鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎的临床对比研究

目的 将鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎(下鼻甲黏膜、骨膜及骨质均增生肥大、鼻甲形态异常、VAS评分重度)进行对比研究。 方法 回顾性分析124例重度慢性肥厚性鼻炎患者,按照手术方式分为A(64例)、B(60例)两组,A组采用改良下鼻甲成形术,B组采用下鼻甲低温等离子消融加骨折外移术。术前1周、术后6个月、术后12个月分别用VAS标准评分患者鼻腔症状。糖精试验评价术前1周及术后6个月两组患者鼻腔黏膜纤毛传送功能。术前1周及术后6个月测定鼻阻力,评定鼻塞改善情况。 结果 下鼻甲低温等离子消融加骨折外移术组术中出血、手术时间较改良下鼻甲成形组明显减少,且术后并发症较少;术后6个月两种患者鼻塞均有显著改善;两种手术方式对鼻腔黏膜纤毛功能均无明显影响。A组平均手术时间27.80 min、并发症发生率9.38%,B组平均手术时间19.10 min、并发症发生率6.67%。两组患者术后6个月VAS平均评分差异无统计学意义(P=0.12),术后12个月差异有统计学意义(P=0.03)。 结论 改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎近期效果(6个月内)都良好,但远期效果(1年以上)改良下鼻甲成形术效果更好,因而建议对于重度慢性肥厚性鼻炎患者应因人而异精准诊疗。

A comparative study on the treatment of severe chronic hypertrophic rhinitis by modified inferior turbinate plasty under nasal endoscopy and low-temperature plasma ablation with fracture displacement of the inferior turbinate

Objective To compare the clinical effect of modified inferior turbinate plasty under nasal endoscopy and low-temperature plasma ablation with fracture displacement of the inferior turbinate in the treatment of severe chronic hypertrophic rhinitis(hypertrophy of the inferior turbinate mucosa and periosteum, abnormal turbinate morphology, and severe VAS score). Methods A total of 124 patients with severe chronic hypertrophic rhinitis were retrospectively analyzed. Patients were randomly divided into two groups according to the surgical method used: 64 patients in group A were treated with modified inferior turbinate plasty, and 60 patients in group B were treated with low-temperature plasma ablation of the inferior turbinate plus external fracture removal. The VAS standard score was used to evaluate nasal symptoms 1 week before as well as 6 and 12 months after surgery. Saccharin test was used to evaluate the nasal mucociliary transport function of patients in both groups, 1 week before and 6 months after surgery. Nasal resistance was measured 1 week before and 6 months after surgery, and the improvement in nasal obstruction was evaluated. Results Intraoperative hemorrhage was reduced, operative time was shorter, and the complications rate was lower in group B compared with group A. Six months after the surgery, nasal congestion significantly improved in both groups. Nasal mucociliary function was not significantly affected by either surgical methods. The average operation times were 27.80 min and 19.10 min, and the complication rates were 9.38% and 6.67%, in groups A and B, respectively. Comparison of the average VAS score after surgery between the two groups showed no statistically significant difference at 6 months after surgery(P=0.12); however, a statistically significant difference was found at 12 months after surgery(P=0.03) Conclusion Both surgical methods, modified inferior turbinate plasty and low-temperature plasma ablation of the inferior turbinate combined with fracture displacement, had good short-term effects(6 months)in the treatment of severe chronic hypertrophic rhinitis; further, modified inferior turbinate plasty had better long-term effect(>1 year). Therefore, it is suggested that precise diagnosis should be made and treatment should be accordingly performed in different patients with severe chronic hypertrophic rhinitis.