Batra Pete S, Kern Robert C, Tripathi Anju, Conley David B, Ditto A M, Haines G K, Yarnold Paul R, Grammar Leslie
Department of Otolaryngology/Head and Neck Surgery, Northwestern University Medical School, 675 North St. Clair, Chicago, IL 60611, USA.
Laryngoscope. 2003 Oct;113(10):1703-6. doi: 10.1097/00005537-200310000-00008.
To investigate the efficacy of endoscopic sinus surgery (ESS) in the management of chronic sinusitis and asthma in patients with nasal polyps and steroid-dependent asthma.
Retrospective chart review.
The study included 17 patients who underwent ESS with nasal polyps, steroid-dependent asthma with or without aspirin sensitivity and a minimum of 1 year postoperative follow-up. Nine patients were ASA sensitive, and eight patients were ASA tolerant. Chronic sinusitis and asthma were evaluated using subjective (patient complaints) and objective (computed tomography scans, pulmonary function tests, steroid doses) criteria. Preoperative data were compared with data obtained 12 to 18 months postESS. Tissue samples were graded for degree of inflammation and edema.
Thirteen of the 17 (76.5%) patients reported improved clinical symptoms postESS. The postoperative Lund-Mackay scores were statistically lower for the 17 patients (P <.0001). The group experienced improvement in postoperative forced expiratory volume at 1 second (FEV1) (P <.014). Twelve of 17 (70.6%) experienced reduction in systemic steroid usage (P <.048). The ASA sensitive patients did not have a statistical improvement in postoperative FEV1 (P >.08) and sinonasal symptoms (P >.16) compared with the ASA tolerant group. Polyp tissue from the ASA sensitive patients demonstrated more edema and more inflammation on average than ASA tolerant polyps, but the results were not statistically significant.
ESS demonstrates a beneficial effect on the sinonasal and asthma symptomatology in patients with nasal polyps and asthma using objective measures. Subset of aspirin-tolerant patients have statistically better outcome for sinonasal symptoms and pulmonary function testing than aspirin-sensitive patients.
探讨鼻内镜鼻窦手术（ESS）治疗鼻息肉合并激素依赖型哮喘患者慢性鼻窦炎和哮喘的疗效。
回顾性病历审查。
本研究纳入了17例行ESS的患者，这些患者患有鼻息肉、激素依赖型哮喘，伴有或不伴有阿司匹林敏感性，且术后随访至少1年。9例患者对阿司匹林敏感，8例患者对阿司匹林耐受。采用主观（患者主诉）和客观（计算机断层扫描、肺功能测试、激素剂量）标准评估慢性鼻窦炎和哮喘。将术前数据与ESS术后12至18个月获得的数据进行比较。对组织样本的炎症和水肿程度进行分级。
17例患者中有13例（76.5%）报告ESS术后临床症状改善。17例患者术后的Lund-Mackay评分在统计学上更低（P<.0001）。该组患者术后第1秒用力呼气量（FEV1）有所改善（P<.014）。17例患者中有12例（70.6%）全身激素用量减少（P<.048）。与阿司匹林耐受组相比，阿司匹林敏感患者术后FEV1（P>.08）和鼻窦症状（P>.16）在统计学上没有改善。与阿司匹林耐受息肉相比，阿司匹林敏感患者的息肉组织平均显示出更多的水肿和炎症，但结果无统计学意义。
ESS通过客观指标对鼻息肉合并哮喘患者的鼻窦和哮喘症状显示出有益效果。与阿司匹林敏感患者相比，阿司匹林耐受患者亚组在鼻窦症状和肺功能测试方面的统计学结果更好。
