修正性鼻内镜手术治疗复发性鼻-鼻窦炎的临床分析

Revision endoscopic sinus surgery for the treatment of recurrent rhinosinusitis

摘要:

目的  探讨慢性鼻-鼻窦炎鼻内镜术后复发的原因及提高修正性鼻内镜手术效果的相关措施。方法  回顾性分析84例复发性鼻-鼻窦炎患者的临床资料，所有患者均在鼻内镜下行修正性手术，并在围手术期进行规范化的综合处理，术后随访12个月以上，观察临床疗效。结果  84例患者术后1年，病情完全控制57例（67.9%），部分控制19例（22.6%），总有效率90.5%，未控制8例（9.5%）。术后无严重并发症。其中，伴有哮喘组有效率为79.2%，而无哮喘组的有效率为95.0%，经χ2检验差异有统计学意义（P <0.05）。结论  慢性鼻-鼻窦炎鼻内镜术后复发原因主要有：病变窦腔开放不全、解剖变异未矫正、术腔增生粘连、骨炎和变应性炎症等。通过修正性鼻内镜手术，结合围手术期规范的综合治疗，复发性鼻-鼻窦炎治疗效果满意，合理的鼻内镜手术操作是提高复发性鼻-鼻窦炎疗效的关键。

Abstract:

 【Objective】 To investigate the causes of recurrent rhinosinusitis (RR) after endoscopic sinus surgery (ESS), and to discuss the methods to improve the therapeutical effect of revision ESS. 【Methods】 The clinical data involving 84 patients with RR were analyzed retrospectively. All patients received revision ESS following the standardized therapy during the perioperation period, and they were followed up for over 12 months. 【Results】 Within a 12-month follow-up, 57 of 84 patients (67.9%) were cured, and 19 of 84 patients (22.6%) were improved. However, 8 of 84 patients (9.5%) were ineffective. Therefore, the total effective rate in all 84 patients was 91.7%. Moreover, the effective rate in the asthma group was 79.2%, while it was 95.0% in the asthma-free group, which was statistically significant by the chi-square test (P < 0.05). 【Conclusion】 The main causes of RR after ESS include incompletely removal of lesions sinus, anatomic variations without correction, postoperative adhesion, osteitis and allergic inflammation. The revision ESS, together with the combined modality therapy is effective for the treatment of RR. Additionally, the proper surgical skills during the ESS play a key role to improve the final outcome of the RR.