鼻内镜Messerklinger中鼻甲成形术与鼻内镜中鼻甲部分切除术治疗CRSwNP的效果  

Comparison of effects of nasal endoscopic Messerklinger middle turbinoplasty and nasal endoscopic partial middle turbinate resection in the treatment of chronic rhinosinusitis with nasal polyps

作　　者：秦晨晨 杜辉虎 汪永宽 刘建敏[1] 李玲[1] QIN Chenchen;DU Huihu;WANG Yongkuan;LIU Jianmin;LI Ling(Department of Otolaryngology Head and Neck Surgery,Deyang People's Hospital,Deyang 618000,Sichuan,China)

机构地区：[1]德阳市人民医院耳鼻咽喉头颈外科,四川德阳618000

出　　处：《西部医学》2024年第6期910-915,共6页Medical Journal of West China

基　　金：四川省医学科研青年创新课题(Q18007)。

摘　　要：目的探讨鼻内镜Messerklinger中鼻甲成形术与鼻内镜中鼻甲部分切除术治疗慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的效果。方法选取2019年1月—2021年1月在我院拟行鼻内镜手术治疗的CRSwNP患者94例,随机分为鼻甲成形组和鼻甲部分切除组,每组47例。鼻甲成形组选择鼻内镜Messerklinger中鼻甲成形术治疗,鼻甲部分切除组选择鼻内镜中鼻甲部分切除术治疗,评估两组临床疗效,并对比两组术前、术后1周及术后3个月的鼻功能和粘膜组织炎症生化指标含量[人软骨糖蛋白-39(YKL-40)、白介素细胞-6(IL-6)、MUC5AC阳性表达面积百分率]变化,记录两组术后并发症和术后随访1年的复发率。结果与鼻甲部分切除组比较,鼻甲成形组的临床总有效率显著性提升(93.62%vs 76.60%,P<0.05);观察各项鼻功能指标和粘膜组织炎症生化指标发现,两组进行组间、时间点及组间·时间点的交互效应时,差异均有统计学意义(P<0.05),其中两组术后1周及3个月后的鼻粘膜纤毛输送速率相比术前有显著性提高,鼻气道阻力、内镜Lund-Kennedy、嗅觉功能评分和粘膜组织YKL-40、IL-6含量及MUC5AC阳性表达面积百分率相比术前显著降低(均P<0.05),上述指标两组间比较差异均有统计学意义(P<0.05);两组患者术后并发症总发生率差异无统计学意义(P>0.05);鼻甲成形组随访1年的复发率均显著低于鼻甲部分切除组(P<0.05)。结论CRSwNP患者选择鼻内镜Messerklinger中鼻甲成形术治疗,能提升临床疗效,促使患者的鼻功能、鼻粘膜炎症改善,效果比鼻内镜中鼻甲部分切除术更好,且并未增加术后并发症,患者术后复发率也更低。Objective To explore and compare the effects of nasal endoscopic Messerklinger middle turbinoplasty and nasal endoscopic partial middle turbinate resection in treating chronic rhinosinusitis with nasal polyps(CRSwNP).Methods 94 patients with CRSwNP were selected and randomly assigned to turbinoplasty group(n=47)and partial turbinate resection group(n=47).The turbinoplasty group was given nasal endoscopic Messerklinger middle turbinoplasty while the partial turbinate resection group chose nasal endoscopic partial resection of middle turbinate.The clinical efficacy of the two groups was evaluated.The nasal function indicators(nasal mucociliary transport rate,nasal airway resistance,endoscopic Lund-Kennedy score,olfactory function score)and mucosal inflammatory biochemical indicators[human cartilage glycoprotein-39(YKL-40),interleukin-6(IL-6),percentage of MUC5AC positive expression area]of both groups before surgery and at 1 week and 3 months after surgery were compared.The postoperative complications and recurrence rate at 1 year of follow-up after surgery were recorded.Results Compared with partial turbinate resection group,the total effective rate in turbinoplasty group was significantly enhanced(93.62%vs 76.60%,P<0.05).Observations of nasal function indicators and mucosal inflammatory biochemical indicators found there were significant differences from the perspectives of between-group effect,time-point effect and interaction effect of between-group with time-point(P<0.05).The ciliary transport rate of nasal mucosa in both groups at 1 week and 3 months after surgery was significantly increased compared with that before surgery while the nasal airway resistance,endoscopic Lund-Kennedy score,olfactory function score,mucosal tissue YKL-40 and IL-6 levels and MUC5AC positive expression area percentage were significantly decreased compared to before surgery(P<0.05),and the differences in the above indicators between both groups were significant(P<0.05).The total incidence rate of postoperative complications showed n

关 键 词：慢性鼻-鼻窦炎伴鼻息肉 鼻内镜Messerklinger中鼻甲成形术 鼻内镜中鼻甲部分切除术 复发率 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]