两种手术方式对嗜酸粒细胞性慢性鼻窦炎伴鼻息肉患者术腔状态转归的影响  

The influence of two kinds of transnasal endoscopic surgery on the outcome status of sinus cavity in patients with eosinophilic chronic rhinosinusitis with nasal polyps

作　　者：武勇进 刘涛 马建仁 王文烨 欧淑敏 赵勇[4] 高杰 许庚 孙悦奇[7] Wu Yongjin;Liu Tao;Ma Jianren;Wang Wenye;Ou Shumin;Zhao Yong;Gao Jie;Xu Geng;Sun Yueqi(Department of Otorhinolaryngology,Longgang ENT Hospital&Shenzhen Key Laboratory of ENT Institute,Shenzhen 518172,China;Department of Otorhinolaryngology of Xiamen Humanity Hospital,Xiamen 361009,China;Department of Otorhinolaryngology of Guangdong Clifford Hospital,Guangzhou 511495,China;Department of Pathology of District Maternity and Longgang Heathcare Hospital,Shenzhen 518172,China;Department of Pathology of Xiamen Humanity Hospital,Xiamen 361009,China;Otorhinolaryngology Hospital of the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 518000,China;Department of Otorhinolaryngology of the Seventh Affiliated Hospital,Sun Yat-Sen University,Shenzhen 510080,China)

机构地区：[1]深圳市龙岗区耳鼻咽喉科医院耳鼻咽喉科、深圳市耳鼻咽喉研究所,深圳518172 [2]厦门弘爱医院耳鼻咽喉科,厦门361009 [3]广东祈福医院耳鼻咽喉科,广州511495 [4]深圳市龙岗区妇幼保健院病理科,深圳518172 [5]厦门弘爱医院病理科,厦门361009 [6]中山大学附属第一医院耳鼻咽喉科医院,广州518000 [7]中山大学附属第七医院耳鼻咽喉科,深圳510080

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第12期1450-1456,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：深圳市医学重点学科建设经费(SZXK039);深圳市科技计划项目(JCYJ20180305163337325);深圳市龙岗区医疗卫生科技计划项目(LGKCYLWS2019000577);厦门市医疗卫生指导性项目(3502Z20209071)。

摘　　要：目的观察全鼻窦轮廓化手术和部分重启手术对嗜酸粒细胞性慢性鼻窦炎伴鼻息肉(eosinophilic chronic rhinosinusitis with nasal polyps,eCRSwNP)术腔状态转归的影响,并探讨嗜酸粒细胞含量与术腔状态的相关性。方法对2018年3月至2021年10月,于深圳市龙岗区耳鼻咽喉科医院、厦门弘爱医院、广东番禺祈福医院和中山大学附属第一医院共4家医院诊治的eCRSwNP患者分别施行全鼻窦轮廓化手术和部分重启手术,对前期无手术史者采用全鼻窦轮廓化手术,对前期有手术史者采用部分重启手术,并持续进行术后随访观察。将术后随访时间定为以下5个阶段,分别为术后6、12、20~24、32~36个月,以及42个月以上。术后鼻内镜评估采用功能性内镜鼻窦手术(FESS)-95广州标准,将术腔状态分为:良好、较好、不好3类。对术后5个时间段的术腔状态与嗜酸粒细胞含量的关联进行单因素方差分析,P<0.05认为差异有统计学意义。结果共72例符合要求的eCRSwNP患者完成随访观察,其中男47例,女25例,年龄11~67岁。其中全鼻窦轮廓化手术组50例,部分重启手术组22例,术后随访时间6~48个月。随访情况如下:完成6个月者72例(100.0%),12个月者72例(100.0%),20~24个月者46例(63.9%),32~36个月者36例(50.0%),42个月以上者16例(22.2%)。无论轮廓化手术还是部分重启手术,术后6个月均未出现术腔状态"不好"的情况,直至术后1年以上才逐渐出现分化。术后随访的5个阶段中,术腔状态"良好"率轮廓化手术组为78.0%、66.0%、56.7%、47.6%和42.9%,部分重启手术组为63.6%、45.5%、25.0%、20.0%和11.1%,轮廓化手术组始终优于部分重启手术组;术腔状态"不好"率轮廓化手术组为0、8.0%、10.0%、14.3%和28.6%,部分重启手术组为0、27.3%、18.8%、33.3%和55.6%,部分重启手术组始终高于轮廓化手术组。72例eCRSwNP患者的鼻息肉中嗜酸粒细胞含量平均为42.1%,嗜酸粒细胞含量对术腔状�Objective To investigate the trend of postoperative cavity status in patients with eosinophilic chronic sinusitis with nasal polyps(eCRSwNP)who underwent total nasalization surgery and partial reboot surgery.And to discuss the relationship between tissue eosinophil counts and status of postoperative cavity.Methods Patients with eCRSwNP in four tertiary medical centers(Longgang ENT Hospital,Xiamen Humanity Hospital,Guangdong Clifford Hospital and the First Affiliated Hospital of Sun Yat-Sen University)from March 2018 to October 2021 were divided into 2 groups.The group without previous surgery history was performed for the nasalization surgery,and another group with previous surgery history underwent the part-reboot surgery.The follow-up time after operation was defined as the following 5 stages:6,12,20-24,36 and more than 42 months.According to FESS-95 Guangzhou standard,status of sinus cavity was assessed and classified into 3 categories:good,better and bad.The association between the sinus cavity status and tissue eosinophil counts in the above 5 stages was analyzed by one-way ANOVA,and P<0.05 was considered statistically significant.Results A total of 72 eCRSwNP patients finished the follow-up in this study.There were 47 males and 25 females in these patients,aged from 11 to 67 years.A total of 50 cases underwent nasalization surgery and 22 cases underwent partial reboot surgery.With the follow-up time from 6 to 48 months,there were 72 cases(100.0%)who completed 6 months and 12 months follow up,46 cases(63.9%)for 20-24 months,36 cases(50.0%)for 32-36 months and 16 cases(22.2%)with the follow-up time more than 42 months.No matter what kind of surgery,there was no"bad"situation of the surgical cavity status 6 months after the operation,and the differentiation gradually occurred more than 12 months after the surgery.Moreover,the rates of"good"cavity status for the 5 stages in the group of nasalization surgery were 78.0%,66.0%,56.7%,47.6%and 42.9%,and were 63.6%,45.5%,25.0%,20.0%and 11.1%in the partial reboot surg

关 键 词：嗜酸粒细胞性慢性鼻窦炎伴鼻息肉 全鼻窦轮廓化手术 部分重启手术 术腔状态 形态学转归 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]