内镜下中鼻道上颌窦自然开口入路与泪前隐窝入路治疗上颌窦后鼻孔息肉的临床效果和术后复发情况

Clinical effects and postoperative recurrence of endoscopic natural opening in the middle nasal meatus-maxillary sinus and prelacrimal recess approach in treating antrochoanal polyp

摘要:

目的 观察内镜下中鼻道上颌窦自然开口入路与泪前隐窝入路治疗上颌窦后鼻孔息肉（ACP）的临床效果和术后复发情况。方法 回顾性分析2019年3月－2023年3月该院收治的64例ACP患者的临床资料，根据手术入路不同，分为对照组（n = 32）与研究组（n = 32），对照组采用内镜下中鼻道上颌窦自然开口入路治疗，研究组采用内镜下泪前隐窝入路治疗，比较两组患者临床疗效、手术指标、手术前后Lund-Mackay鼻内镜评分和鼻窦CT Lund-Mackay评分，以及术后5个月并发症和复发情况。结果 研究组总有效率为93.75%，高于对照组的75.00%，且研究组术中出血量少于对照组，住院时间短于对照组，差异均有统计学意义（P < 0.05）；术后3个月，两组患者Lund-Mackay鼻内镜评分和鼻窦CT Lund-Mackay评分较术前低，且研究组低于对照组，差异均有统计学意义（P < 0.05）；研究组复发率为3.13%，低于对照组的18.75%，差异有统计学意义（P < 0.05），两组患者术后并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 内镜下泪前隐窝入路治疗ACP的临床疗效好，能全面地清理病灶，且术中出血少，住院时间短，术后复发率较低，较内镜下中鼻道上颌窦自然开口入路更具优势。

Abstract:

Objective To observe the clinical effects and postoperative recurrence of endoscopic natural opening in the middle nasal meatus-maxillary sinus and prelacrimal recess approach in treating antrochoanal polyp (ACP).Methods Clinical data of 64 patients with ACP from March 2019 to March 2023 were analyzed retrospectively. According to different surgical approaches, the patients were divided into control group (n = 32, endoscopic natural opening in the middle nasal meatus-maxillary sinus) and study group (n = 32, endoscopic prelacrimal recess approach). Clinical efficacy, surgical indicators, preoperative and postoperative Lund-Mackay nasal endoscopy scores and sinus CT scores were compared between the two groups. Complications and recurrence that occurred within 5 months after surgery were recorded.Results The total clinical effective rate in the study group was 93.75%, higher than that in the control group 75.00%, the difference was statistically significant (P < 0.05). Intraoperative blood loss of the study group less than that of control group, hospital stay of the study group shorter than that of the control group, the differences were statistically significant (P < 0.05). Three months after surgery, Lund-Mackay nasal endoscopy scores and Lund-Mackay CT scores of both groups decreased, and the study group was lower than those of the control group, the differences were statistically significant (P < 0.05). The recurrence rate in the study group was 3.13%, lower than that in the control group 18.75%, the difference was statistically significant (P < 0.05), but there was no significant difference in the total incidence of postoperative complications between the groups (P > 0.05).Conclusion Endoscopic prelacrimal recess approach is effective in the treatment of ACP. It can clean up the lesions, with little intraoperative blood loss and short hospital stay. Compared with endoscopic natural opening in the middle nasal meatus-maxillary sinus, the recurrence rate after endoscopic prelacrimal recess approach is lower.