观察功能性鼻窦内窥镜(FESS)术后联合采用缓冲高渗盐溶液鼻腔冲洗治疗变应性鼻-鼻窦炎(ARS)患者的临床疗效

目的 研究变应性鼻-鼻窦炎(ARS)患者经功能性鼻窦内窥镜(FESS)术后+缓冲高渗盐溶液鼻腔冲洗治疗效果。方法采集本院就诊60例ARS患者,FESS术,随机分观察组(缓冲高渗盐溶液,n=30)与对照组(丙酸氟替卡松喷雾剂,n=30),两组疗效比较。结果治疗前比较炎症指标无差异,P>0.05;治疗后与对照组比较,观察组炎症改善更优、有效率更高,P<0.05。结论 FESS术后+缓冲高渗盐溶液能增强疗效、值得借鉴。     

FESS术后两性霉素B鼻窦冲洗治疗真菌球型鼻窦炎的疗效观察

目的 观察功能性鼻内镜手术(FESS)术后两性霉素B(AmB)鼻窦冲洗治疗真菌球型鼻窦炎(FBS)的临床疗效.方法 选取2019年6月～2021年5月期间本院收治的50例行FESS的FBS患者,根据治疗方法不同,将患者分为治疗组和对照组每组25例,术后治疗组(n=25)予200μg/ml AmB行鼻窦内冲洗,对照组(n...     

康复新液在FESS术后冲洗的临床研究

目的观察康复新液对慢性鼻窦炎伴鼻息肉患者功能性内窥镜鼻窦手术(functional endoscopic sinus surgery,FESS)术后术腔冲洗的临床症状、体征、粘膜上皮化时间等的影响,探索促进本病患者术后康复更加有效的治疗手段。方法收集2013年1月~2016年12月我院60例(120侧)慢性鼻窦炎伴鼻息肉术后患者,随机分为两组,将康复新液与0.9%生理盐水1∶10混合液500ml作为治疗组冲洗液,对照组则以0.9%生理盐水500ml冲洗,每组各30例(60侧)。自术后第3天患者自行冲洗术腔并定期来门诊行鼻腔清洗,随访3个月。分别于术后1月、2月及3月进行鼻内窥镜下复查,记录观察患者的症状及窦腔粘膜情况。结果 (1)术后1月两组患者内镜下评分及主观症状评分均无显著性差异(P0.05);(2)术后2月及3月两组患者术后鼻内镜下评分及主观症状评分均有显著性差异(P0.05)。结论 FESS术后应用康复新液组冲洗术腔疗效显著,可以缩短粘膜修复时间。     

去氨加压素用于鼻窦内镜手术的临床研究

目的观察去氨加压素(DDAVP)用于功能性鼻窦内镜手术(FESS) 的效果.方法择期行FESS的病人59人,随机分成治疗组(n=30)和对照组( n=29),治疗组于麻醉诱导前30 min将DDAVP 0.3 μg/kg用生理盐水稀释到100 ml,15 min 内静滴完毕,对照组输入等量生理盐水.测定两组术前和用药后1 h的血小板计数(PLT)、凝 血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)、第八因子促凝活性(F ⅧC);监测两组平均动脉压(MAP)、心率(HR),计算心率和收缩压的乘积(RPP);记录术中 出血量和手术时间;据以评价其临床效果.结果治疗组用药1 h后APTT显 著缩短,FⅧC显著升高(P<0.05),术中出血量和手术时间显著少于对照组(P< 0.05),总有效率为90%,显著高于对照组(P<0.05).结论 D DAVP可明显增强病人的凝血功能,减少鼻窦内镜手术的出血量.     

嗓音训练应用于声带息肉术后的效果评价

目的 探讨嗓音训练应用于声带息肉术后的疗效.方法 选取92例接受声带息肉切除术患者作为研究对象,所有患者随机分为实验组(n=46)与对照组(n=46)两组.两组患者均行喉显微声带息肉切除术,对照组术后给予金嗓散结丸口服治疗4周,实验组在对照组基础上术后1周起联合嗓音训练治疗3周,术后4周两组同时结束治疗.比较两组患者治...     

特异性免疫治疗对慢性鼻窦炎伴变应性鼻炎患者鼻内镜手术效果的影响

目的 探讨特异性免疫治疗对慢性鼻窦炎(CRS)伴变应性鼻炎患者功能性内镜鼻窦手术(FESS)效果的影响.方法 将确诊为CRS伴常年性变应性鼻炎的57例患者按照尘螨过敏与否分成两组,尘螨过敏者为治疗Ⅰ组,FESS术后采用皮下免疫治疗;非尘螨过敏者为治疗Ⅱ组,单纯行FESS.分别对两组患者术前、术后6个月、术后1年的症状及体征进行评分并对比,采用鼻腔鼻窦结局测试-20 (SNOT-20)量表及Lund-Kennedy鼻内镜评分法.结果 两组患者术后6个月和1年的SNOT-20及Lund-Kennedy评分较术前均有明显改善(P＜0.01),治疗Ⅰ组患者的疗效优于治疗Ⅱ组且组间差异有统计学意义(P＜0.05).结论 特异性免疫治疗可改善CRS伴变应性鼻炎患者的手术效果.     

鼻内镜术后应用康复新加布地奈德鼻腔雾化治疗的临床观察

目的 探讨应用中成药康复新加布地奈德混悬液鼻腔雾化,对于鼻内镜术后术腔上皮化和纤毛功能恢复的治疗作用.方法 80例慢性鼻窦炎患者随机分为治疗组与对照组(各40例),采用两种不同的治疗方法,从术后第1周起.治疗组应用布地奈德混悬液加康复新液,进行术腔的雾化治疗;对照组则仅采用布地奈德鼻腔雾化,每天1次.除此之外,两组患者围手术期的治疗措施均相同.鼻内镜下观察并记录两组患者术腔上皮化时间及疗效差异.结果 术腔清洁时间的比较,治疗组平均术腔清洁时间为(2.73±1.11)周,对照组为(3.32±0.97)周,两组比较差异有统计学意义(P<0.05).结论 鼻内镜术后应用康复新加布地奈德混悬液对鼻腔、鼻窦行雾化吸入治疗,可以明显缩短术腔上皮化时间,显著提高治愈率.     

高渗盐水普米克令舒治疗慢性鼻窦炎、鼻息肉FESS术后复发

目的 评价3%的高渗盐水普米克令舒溶液治疗伴有变应性鼻炎的慢性鼻窦炎、鼻息肉功能性内镜鼻窦手术(FESS)术后复发的疗效。方法 对伴有变应性鼻炎的慢性鼻窦炎、鼻息肉FESS术后复发患者给予3%的高渗盐水普米克令舒溶液鼻腔灌洗3~5周,每日1次,比较治疗前后CT、鼻内镜检查结果及症状改善情况。结果 治疗组30例,治愈 20例,好转8例,无效2例。对照组20例,治愈4例,好转8例,无效8例。结论 3%的高渗盐水普米克令舒溶液治疗伴有变应性鼻炎的慢性鼻窦炎、鼻息肉FESS术后复发安全、有效。     

鼻渊舒口服液应用在FESS术后的临床观察

目的 探讨FESS(功能性鼻内镜手术)后应用鼻渊舒口服液的疗效.方法 对80例慢性鼻-鼻窦炎鼻息肉患者行FESS后随机分为对照组(40例)和鼻渊舒口服液组(40例),随访1年比较两组疗效.结果 鼻渊舒口服液组与对照组比较,其治愈率、总有效率均有差异,差异有统计学意义(P＜0.05).结论 对于FESS术后鼻黏膜愈合、消除黏膜水肿,促进术后上皮化以及预防鼻息肉复发中,鼻渊舒口服液有显著疗效.     

中医序贯疗法联合FESS治疗慢性鼻窦炎的临床研究

目的观察中医序贯疗法联合功能性内镜鼻窦手术(FESS)治疗慢性鼻窦炎的临床疗效。方法将符合纳入条件的80例慢性鼻窦炎Ⅱ型患者,常规行FESS,术后按1:1随机分为对照组及治疗组,比较两组治疗前、治疗后3月、治疗后6月症状体征积分、鼻黏膜纤毛传输速率指标的差异。结果两组患者症状体征积分、鼻黏膜纤毛传输速率(MTR)治疗后3月、治疗后6月与治疗前比较差异均有显著性(P<0.05)、治疗后6月与治疗后3月比较差异有显著性(P<0.05),两组间治疗后3月、治疗后6月比较差异有显著性(P<0.05);治疗组与对照组疗效相比,差异均有显著性(P<0.05),治疗组疗效优于对照组。结论中医序贯治疗能促进鼻窦炎术后黏膜上皮化、有效预防术后复发。     

维生素D对慢性鼻-鼻窦炎鼻内镜手术疗效的影响

目的　分析慢性鼻-鼻窦炎伴鼻息肉（ chronic rhinosinusitis with nasal polyps,CRSwNP）患者的血清维生素D水平与鼻内镜临床疗效的相关性。方法　40例CRSwNP患者入院行鼻内镜手术,随机分为试验组和对照组。试验组每日口服维生素D（800 IU）+布地奈德喷鼻剂喷鼻,对照组只给予布地奈德喷鼻剂喷鼻,持续8周。实验前后分别测量血清25羟基维生素D水平,记录Lund-Kennedy评分、鼻腔鼻窦结局测试-20条、视觉模拟量表评分。结果  筛查60例试验对象血清维生素D水平,其中80%患者伴有维生素D不足（<50 nmol/L）;试验后两组间VD水平的差异有统计学意义（P =0.001）;治疗后,试验组与对照组间鼻塞、脓涕、头面部疼痛、视觉模拟量表评分总分等评分的差异均具有统计学意义;两组间嗅觉障碍症状评分的差异无统计学意义。治疗后试验组与对照组间鼻腔鼻窦结局测试-20条评分、Lund-Kennedy评分的差异均具有统计学意义。结论　在CRSwNP患者中血清维生素D水平普遍较低,临床上对患者予以补充维生素D后可显著提高患者血清中25羟基维生素D的水平,与改善CRSwNP患者的临床症状及提高临床综合治疗效果呈正相关。     

瘦素在肥胖成人慢性鼻-鼻窦炎伴鼻息肉发病中的作用

1007 1520.202003008·论著· 目的初步探讨瘦素（Leptin）在肥胖成人慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）发病中的作用及机制。方法按照体重指数（BMI）随机选取肥胖CRSwNP患者40例,体重正常CRSwNP患者30例,选取同期肥胖鼻中隔偏曲患者30例为对照组。通过酶联免疫吸附法（ELISA）测定3组患者血清中Leptin及其受体水平、EOS相关因子IL 4、IL 13的水平;RT PCR及免疫组织化学方法检测3组患者局部鼻黏膜中Leptin及其受体水平表达;苏木精-伊红染色法观察3组患者组织中EOS细胞浸润程度。另Pearson相关性分析Leptin水平与EOS相关指标及浸润程度的关系。结果与对照组比较,两组CRSwNP患者的血清与局部Leptin及其受体水平表达均升高,血清中EOS相关因子IL 4、IL 13的水平表达均显著升高,差异具有统计学意义（P<0.05）;两组CRSwNP患者中肥胖患者的各项检测指标均显著高于体重正常患者（P<0.05）,且Leptin及其受体水平与EOS相关指标、EOS浸润程度均呈正相关（P<0.05）。结论Leptin在CRSwNP患者中水平显著升高,且肥胖患者组更高,并与EOS浸润及其促进因子显著相关,提示Leptin可能通过促进EOS增殖浸润参与肥胖成人CRSwNP发病。     

糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响

目的 探讨糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响。 方法 将嗜酸粒细胞性慢性鼻窦炎伴鼻息肉患者40例,以随机数字表法分为对照组(20例)和观察组(20例),分别给予糖皮质激素短疗程喷鼻和雾化吸入方案治疗。比较两组患者近期疗效,治疗前后鼻部症状VAS评分,内镜Lund-Kennedy评分,嗜酸性粒细胞绝对值(EOS)计数水平、血清皮质醇水平及随访复发率等。 结果 观察组患者治疗显效率和总有效率均高于对照组(P<0.05);观察组患者治疗后鼻部症状VAS评分和内镜Lund-Kennedy评分均低于对照组及本组治疗前(P<0.05);观察组患者随访3个月和6个月复发率均低于对照组(P<0.05);观察组患者治疗后EOS计数水平均低于对照组及本组治疗前(P<0.05);同时两组患者治疗前后血清皮质醇水平比较差异无统计学意义(P>0.05)。 结论 相较于喷鼻方案,糖皮质激素短疗程雾化吸入方案治疗嗜酸粒细胞性鼻窦炎伴鼻息肉可有效缓解鼻部症状体征,抑制嗜酸性粒细胞聚集,降低远期复发风险,且未对肾上腺皮质功能产生明显影响。     

Long-term effects of postoperative measures after sinus surgery

To compare the long-term effects of different postoperative treatment regimes after functional endoscopic sinus surgery (FESS), we performed a randomized controlled trial. Inclusion criteria were chronic rhinosinusitis with (CRSwNP) or without (CRS-NP) bilateral nasal polyps and acute recurrent rhinosinusitis (ARR). All patients (male/female = 56/65; mean age = 42.8 years; age range 18–73 years) underwent sinus surgery for the first time. The patients included in 2004 were allocated to a packing in middle meatus for 5 days or saline irrigation only postoperatively. The patients included in 2005 were randomized to debridement 6 and 12 days postoperatively or saline irrigation. At baseline and 56 weeks (32–77) postoperatively, the patients reported symptoms such as nasal congestion, facial pain, headache, and change in sense of smell, nasal discharge, sneezing and reduced general condition on visual analogue scale (VAS). We used ANCOVA to compare symptom improvement. Among patients with CRSwNP, nasal congestion and sneezing improved, respectively, 20 mm (P value = 0.041) and 18 mm (P value = 0.011) more in the debridement group than in the saline irrigation group. Although a packing had positive effects on the symptom improvement they were not significant. Patients with CRSwNP, who had undergone debridement after FESS, had significantly larger symptom improvement 56 weeks after surgery than patients who had only done saline irrigation.     

功能性鼻内镜鼻窦手术后换药应用布地奈德混悬液的效果分析

目的 探讨在慢性鼻-鼻窦炎患者术后应用布地奈德混悬液（普米克令舒）的效果。方法 分析280例慢性鼻-鼻窦炎行鼻内镜手术的患者,随机分为2组,A组常规换药,术后常规使用布地奈德鼻喷剂喷鼻;B组对有囊泡及水肿明显者在术后换药过程中清理后予以明胶海绵浸润布地奈德混悬液置于囊泡及水肿部位,每周1~2次,观察术后1个月、3个月及6个月的疗效,包括VAS视觉量表主观评估及鼻内镜Lund-Kennedy客观评估。结果 A、B组术后1、3、6个月VAS评分分别为4.48±1.33,2.16±0.81,2.04±0.96;3.85±1.09,1.90±0.88,1.93±0.74。A、B组术后1、3、6个月Lund-Kennedy评分分别为11.44±1.73,4.51±1.05,3.94±0.86;6.82±2.08,4.26±1.17,2.17±0.79。两组患者的VAS评分在术后三个时间点差异均有统计学意义（P<0.05）;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,差异无统计学意义。两组间Lund-Kennedy 客观评估比较,在术后1个月和6个月两个时间点差异有统计学意义（P<0.05）,而在术后3个月,两组比较差异无统计学意义;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,A组在两个时间点差异有统计学意义,B组在两个时间点差异无统计学意义。结论 慢性鼻-鼻窦炎鼻内镜术后应用布地奈德混悬液能更好地减少术后囊泡形成、减轻水肿,促进黏膜上皮化。     

慢性鼻窦炎伴或不伴鼻息肉患者血清嗜酸粒细胞阳离子蛋白水平的比较

目的 比较慢性鼻窦炎伴有鼻息肉（CRSwNP）和不伴鼻息肉（CRSsNP）患者中血清嗜酸粒细胞阳离子蛋白（ECP）水平的差异。方法 采用ImmunoCAP100E系统,检测99例CRSwNP患者和59例CRSsNP患者的血清ECP水平,并与健康对照组84例比较。结果 三组间血清ECP水平的差异有统计学意义（P＜0.05）,其中CRSwNP组明显高于健康对照组（P＜0.01）,尤其是中-重度患者与健康对照组比较血清ECP水平显著升高（P＜0.01）。但CRSwNP组与CRSsNP组比较,差异无统计学意义（P＞0.05）;两组轻度与中-重度患者之间分别进行比较,差异均无统计学意义（P＞0.05）。结论 嗜酸粒细胞性炎症反应在慢性鼻窦炎伴或不伴鼻息肉的发病中可能均发挥了作用,但疾病的严重程度与炎性指标ECP的血清浓度之间未见明显相关性,有待进一步探讨。     

Effect of hypochlorous acid nasal spray as an adjuvant therapy after functional endoscopic sinus surgery

ObjectivesTo evaluate the efficacy of hypochlorous acid (HOCl) nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS).Material and methodsPatients with chronic rhinosinusitis who had received FESS for treatment were recruited and assigned to one of two groups at random at one month post-surgery. In the HOCl group, patients received 0.02% HOCl nasal spray three times a day for two months. In the control group, normal saline (NS) nasal irrigation was given. Before FESS and before and after nasal spray or irrigation, patients completed the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meatus.ResultsSeventy-eight patients completed the study. Among them, 41 received HOCl nasal spray, and 37 received NS irrigation. Endoscopic score significantly decreased after 2-month HOCl nasal spray (p = 0.036). TWSNOT-22 score also decreased, although insignificantly (p = 0.285). In contrast, TWSNOT-22 score significantly decreased after NS nasal irrigation (p = 0.017), but endoscopic score did not significantly decrease (p = 0.142).ConclusionsOur results showed that HOCl nasal spray had a similar effect to that of NS nasal irrigation in post-FESS care. It can be an alternative of NS nasal irrigation for its convenient application.     

Efficacy of posterior nasal neurectomy for allergic rhinitis combined with chronic rhinosinusitis with nasal polyps

Abstract

Background: Allergic rhinitis combined with chronic rhinosinusitis with nasal polyps (ARwCRSwNP) is very common clinically. Conventionally, the treatment for these patients is surgical method for CRSwNP followed by treatment with a nasal steroid spray or other antiallergic drugs to control AR. In recent years, some rhinologists introduced vidian neurectomy (VN) or posterior nasal neurectomy (PNN) into endoscopy to treat refractory AR and reported an encouraging outcome. Furthermore, we explore the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Objective: To investigate the control of recurrence of nasal polyps and improvement in symptoms after endoscopic PNN for the treatment of ARwCRSwNP.

Methods: Eighty-five patients with ARwCRSwNP who were admitted to our hospital from November 2016 to July 2018 were enrolled in two groups. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN; group B underwent conventional FESS alone. VAS, RQLQ, SNOT-22 and postoperative nasal endoscopy were used to evaluate the improvement in symptoms and the recurrence of nasal polyps.

Results: The experimental group had better control of sneezing (p?<?.05) and rhinorrhea (p?<?.01) than the control group. For those who underwent surgery more than 6 months prior in both groups, the recurrence rate was 29.6% (8/27) in the experimental group and 44.4% (8/18) in the control group, and there was no significant difference (χ² = .483, p?=?.487).

Conclusion: FESS combined with PNN can improve the symptoms of sneezing and rhinorrhea caused by ARwCRSwNP more obviously than FESS alone, but there is no clear statistical advantage of this procedure for improving the overall symptoms and controlling the recurrence of nasal polyps.     

Notch通路在鼻息肉中的表达及其与调节性T细胞表达和嗜酸粒细胞浸润的相关性研究

目的:探讨Notch通路在鼻息肉中的表达及其与调节性T细胞（Treg细胞）表达和嗜酸粒细胞（Eos）浸润的相关性。方法:选择2012年11月至2018年8月期间在中山大学附属第三医院接受鼻内镜手术的慢性鼻窦炎（CRS）和鼻中隔偏曲的患者,分别作为CRS组和对照组。收集慢性鼻窦炎不伴鼻息肉（CRSsNP）患者（30例,男...     

Post-operative steroid treatment for eosinophilic-type sinonasal polyposis

Conclusions: The preliminary finding of significantly lower eosinophilic-type CRSwNP recurrence rates in patients with associated asthma or ASA intolerance treated post-operatively with local nasal and oral steroids warrants further investigation in larger, prospective series. Objective: A high recurrence rate after functional endoscopic sinus surgery (FESS) has been widely reported in patients with eosinophilic-type chronic rhinosinusitis with nasal polyps (CRSwNP). This study compared the influence of two post-operative medical treatments – local nasal steroids alone vs local nasal and oral steroids – on the recurrence of eosinophilic-type CRSwNP. Method: Between January 2009–December 2010, 32 patients with eosinophilic-type CRSwNP received local steroid nasal therapy after FESS (Group A); from January 2011 onwards, another 28 patients were treated post-operatively with the same nasal treatment plus two cycles a year of oral steroids (Group B). All patients in both groups had a follow-up of at least 36 months. Results: Groups A and B did not differ significantly in recurrence rate (31.25% vs 32.14%, p = 1) or disease-free interval (p = 0.91), but Group B patients who were asthmatic or ASA-intolerant had a significantly lower recurrence rate than Group A patients with asthma or ASA intolerance (p = 0.04 and p = 0.004, respectively).