摘要
目的:探讨基于炎症负荷理念下轮廓化鼻内镜术治疗难治性鼻窦炎(Difficult-to-treat rhinosinusitis,DTRS)患者的效果。方法:按照随机数字表法将2020年6月至2022年6月我院96例DTRS患者分为两组,每组各48例,两组均符合炎症负荷理念,其中功能组行功能性鼻内镜术(Functional Endoscopic Sinus Surgery,FESS),轮廓组行轮廓化鼻内镜术(Radical sinus surgery,RSS),术后6 m末,采用鼻内镜观察鼻黏膜,评估手术疗效;术后6 m末,采用ELISA检测免疫球蛋白E(Immunoglobulin E,IgE)、嗜酸性粒细胞阳离子蛋白(Eosinophil cationic protein,ECP)水平;术后6 m末,采用鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分分别评估鼻腔、鼻窦症状;术后统计两组并发症,随访6 m观察复发率。结果:轮廓组总有效率高于功能组(P<0.05);术后1 d,两组血清IgE、ECP均较术前降低,且轮廓组低于功能组(P<0.05),术后6 m末,两组IgE、ECP均较术后1 d降低,但两组对比无显著差异(P>0.05);术后6 m末,轮廓组Lund-Kennedy、鼻窦CT Lund-Mackay评分均低于功能组(P<0.05);两组并发症发生率和复发率对比无显著差异(P>0.05)。结论:在DTRS患者中实施基于炎症负荷理念下的RSS手术治疗效果显著,可有效减轻机体免疫炎性反应,改善鼻腔鼻窦功能,且未增加相关并发症和复发率,手术安全性好。
Objective:To investigate the efficacy of contouring rhinosinusitis(DTRS)in patients with Difficult-to-treat rhinosinusitis(DTRS)based on the concept of inflammatory load.Methods:According to the method of random number table,ninety-six patients with DTRS in our hospital from June 2020 to June 2022 were divided into two groups,with 48 cases in each group.Both groups were in line with the concept of inflammatory load,and the Functional group underwent Functional Endoscopic Sinus Surgery(FESS).In the contour group,Radical sinus surgery(RSS)was performed.Nasal mucosa was observed by nasal endoscope at the end of 6 months after surgery,and the curative effect was evaluated.At the end of 6 months after surgery,Immunoglobulin E(IgE)and Eosinophil cationic protein(ECP)levels were detected by ELISA.At the end of 6 months after the operation,nasal symptoms and sinus symptoms were evaluated by nasal endoscope Lund-Kennedy score and sinus CT Lund-Mackay score.The complications of the two groups were counted after the operation,and the recurrence rate was observed at a follow-up of 6 months.Results:The total effective rate of the contour group was higher than that of the function group(P<0.05).One day after surgery,serum IgE and ECP in both groups were lower than before surgery,and the contour group was lower than the functional group(P<0.05).Six months after surgery,IgE and ECP were lower than 1 day after surgery,but there was no significant difference between the two groups(P>0.05).At the end of 6 months after surgery,the Lund-Kennedy and sinus CT Lund-Mackay scores in the contour group were lower than those in the functional group(P<0.05).There was no significant difference in complication rate and recurrence rate between the two groups(P>0.05).Conclusion:In DTRS patients,the implementation of RSS surgery based on the concept of inflammation load has significant effects,which can effectively reduce the immune inflammatory response of the body,improve the function of nasal and nasal sinuses,and not increase the related complications and recurrence rate,and the surgical safety is good.
作者
张金增
郭瑞华
王英
Zhang Jin-zeng;Guo Rui-hua;Wang Ying(Department of Otorhinolaryngology,Xunxian People's Hospital,Xunxian 456250,Henan,China;Department of Pathology,Xunxian People's Hospital,Xunxian 456250,Henan,China;Department of Rhinology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
关键词
炎症负荷理念
轮廓化鼻内镜术
难治性鼻窦炎
炎性变态反应
鼻腔鼻窦功能
Inflammatory load concept
Contouring nasal endoscopy
Refractory sinusitis
Inflammatory allergy
Nasal sinus function
作者简介
张金增,男,副主任医师,主要从事经鼻内窥镜鼻窦手术,Email:zhangjinzengiod@163.com。
