Abstract: Objective In order to evaluate the efficacy and safety of orally administered Xiangju Capsule and lavage with the Kangfuxin solution in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)after functional endoscopic sinus surgery(FESS). Methods From January to December 2019, 90 patients with CRSwNP were randomly divided into three groups: rehabilitation (n=30), Xiangju(n=30), and control (n=30). All patients underwent FESS and the same routine postoperative management. After FESS, the control, Xiangju, and Kangfuxin groups were treated with budesonide nasal spray, Xiangju capsule, and Kangfuxin solution, respectively. The course of treatment was 12 weeks. The clinical effects, postoperative mucosal outcome, adverse reactions, and recurrence were compared among the three groups. The visual analogue scale(VAS)score of subjective symptoms and levels of high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factors, and interleukin(IL)-6 and IL-10 were measured before and after the operation. Results There was no significant difference in the total effective rate in 96.7%(29/30)of the rehabilitation group, 93.3%(28/30)of the Xiangju group, and 86.7%(26/30)of the control group(P>0.05). Compared to the Xiangju group, there was no significant difference in the recurrence rate 1 year postoperatively in the group(P>0.05). As the treatment time prolonged, the VAS scores of subjective symptoms in all three groups gradually decreased(P<0.05). Four and 12 weeks postoperatively, the subjective symptom scores were significantly lower in the rehabilitation and Xiangju groups than in the control group(P<0.05)and in the rehabilitation group compared to the Xiangju group(P< 0.05). Eight weeks postoperatively, the epithelialization rate was 65.5%(19/29)in the Kangfuxin group, which was significantly higher than that in the Xiangju or control group(40.0% ［12/30］; 26.7% ［8/30］, P<0.05). Compared to the control group, the time of Mucosal epithelization in Kangfuxin group and Xiangju group was significantly shorter (P<0.05), and the time of mucosal epithelization in the Kangfuxin group was more favorable than that in the Xiangju group(P<0.05). The Lund-Kennedy score in all three groups decreased gradually with the treatment time(P<0.05). At the same time point, the Lund-Kennedy score in the rehabilitation and Xiangju groups were significantly lower than those in the control group(P<0.05)and in the rehabilitation group compared to the Xiangju group(P<0.05). The levels of serum hs-CRP, TNF, and IL-6 were significantly lower in the Kangfuxin and Xiangju groups than in the control group(P<0.05), and the levels of serum IL-10 were significantly higher in the Kangfuxin and Xiangju groups than in the control group(P<0.05). After 3, 7, and 15 days, the improvement in serum inflammatory factors in the rehabilitation group was significantly better than that in the Xiangju group(P<0.05). There were no significant drug-related side effects in any patient. Conclusion Compared to the treatment with the oral Xiangju capsule, the overall efficacy, recurrence control, and safety of post-FESS nasal spray combined with budesonide nasal spray and Kangfuxin irrigation were similar. However, the clinical symptoms of patients with CRSwNP can be quickly alleviated using the Kangfuxin solution, which can speed up the improvement of the mucosa and further shorten the time of mucosal epithelization. The mechanism of action may be the rapid correction of the imbalance of inflammatory factors in the body. “Budesonide nasal spray plus rehabilitation fluid irrigation cavity” is expected to become a standard treatment after FESS.

Key words: Chronic rhinosinusitis with nasal polyps, Functional endoscopic sinus surgery, Xiangju capsule, Kangfuxin solution, Mucosal outcome, Inflammatory factors