内镜鼻窦术后筛窦糖皮质激素支架植入治疗鼻窦炎伴鼻息肉的疗效评估  

Efficacy of glucocorticoid stent implantation in ethmoid sinus after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

作　　者：周慧琴 章薇[1] 龚婉扬 靳晶 刘锟钰 许昱[1] ZHOU Huiqin;ZHANG Wei;GONG Wanyang;JIN Jing;LIU Kunyu;XU Yu(Department of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Research Institute of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Hubei Province Key Laboratory of Allergy and Immunology,Wuhan,430060,China)

机构地区：[1]武汉大学人民医院耳鼻咽喉头颈外科、武汉大学人民医院耳鼻咽喉头颈外科研究所、过敏及免疫相关疾病湖北省重点实验室,武汉430060

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第4期252-257,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金面上项目(No:82071017,82271134);中央高校基本科研业务费专项资金(No:2042021kf0232)。

摘　　要：目的:评估在功能性内镜鼻窦手术(FESS)术后2周植入糖皮质激素鼻窦支架治疗慢性鼻窦炎伴鼻息肉(CRSwNP)的疗效。方法:选取双侧病变程度相近的49例全组CRSwNP患者,随机分为支架组(25例)和对照组(24例)。支架组患者于FESS术后2周将糖皮质激素鼻窦支架植入双侧筛窦,对照组仅进行术腔清理。2组接受相同的术后治疗,分别于术后2、4、8、12周行随访评估。采集患者的鼻部症状视觉模拟量表(VAS)评分;通过鼻内镜检查评估筛窦阻塞及结痂/凝结物情况、有无囊泡或息肉样变黏膜形成、中鼻甲位置、有无粘连、鼻窦黏膜是否上皮化及筛窦术区是否需要干预等。应用GraphPad Prism 9进行统计学分析。结果:术后4周和8周,支架组患者鼻塞、流涕两项VAS评分较对照组有改善,差异有统计学意义(P<0.05)。在头面部闷胀感、嗅觉减退及鼻腔干燥/结痂感3项VAS评分中,2组差异无统计学意义(P>0.05)。相较于对照组,支架组患者在术后4、8、12周,筛窦黏膜形成囊泡或息肉样变率更低;术后12周,支架组筛窦腔黏膜上皮化率明显高于对照组;整个随访过程中,支架组需要术后干预的比例明显低于对照组(P<0.05)。在术后8、12周,支架组中鼻甲外移发生率较低;术后8周,支架组患者术腔粘连率显著降低(P<0.05)。结论:FESS术后植入糖皮质激素鼻窦支架可以保持窦腔通畅,改善术腔炎症状态,减少术后干预,促进术腔良性转归。Objective: To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery(FESS)for the treatment of chronic rhinosinusitis with nasal polyps(CRSwNP).Methods: CRSwNP patients with similar bilateral lesions were randomly divided into two groups,with a stent group of 25 patients and a control group of 24 patients.Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS,while the control group underwent postoperative debridement only.Follow-up assessments occurred at postoperative weeks 2,4,8,and 12.Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale.Efficacy was assessed by endoscopic evaluations.Sinus obstruction,crusting/coagulation,polyp formation,middle turbinate position,adhesions,mucosa epithelialization,and postoperative intervention were assessed as efficacy outcomes.GraphPad Prism 9 was applied for statistical analysis.Results: At 4 and 8 weeks postoperatively,the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group(P<0.05).No significant difference was observed in the VAS scores of head and facial stuffiness,loss of smell,or nasal dryness/crusting between the two groups(P>0.05).Compared with the control group,the stent group had a lower rate of polypoid formation at 4,8,and 12 weeks postoperatively.At postoperative week 12,the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group.During the follow-up,the frequency of postoperative intervention was significantly lower in the stent group than in the control group(P<0.05).Besides,a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively.At 8 weeks postoperatively,the stent group had a percentage of adhesion lower than that of the control group(all P<0.05).Conclusion: Implantation of glucocorticoid sinus stents after FESS

关 键 词：鼻窦炎 鼻息肉 内镜鼻窦手术 鼻窦支架 糖皮质激素 

分 类 号：R765.2[医药卫生—耳鼻咽喉科]