-820. doi:10.1002/alr.21963
[21] Konno W, Kashiwagi T, Tsunemi Y, et al. Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid[J]. Auris Nasus Larynx, 2019, 46(3): 365-373. doi:10.1016/j.anl.2018.09.001
[22] 倪祎华, 许政敏. 鼻窦球囊扩张结合全降解药物支架治疗儿童慢性鼻窦炎的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(6): 481-485, 491. doi:10.13201/j.issn.2096-7993.2020.06.001 NI Yihua, XU Zhengmin. Use of balloon catheter dilation and bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(6): 481-485, 491. doi:10.13201/j.issn.2096-7993.2020.06.001
[23] 钟建文, 罗向前, 程超, 等. 鼻窦球囊扩张联合药物支架治疗儿童慢性鼻-鼻窦炎伴鼻息肉的疗效及并发症分析[J]. 中国耳鼻咽喉头颈外科, 2021, 28(4): 208-211. doi:10.16066/j.1672-7002.2021.04.003 ZHONG Jianwen, LUO Xiangqian, CHENG Chao, et al. Analysis of efficacy and complications of drug stent in sinus balloon dilatation for children with chronic sinusitis with nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(4): 208-211. doi:10.16066/j.1672-7002.2021.04.003
[24] Hwang CS, Al Sharhan SS, Kim BR, et al. Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery[J]. Laryngoscope, 2018, 128(2): 311-316. doi:10.1002/lary.26871. doi:10.6040/j.issn.1673-3770.2022.228

相关文章 15

[1]	朱希倩,王佳,孙祖贤,冯建秀,张梦佳,赵颖,王宏,姜敏敏. 上海市杨浦区2022—2024年6~9岁学龄儿童屈光状态分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 102-109.
[2]	宋艳玲,司元元,崔彦. 微量玻璃体切除治疗激光笔致儿童全层黄斑裂孔1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 144-147.
[3]	刘南仙,杨泽垠,韩琳,张爱英,赵宇亮,薛静,孙怡君,邵永良. 视频脑电图在儿童复发性眩晕诊断中的意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 20-25.
[4]	黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[5]	王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.
[6]	郭荣昌,刘晴航,王洪增,孙树军. 巨大鼻眼贯通、颅底嵌顿异物损伤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 135-141.
[7]	王华,张丰珍,龙婷,赵靖,李宏彬,王生才,王桂香. 后颅窝肿瘤术后儿童气管切开原因及预后转归分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 168-173.
[8]	乐冰艳,邹剑,雷蕾,文巧,钱应雪. 儿童扁桃体微生物群与免疫调节及疾病关联[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 193-200.
[9]	黄爱萍,王娟,王丽,耿江桥,王亚芳,温鑫. 儿童原发扁桃体Burkitt淋巴瘤累及上颌骨和肺1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 148-152.
[10]	刘畅,杨景朴,高雨,王文佳. 长春地区儿童变应性鼻炎变应原检测结果分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 51-58.
[11]	付圣尧,陈敏,庞文会,李娜. 内镜辅助个体化手术入路治疗儿童鼻中线囊肿及瘘管[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 65-71.
[12]	陈丹萍,何子键,虞幼军,周晓娓. 儿童突发性聋10年住院病例的疗效及预后相关因素分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 16-22.
[13]	杨娜,柳荫,郭宝,纪尧峰,成晨,张琛,董丽娜. 高频超声在儿童鼻骨骨折闭合复位术的应用研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 41-45.
[14]	王登茂,温鑫,耿江桥,张光远,刘晓峰. 儿童咽鼓管毛息肉合并鼻咽部错构瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 105-109.
[15]	姚婷婷,张德伦,李兰. 婴儿下咽部胃黏膜异位症引发咽喉反流症状1例并文献回顾[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 126-130.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed