修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎

目的探讨修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻一鼻窦炎的手术效果及应用价值。方法35例难治性鼻一鼻窦炎经CT检查、鼻内窥镜检查、局部用药等规范术前准备，行改良鼻丘径路额窦开放为主修正手术加中鼻甲全部或部分切除，术后凭鼻内镜保健手册进行定期复查，规范随访。26例合并鼻中隔偏曲者其中16例行内镜下传统矫正切除，10例行局限性矫正切除；15例合并变应性鼻炎者对下鼻甲前端、中鼻甲对应鼻中隔等部位黏膜电凝。结果35例患者门诊内镜随诊3～6月以上，治愈11例（31．4％），黏膜完全上皮化；好转18例（51．4％），黏膜可以上皮化，但变应性鼻炎发作时，术腔黏膜水肿，经局部处理及药物治疗后可恢复上皮化；无效6例（17．2％）。总有效率82-8％，6例无效均为合并变应性鼻炎及哮喘患者。结论修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻鼻窦炎，疗效较为确切，值得临床推广。

Revised endoscopic sinus surgery with combined middle turbinectomy in refractory rhinosinusitis

Objective To evaluate differences in chronic rhinosinusitis after endoscopic sinus surgery for patients with and without partial middle turbinate resection（PMT）.Methods The clinical data of 122 patients with chronic rhinosinusitis treated by nasal endoscopic were analyzed by retrospective analysis.Using visual analogue scale（VAS）,sino-nasal outcome test-20 Chinese version scales（SNOT-20 CV）,Lund-Mackay CT and Lund-Kennedy endoscopy methods to do the subjective and objective assessment.Comprehensive evaluation of clinical outcome for patients with and without partial middle turbinate resection was performed before and after treatment.Results①Patients with PMT resection were more likely to have nasal polyps and/or deviation of nasal septum compared to those with PMT preservation（P〈0.05）,but there was no significant differences between the incidence rate of allergic rhinitis and/or asthma in the two groups（P〉0.05）;②Patients with PMT resection had significantly higher baseline disease burden measured by endoscopy and CT scores（P〈0.05）,but there was no significant differences in VAS and SNOT-20CV scores between patients with PMT resection and those with PMT preservation before surgery（P〉0.05）;③Patients undergoing PMT resection were more likely to show improvements in endoscopy scores（P〈0.05）,but no significant differences in improvement were found in VAS and SNOT-20CV scores between patients with PMT resection and those with PMT preservation after endoscopic sinus surgery（P〉0.05）.Conclusion Our study shows that Patients undergoing partial resection of middle turbinate were usually combined with nasal polyps and/or deviation of nasal septum.We also found there was no difference in baseline quality-of-life between or quality-of-life improvement after endoscopic sinus surgery.Patients undergoing partial resection of middle turbinate did,however,show greater improvements in endoscopy scores.