鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的疗效分析

探讨鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的疗效。方法 选取81例就诊于我科的变应性鼻炎伴鼻中隔偏曲患者,随机分为对照组40例和治疗组41例。对照组采用鼻中隔矫正术治疗,治疗组采用鼻中隔矫正联合射频消融治疗。观察两组治疗后3个月、6个月和1年的临床疗效以及并发症情况。结果 两组患者术后3个月治疗总有效率比较,差异无统计学意义（P＞0.05）;治疗组患者术后6个月和术后1年的治疗总有效率分别为85.00%和82.50%,均高于对照组的63.41%和58.54%,差异具有统计学意义（P＜0.05）。手术病例均未见鼻中隔穿孔、鼻腔粘连、下鼻甲萎缩等严重并发症。结论 相对于单纯鼻中隔矫正术,鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的远期疗效明显,安全性较高。     

改良切口鼻中隔成形术治疗变应性鼻炎

目的分析改良切口鼻中隔成形术治疗变应性鼻炎的临床疗效及对患者生存质量的影响。方法选取2013年7月至2015年4月在我院耳鼻喉科手术治疗的42例持续性中重度合并鼻中隔偏曲的变应性鼻炎患者,按手术方式不同分为观察组和对照组,观察组给予改良切口鼻中隔成形术治疗,对照组给予传统Kill Ian切口单纯鼻中隔黏膜切除术治疗,对2组患者的临床疗效,生存质量及视觉模拟评分进行比较。结果治疗后观察组总有效率94.24%,显著高于对照组的85.71%(χ~2=7.15,P0.05);治疗后观察组患者鼻塞、鼻痒、喷嚏等症状单项评分及总分均显著低于对照组(P0.05);治疗后观察组患者的鼻部问题、眼部问题、非鼻眼部问题及睡眠障碍较对照组得分显著降低(P0.05);术中情况显著优于对照组(P0.05)。结论采用改良切口鼻中隔形成术治疗合并鼻中隔偏曲的变应性鼻炎患者临床效果显著,能够显著改善患者的临床症状及生存质量。     

鼻内镜下鼻甲黏膜下部分切除术联合鼻中隔矫正术改善变应性鼻炎伴鼻中隔偏曲患者的嗅觉功能

目的:探讨鼻内镜下鼻甲黏膜下部分切除术联合鼻中隔矫正术治疗对变应性鼻炎(allergic rhinitis,AR)伴鼻中隔偏曲患者嗅觉的影响.方法:选取2017年6月至2020年12月收治的150例AR伴鼻中隔偏曲患者作为研究对象,采用随机数表法分为观察组和对照组,每组75例.两组均行鼻中隔矫正术,观察组在此基础上联合...     

手术联合治疗鼻中隔偏曲合并下鼻甲肥大临床观察

目的：总结分析手术联合治疗在鼻中隔偏曲合并下鼻甲肥大患者治疗中的应用效果。方法选择2010年6月~2012年12月我院收治的60例鼻中隔偏曲合并下鼻甲肥大患者为研究对象，根据治疗方法分为联合手术组和对照组各30例，对照组患者进行鼻中隔矫正术，联合手术组联合进行鼻中隔矫正术与下鼻甲外移术，观察比较两组患者的治疗效果。结果联合手术组治愈率73.33%明显高于对照组33.33%，差异具有统计学意义(P<0.05)；同时联合手术组好转率100.00%明显高于对照组80.00%，差异具有统计学意义(P<0.05)；联合手术治疗组术后3 d 1例鼻中隔局部血肿，并发症发生率为3.33%。对照组患者术后复查2例出现鼻腔局部粘连现象，并发症发生率为6.67%。两组患者术后并发症发生率之间相比不具有统计学意义(P>0.05)。结论对于鼻中隔偏曲合并下鼻甲肥大患者在CT与内镜技术辅助下试试鼻中隔偏曲矫正联合下鼻甲外移术治疗效果较好，且对组织损伤小，手术安全可靠，符合临床上功能性治疗原则，提高临床效果。     

鼻内镜下鼻中隔局部矫正术临床观察

目的:探讨鼻内镜下鼻中隔局部手术治疗的操作方法及临床疗效.方法:2007年8月至2009年7月,采用鼻内窥镜下鼻中隔局部矫正术治疗鼻中隔偏曲113例,其中软骨部"c"型偏曲19例、"s"型偏曲29例、嵴突31例、棘突26例、高位偏曲8例,合并鼻窦炎、鼻息肉48例.结果:本组113例鼻中隔偏曲手术矫正满意.术后随访3～12个月,所有主观症状均消失或明显减轻,治愈率82.3%(93 /113),好转率17.7%(20/113).无并发症发生.结论:鼻内窥镜下鼻中隔偏曲矫正手术视野清晰,手术精确彻底,大大降低了并发症的发生机率,是治疗鼻中隔偏曲较好的手术方法.     

内镜下改良切口个性化三线减张鼻中隔成形的疗效分析

目的 探讨鼻内窥镜下鼻中隔成形术术式的改良及手术疗效。方法 采用随机抽样法将2014年1月~2017年7月100例鼻中隔偏曲手术患者,随机分为改良组与对照组,每组50例,改良组采用鼻内镜下改良切口鼻中隔成形术新方法,对照组采用传统鼻中隔黏膜下矫正术手术方法,针对两组患者术后的鼻中隔病变、症状消失率、伤口出血、肿胀,疼痛、愈合情况及术后并发症进行回顾对比分析。结果 观察组手术时间、术中出血量、并发症、治疗效果优于对照组,比较差异均有统计学意义(P＜0.05);随访6个月,观察组无鼻中隔穿孔、鼻腔粘连等并发症发生,鼻塞、头痛等症状改善,改良组患者有效率（96.00%）高于对照组（84.00%）,差异有统计学意义（P<0.05）,整体治疗满意度高。结论 采用鼻内窥镜下改良切口个性化鼻中隔成形术改变了以往传统的手术方式,具有出血少、粘膜张力小、视野广、愈合好、微创、并发症少、疗效确切,更符合鼻腔生理功能,值得临床推广应用。     

鼻窦炎合并鼻中隔偏曲鼻内镜下联合手术治疗的临床体会

目的总结慢性鼻窦炎合并鼻中隔偏曲鼻内镜下联合手术治疗的优点疗效及安全性。方法对42例慢性鼻窦炎合并鼻中隔偏曲的患者行鼻窦手术联合鼻中隔矫正术。结果术后随访3~6个月,观察其疗效及并发症。所有手术患者术腔粘膜上皮化良好,鼻中隔矫正后未出现穿孔,血肿及脓肿,脑脊液鼻漏等严重并发症。结论鼻内镜手术过程中同时处理鼻窦炎及鼻中隔偏曲有效减少鼻窦炎复发。     

鼻内镜下手术治疗100例鼻中隔高位偏曲伴慢性鼻-鼻窦炎临床疗效观察

目的研究分析鼻内窥镜下手术治疗鼻中隔高位偏曲伴慢性鼻-鼻窦炎的临床疗效。方法选取本院收治的100例鼻中隔高位偏曲伴慢性鼻-鼻窦炎患者作为研究对象,将所选患者按照随机数字表法分为研究组和对照组,每组各50例。对照组患者给予鼻内镜下鼻窦手术进行治疗,研究组患者在对照组基础上联合鼻中隔高位偏曲矫正术进行治疗。回顾性分析两组患者的临床资料,比较分析两组患者治疗后的临床疗效及并发症发生情况。结果研究组患者治疗后的临床疗效总有效率(92.00%),明显高于对照组患者(74.00%),对比存在明显差异(P0.05);经治疗后,研究组患者的术后并发症发生率(12.00%),明显低于对照组患者(26.00%)(P0.05);研究组患者治疗后的复发率(6.00%),明显低于对照组患者(16.00%)(P0.05)。结论慢性鼻-鼻窦炎合并鼻中隔高位偏曲矫正患者应用鼻内镜下鼻窦开放术联合同期鼻中隔高位偏曲矫正术进行治疗可以获得良好疗效,并发症少,复发率低,有利于患者术后恢复,值得临床推广应用。     

负压引流在内镜下鼻中隔偏曲矫正术后的应用研究

目的分析内镜下鼻中隔偏曲矫正术后应用负压引流对并发症及预后的影响。方法选择2014年5月至2015年3月在我院就诊的鼻中隔偏曲患者80例,将其随机分为观察组和对照组。所有患者均在内镜下行鼻中隔偏曲矫正术,观察组患者在术后应用负压引流技术,对照组患者则在术后进行鼻腔填塞处理;观察2组患者术后12 h和24 h的主观症状、病情程度及并发症的情况,在术后1周观察并分析其临床疗效。结果术后24 h,观察组的主观症状明显的优于对照组,组间比较差异具有统计学意义(P0.05)。术后观察组的病情程度与对照组比较显著改善,即鼻黏膜水肿0级的比为40%,高于对照组的10%,差异具有统计学意义(P0.05)。术后1周观察2组的疗效,观察组的总有效率为97.50%,对照组的总有效率为80%,组间比较差异具有统计学意义(P0.05)。术后观察组并发症的发生率为2.50%,低于对照组的20%,差异具有统计学意义(P0.05)。结论在内镜下鼻中隔偏曲矫正术后应用负压引流,可有效缓解患者的痛苦,减少并发症的发生,且预后效果较好。     

奥马珠单抗联合布地奈德对变应性鼻炎患者临床疗效及外周血Eos、IgE的影响

目的 探讨奥马珠单抗联合布地奈德治疗变应性鼻炎(allergic rhinitis,AR)患者临床疗效、外周血嗜酸性粒细胞(eosnphils,Eos)及免疫球蛋白E(immunoglobulin E,IgE)的影响.方法 选择2017年1月至2019年10月于我院诊断为AR的患者150例,按照随机表法分为两组,各75例,对照组给予布地奈德治疗,研究组给予奥马珠单抗联合布地奈德治疗,比较两组患者临床疗效、外周血Eos及血清IgE变化.结果 研究组治疗有效率较对照组高(P＜0.05),且两组打喷嚏、流涕、鼻痒、鼻塞症状均较治疗前好转(P＜0.05),治疗后研究组鼻部症状缓解明显高于对照组,差异有统计学意义(P＜0.05).治疗后两组患者的RQLQ评分均较前下降(P＜0.05),研究组的RQLQ评分(21.34±5.62)较对照组(31.52±8.95)下降更明显(P＜0.05).治疗后两组患者NR、MTT均较治疗前下降,MCV较治疗前上升,且研究组NR、MTT较对照组下降更明显,研究组MCV较对照组上升更明显.治疗后两组患者的Eos均较前下降(P＜0.05),研究组(0.32±0.02)较对照组Eos(0.46±0.07)下降更明显(P＜0.05).治疗后两组患者血清IL-4、IL-10较治疗前下降,且研究组下降更明显(P＜0.05),血清IL-2、IFN-γ较治疗前均上升,研究组上升更明显(P＜0.05).治疗后两组患者血清IgE均较前下降,研究组血清IgE(0.31±0.08)较对照组(0.42±0.09)下降更明显(P＜0.05).两组患者有出现鼻出血、腹痛、头痛症状,差异无统计学意义(x2=2.788,P＞0.05).结论 奥马珠单抗联合布地奈德治疗变应性鼻炎较单用布地奈德能够提高临床疗效,改善生活质量、改善鼻功能,调整Th1/Th2失衡状态,降低外周血Eos及血清IgE水平.     

Use of nasal peak flow to assess nasal patency

Nasal patency is usually assessed in the laboratory by measuring nasal airflow conductance ( Gnaw ); peak inspiratory and/or expiratory flow measurements via the nose (PIFna, PEFna) have been proposed as simple alternatives suitable for home monitoring of rhinitis. We have compared the scale of changes in PIFna and PEFna (measured with a pneumotachograph) with changes in Gnaw (measured by the forced-oscillation technique) when nasal patency was increased by a topical α-adrenergic agonist, xylometazoline (five control subjects, seven with seasonal rhinitis, studied when asymptomatic) or decreased by topical histamine (eight control subjects). In further experiments, we altered intrapulmonary airway calibre by having subjects inhale histamine or salbutamol aerosols and examined effects on the configuration of nasal flow-volume curves (six subjects with rhinitis and mild asthma). After topical xylometazoline, there was a mean 283% increase in Gnaw 80% increase in PEFna, and 63% increase in PIFna. After topical histamine, there was a mean 72% decrease in Gnaw, 38% decrease in PEFna, and 39% decrease in PIFna. Inducing intrapulmonary airway obstruction sometimes obscured changes in nasal patency by removing the effects of added nasal resistance on expiration and preventing development of flow limitation in the nose on inspiration. Thus, after topical drug treatment to the nose, changes in Gnaw were considerably larger than in PEFna or PIFna, which were proportionately similar. Because PIFna is usually restricted by nasal flow limitation, it is probably superior to PEFna for assessing nasal patency. When effort is submaximal, intrapulmonary dynamic resistance is increased, or nasal dynamic resistance is low, PEFna and PIFna can give a misleading impression of nasal patency. These errors can be avoided by comparisons with mouth PEF and/or PIF, suggesting that nasal and mouth peak flow should both be measured during home monitoring.     

经鼻内窥镜选择性鼻中隔粘膜下切除术

目的：探讨经鼻内窥镜选择性鼻中隔粘膜下切除术的意义及手术方法。方法：根据不同的手术目的对204例需要行鼻中隔手术的病人，经鼻内窥镜实施选择性鼻中隔粘膜下切除术。结果：采用该技术对单纯性鼻中隔偏曲患者手术临床治愈率100％，其手术有效治愈头痛、鼻阻及鼻出血等鼻中隔偏曲临床症状，达到临床治疗目的。未出现鼻腔粘连、鼻中隔穿孔等并发症。有2例形成鼻中隔血肿，经放置引流管处理后治愈。对于解除高位鼻中隔偏曲解剖异常引发的鼻窦炎，手术后效果良好。取鼻中隔软骨做为修补材料手术效果满意。结论：经鼻内镜选择性鼻中隔粘膜下切除术目的性强、方法灵活、创伤小、并发症少、手术效果确切。     

Paradoxical low nasal nitric oxide in nasal polyposis

BACKGROUND: Nitric oxide (NO) is synthesized in the respiratory tract. Three isoforms of NO synthase have been described in man, with the inducible form related to inflammatory disease. In the paranasal sinuses constitutive production of nitric oxide has been demonstrated, with levels of 20-25 p.p.m. being found in sinus puncture. Nasal polyposis is a chronic inflammatory condition in which inducible nitric oxide synthase (iNOS) expression is elevated in nasal polyp epithelium. OBJECTIVES: 1. Measurement of upper airway nitric oxide in nasal polyposis patients compared with those with allergic rhinitis, and with normal controls. 2. To assess the effect of polyp treatment on nasal NO levels. METHODS: NO levels (parts per billion) were measured in nasal and pulmonary exhaled air using a LR 2000 Logan Sinclair nitric oxide gas analyser. This utilizes the chemiluminescence principle. Eighty-two patients were studied: 44 with rhinitis, but without polyps, and 38 with nasal polyps. NO levels were compared with those of 20 normal controls. In 23 further polyp patients, levels were measured pre- and post-treatment and the changes were compared with alterations in polyp size, as assessed by rigid nasendoscopy. RESULTS: Nasal NO levels were significantly lower (Kruskal-Wallis, P = 0.000, chi2 = 27.5, d.f. = 3) in patients with polyps than those found in uncomplicated allergic rhinitis. NO levels were correlated directly with extent of polyposis as graded by the Lund-McKay index. Successful treatment, with reduction in polyp volume, was associated with a rise in NO levels (P = 0.042). CONCLUSION: NO levels are low in nasal polyposis, despite high levels of iNOS, possibly related to blockage of the ostiomeatal complex and failure of NO generated constitutively in the sinuses to reach the nasal airway. A rise in the NO levels is seen with successful polyp treatment, and is proportional to the reduction in endoscopically assessed polyp size, suggesting that with both medical and surgical therapy, the ostiomeatal complex obstruction is decreasing. We propose the following scenario. Nasal NO levels are the result of two processes: inducible NO production by inflamed nasal mucosa plus constitutive sinus mucosal production, detectable in normals. In uncomplicated allergic rhinitis with patent sinus ostia NO levels tend to be elevated, but when inflammation is sufficient to obstruct sinus ostia (as in nasal polyps), NO levels fall because sinus NO makes the major contribution.     

Efficacy and safety of mometasone furoate nasal spray in nasal polyposis

BACKGROUND: Studies have suggested that topical corticosteroids are effective in the treatment of nasal polyps; however, this has yet to be confirmed in a large, robust clinical trial. OBJECTIVE: To evaluate the efficacy and safety of mometasone furoate nasal spray (MFNS) for nasal polyposis. METHODS: A total of 354 subjects with bilateral nasal polyps and clinically significant congestion/obstruction participated in this multinational, randomized, double-blind, placebo-controlled study. Subjects received MFNS 200 microg once or twice daily or placebo for 4 months. Coprimary endpoints were (1) change from baseline to last assessment in physician-evaluated bilateral polyp grade score and (2) change from baseline averaged over month 1 in subject-assessed nasal congestion/obstruction. ANOVA was used for all efficacy endpoints, except for change in bilateral polyp grade score, for which baseline polyp grade was added as a covariate. RESULTS: Compared with placebo, MFNS 200 microg administered once or twice daily produced significantly greater reductions in bilateral polyp grade score (P < .001, P = .010, respectively) and congestion/obstruction (P = .001, P < .001), as well as improvement in loss of smell (P < .001, P = .036), anterior rhinorrhea (P < .001 for both), and postnasal drip (P < .001, P = .001) over month 1. MFNS 200 microg twice daily was superior to MFNS 200 microg once daily in reducing congestion/obstruction (P = .039), and there were more improvers in the MFNS 200 microg twice daily group (P = .035). MFNS was well tolerated in both groups. CONCLUSION: MFNS 200 mug, once or twice daily, was safe and significantly superior to placebo in reducing polyp grade (size and extent) and improving congestion/obstruction and return of sense of smell. MFNS is an effective medical treatment for nasal polyposis and may reduce or delay the need for surgery.     

Effect of nasal anaesthesia on lacrimal function after nasal allergen challenge

Ocular symptoms in allergic rhinoconjunctivitis arise partly from direct contact of the allergen with the conjunctiva and presumably partly from a naso-lacrimal reflex. The aim was to study the importance of this reflex in allergic rhinitis after topical anaesthesia of the nose. Ten patients with allergic rhinoconjunctivitis lo birch pollen were challenged with increasing intranasal doses of allergen until allergic symptoms occurred. The same dose of allergen was used in two other provocations, when the nasal cavity was anaesthetized with topical lidocaine in a double-blind rundomized cross-over manner. The effect on the eyes was evaluated by Shirmer's test, a routine method for measuring tear production. Lidocaine per se and/or allergen challenge had no significant effect on tear production. The naso-lacrimal reflex was not involved in the eye symptoms, in allergic conjunctivitis.     

Pathogenesis of nasal polyposis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory condition that affects a large proportion of the population world‐wide and is associated with high cost of management and significant morbidity. Yet, there is a lack of population‐based epidemiologic studies using current definitions of CRSwNP, and the mechanisms that drive pathogenesis in this disease remain unclear. In this review, we summarize the current evidence for the plethora of factors that likely contribute to CRSwNP pathogenesis. Defects in the innate function of the airway epithelial barrier, including diminished expression of antimicrobial products and loss of barrier integrity, combined with colonization by fungi and bacteria likely play a critical role in the development of chronic inflammation in CRSwNP. This chronic inflammation is characterized by elevated expression of many key inflammatory cytokines and chemokines, including IL‐5, thymic stromal lymphopoietin and CCL11, that help to initiate and perpetuate this chronic inflammatory response. Together, these factors likely combine to drive the influx of a variety of immune cells, including eosinophils, mast cells, group 2 innate lymphoid cells and lymphocytes, which participate in the chronic inflammatory response within the nasal polyps. Importantly, however, future studies are needed to demonstrate the necessity and sufficiency of these potential drivers of disease in CRSwNP. In addition to the development of new tools and models to aid mechanistic studies, the field of CRSwNP research also needs the type of robust epidemiologic data that has served the asthma community so well. Given the high prevalence, costs and morbidity, there is a great need for continued research into CRS that could facilitate the development of novel therapeutic strategies to improve treatment for patients who suffer from this disease.