Observation of the Curative Effect of Enlarged and Opened Middle Turbinate Combined with Nerve Branch Block in Patients with Refractory Sinusitis
-
摘要:
目的 探讨鼻窦扩大开放、中鼻甲大部分切除联合神经分支阻断术在难治性鼻窦炎患者中的疗效观察。 方法 选取2019年5月至2021年5月曲靖市第二人民医院耳鼻喉科收治的60例难治性鼻窦炎患者，采用随机数字表法均分为2组，对照组（n = 30例）实施鼻窦扩大开放、中鼻甲大部分切除治疗，研究组（n = 30例）实施鼻窦扩大开放、中鼻甲大部分切除联合神经分支阻断术治疗。观察分析2组手术有效率、复发率、术后3个月、6个月、1a的视觉模拟评分（visual analogue scale，VAS）、临床症状评分及及临床水平指标。 结果 研究组手术有效率高于对照组、复发率低于对照组，差异有统计学意义（P = 0.021，0.007）；研究组术后3个月、6个月及1 a的VAS评分均低于对照组，差异有统计学意义（P = 0.041，0.039，0.017）；研究组临床症状评分低对照组，差异有统计学意义（P = 0.028，0.037，0.010，0.022）；研究组EOS及IFN-γ、嗜碱粒细胞均优于对照组，差异有统计学意义（P = 0.029，0.003，0.045）。 结论 难治性鼻窦炎患者采用鼻窦扩大开放、中鼻甲大部分切除联合神经分支阻断术治疗可以减轻患者临床症状，降低复发率，值得应用。 Abstract:Objective To investigate the curative effect of sinus enlargement and opening partial middle turbinate resection combined with nerve branch block in patients with refractory sinusitis. Methods A total of 60 patients with refractory sinusitis admitted to the Otolaryngology Department of The Second People’ s Hospital of Qujing city from May 2019 to May 2021 were selected and divided into 2 groups by random number table method. The control group （n = 30 cases） was treated with sinus enlargement and middle turbinate resection, while in the study group （n = 30 cases）, sinus enlargement, middle turbinectomy and nerve branch occlusion were performed. The effective rate, recurrence rate, visual analogue scale （VAS）, clinical symptom score and clinical level indexes of the two groups were observed and analyzed. Results The effective rate of operation in the study group was higher than that in the control group, and the recurrence rate was lower than that in the control group. The differences were statistically significant （P = 0.021, 0.007）. VAS scores of 3 months, 6 months and 1 year after the operation in the study group were lower than those in the control group and the differences were statistically significant （P = 0.041, 0.039, 0.017）. The clinical symptom score of the study group was lower than that of the control group and the differences were statistically significant （P = 0.028, 0.037, 0.010, 0.022）. EOS, IFN-γ and basophils in the study group were better than those in the control group, and the differences were statistically significant （P = 0.029, 0.003, 0.045）. Conclusion The treatment of refractory sinusitis with sinus enlargement, middle turbinate resection and nerve branch block can relieve the clinical symptoms and reduce the recurrence rate, which is worthy of application. -
表 1 2组手术有效率、手术复发率对比 [n （%）]
Table 1. Comparison of effective rate and recurrence rate between the two groups [n （%）]
组别 例数 手术有效率 手术复发率 对照组 30 18（60.0） 9（30.0） 研究组 30 29（96.7） 1（3.3） χ2 / 5.109 6.485 P / < 0.021 * < 0.007 * 与对照组比较，*P < 0.05。 
下载: 导出CSV
表 2 2组术前、术后3个月、6个月及术后1 a VAS评分对比[（
$\bar x \pm s $ ），分]Table 2. VAS scores of the two groups were compared before operation，3 and 6 months after operation and 1 a after operation [（
$\bar x \pm s $ ），points]组别 例数 术前 术后3个月 术后6个月 术后1 a 对照组 30 7.8 ± 2.5 5.7 ± 1.7 4.0 ± 1.6 3.8 ± 0.9 研究组 30 7.7 ± 2.1 3.5 ± 0.5 2.1 ± 0.3 2.1 ± 0.3 t / 1.894 15.423 15.554 14.032 P / 0.079 0.041* 0.039* 0.017* 与对照组比较，*P < 0.05。
下载: 导出CSV
表 3 2组临床症状评分对比[（
$\bar x \pm s $ ），分]Table 3. Comparison of clinical symptom scores between the two groups [（
$\bar x \pm s $ ），points]组别 例数 头痛 鼻塞 嗅觉障碍 鼻分泌物 术前 术后 术前 术后 术前 术后 术前 术后 对照组 30 4.5 ± 1.4 2.3 ± 0.6 7.2 ± 1.6 2.2 ± 0.7 5.5 ± 1.8 2.3 ± 0.8 6.0 ± 1.1 2.2 ± 0.8 研究组 30 4.6 ± 1.5 1.5 ± 0.2 7.3 ± 1.3 1.4 ± 0.3 5.7 ± 1.7 1.3 ± 0.4 6.1 ± 1.1 1.1 ± 0.3 t / 1.098 13.137 1.165 12.996 1.745 13.347 1.382 12.560 P / 0.094 0.028* 0.084 0.037* 0.941 0.010* 0.594 0.022* 与对照组比较，*P < 0.05。
下载: 导出CSV
表 4 2组临床指标对比（
$\bar x \pm s $ ）Table 4. Comparison of clinical indicators between the two groups（
$\bar x \pm s $ ）组别 例数 EOS（个/0.25 mm2） IFN-γ（pg/mg） 嗜碱粒细胞（×109/L） 术前 术后 术前 术后 术前 术后 对照组 30 30.6 ± 10.2 16.5 ± 2.8 22.3 ± 2.7 19.9 ± 3.2 0.95 ± 0.12 0.15 ± 0.06 研究组 30 30.5 ± 11.7 11.4 ± 2.7 22.1 ± 2.6 10.2 ± 2.1 0.96 ± 0.13 0.41 ± 0.10 t / 1.895 18.107 1.475 19.629 0.791 6.392 P / 0.694 0.029* 0.087 0.003* 0.075 0.045* 与对照组比较，*P < 0.05。
下载: 导出CSV
-
[1] 张印,徐开伦,梁传余,等. 慢性鼻窦炎患者手术前后鼻部特异性症状和心理功能障碍改善的评估[J]. 临床耳鼻咽喉头颈外科杂志,2020,34(3):248-251. doi: 10.13201/j.issn.2096-7993.2020.03.015 [2] 蔡润茁,曾令达,李登辉,等. 两性霉素B冲洗对难治性鼻窦炎鼻内镜术后嗜酸性粒细胞、上皮化时间的影响[J]. 昆明医科大学学报,2019,40(3):92-96. doi: 10.3969/j.issn.1003-4706.2019.03.019 [3] 刘升阳,万玉柱,于亮,等. 难治性鼻窦炎的易感因素及诊疗进展[J]. 中华耳鼻咽喉头颈外科杂志,2021,56(10):1118-1124. doi: 10.3760/cma.j.cn115330-20210420-00213 [4] 陈艳娣,孙焕然,孟粹达,等. 伴嗅觉障碍的慢性鼻-鼻窦炎患者术后嗅觉变化的临床研究[J]. 国际耳鼻咽喉头颈外科杂志,2020,44(2):75-78. doi: 10.3760/cma.j.issn.1673-4106.2020.02.003 [5] 齐岩,刘俊其,彭舒娅,等. 鼻内镜下选择性翼管神经切断术对伴有变应性鼻炎的慢性鼻窦炎的疗效观察[J]. 山东大学耳鼻喉眼学报,2019,33(1):109-113. doi: 10.6040/j.issn.1673-3770.1.2018.028 [6] 王广科. 2019年难治性鼻窦炎研究进展[J]. 中华医学信息导报,2020,35(5):21. [7] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志,2019,54(2):81-100. doi: 10.3760/cma.j.issn.1673-0860.2019.02.001 [8] Zhao C L,Yu S Q. Recent clinical advances in refractory chronic sinusitis[J]. Journal of Clinical Otorhinolaryngology,2020,34(1):19-22,27. [9] 张冉. 两种鼻内镜手术方式对难治性鼻窦炎患者近期鼻窦炎症及嗅觉功能的影响对照[J]. 罕少疾病杂志,2021,28(6):20-22,110. doi: 10.3969/j.issn.1009-3257.2021.06.009 [10] 刘飞,朱丽平. 轮廓化鼻内镜手术对难治性鼻窦炎患者的效果及价值评价[J]. 浙江创伤外科,2021,26(1):53-54. [11] 李嘉怡,陈峰,俞晨杰,等. 轮廓化鼻内镜手术治疗难治性鼻窦炎的价值探讨[J]. 临床耳鼻咽喉头颈外科杂志,2018,32(10):749-753. [12] 王旭平,刘金梅,杨培培,等. 功能性鼻内镜手术治疗鼻-鼻窦炎的疗效及对生活质量的影响[J]. 湖南师范大学学报(医学版),2020,17(2):181-183. doi: 10.3969/j.issn.1673-016X.2020.02.053 [13] 刘争,王恒. 难治性慢性鼻-鼻窦炎的手术治疗[J]. 临床耳鼻咽喉头颈外科杂志,2018,32(5):332-335. doi: 10.13201/j.issn.1001-1781.2018.05.004 [14] 牛善利,张艳萍,许心茂,等. 鼻内镜下翼管神经切断术治疗难治性变应性鼻炎近期疗效研究[J]. 中国校医,2019,33(8):623-625. [15] 薛建亭,王亚青. 轮廓化鼻内镜手术对难治性鼻窦炎患者嗅觉功能及血清总IgE水平的影响[J]. 国际医药卫生导报,2020,26(3):402-404. doi: 10.3760/cma.j.issn.1007-1245.2020.03.034 [16] 董玉梅. 内窥镜鼻窦手术联合中鼻甲切除术治疗难治性鼻窦炎的效果观察[J]. 中国民康医学,2020,32(7):77-78. doi: 10.3969/j.issn.1672-0369.2020.07.032 [17] 孙贵虎,李大伟,郭爽,等. 中性粒细胞在慢性鼻窦炎发病机制中的作用[J]. 临床耳鼻咽喉头颈外科杂志,2019,33(8):789-792. doi: 10.13201/j.issn.1001-1781.2019.08.028 [18] 杜建斌,刘志勇,曹忠胜. 鼻腔结构异常与老年慢性鼻-鼻窦炎患者鼻腔分泌物IFN-γ、IL-5、IL-17的表达及相关性[J]. 中国老年学杂志,2018,38(3):652-654. doi: 10.3969/j.issn.1005-9202.2018.03.059 [19] 张志永. 鼻内镜下鼻窦开放术中双鼻中鼻甲切除术治疗难治性鼻息肉鼻窦炎[J]. 河南医学研究,2020,29(32):6035-6037. doi: 10.3969/j.issn.1004-437X.2020.32.032 [20] 张峰. 内窥镜鼻窦手术联合中鼻甲切除术治疗难治性鼻窦炎效果观察[J]. 中国实用医刊,2017,44(16):58-60. doi: 10.3760/cma.j.issn.1674-4756.2017.16.019 -
