Jankowski R, Moneret-Vautrin D A, Goetz R, Wayoff M
Service ORL, Hôptial Central, Nancy, France.
Rhinology. 1992 Dec;30(4):249-58.
The surgical treatment of nasal polyps (in asthmatic patients) is still controversial today because of the contradictory, inconsistent, and unforeseen results reported in the literature. The 50 patients included in this study (mean age 49 years, range 25-67 years) came for a check-up on an average of 18 months (lower limit 12 months, upper limit 40 months) after a radical endoscopic intranasal ethmoidectomy. Thirty patients suffered from polyps and bronchial hyperreactivity; 12 patients in this group also suffered from aspirin intolerance. Twenty patients suffered from nasal polyps alone, and served as a control series. The following parameters were methodically noted relative to the date of ethmoidectomy: 1) the frequency of attacks and possible intervals of respiratory difficulty, pre- and postoperatively; 2) the basic treatment for the asthma, and the difference in size of the therapeutic doses necessary and/or the elimination of one or more therapeutic classes; 3) bronchospasticity, evaluated pre- and postoperatively by auscultation for wheezing and peak flow measurements. A bronchial challenge with carbamyl choline and a four-doses aspirin challenge over two days (10 mg, 50 mg, 100 mg, 400 mg) were carried out pre-and postoperatively in the absence of contra-indications. Ninety-one per cent of the patients have improved and now live in less discomfort. The factors studied show a lower frequency of attacks, a distinct decrease of respiratory difficulty, less need for anti-asthmatic medication and especially less oral corticoids, and a marked improvement in functional respiratory test. The carbamyl choline test confirms these data and even shows the totally reversible nature of nonspecific bronchial hyperreactivity in 30% of these patients. This series is too limited for us to say that intolerance to aspirin is reversible; perhaps only the reactivity threshold changes. In the 20 subjects with nasal polyps alone, no case of asthma have been recorded since the operation. Improvement of the asthmatic condition may be partly dependent upon a global diagnosis and treatment of the patient by the pneumo-immunoallergologist and the ENT-specialist. However, the nature of the surgical act seems to be of prime importance, and we must insist on the need for a radical marsupialization of the paranasal sinuses.
由于文献报道的结果相互矛盾、不一致且不可预见，鼻息肉（哮喘患者）的外科治疗至今仍存在争议。本研究纳入的50例患者（平均年龄49岁，范围25 - 67岁）在接受根治性鼻内镜筛窦切除术后平均18个月（下限12个月，上限40个月）前来复查。30例患者患有息肉和支气管高反应性；该组中的12例患者还存在阿司匹林不耐受。20例患者仅患有鼻息肉，作为对照系列。相对于筛窦切除术日期，系统记录了以下参数：1）术前和术后发作频率及可能的呼吸困难间隔时间；2）哮喘的基础治疗，以及所需治疗剂量大小的差异和/或一种或多种治疗类别药物的停用情况；3）术前和术后通过听诊哮鸣音和测量峰值流量评估支气管痉挛情况。在无禁忌证的情况下，术前和术后均进行了氨甲酰胆碱支气管激发试验以及为期两天的四剂量阿司匹林激发试验（10毫克、50毫克、100毫克、400毫克）。91%的患者病情有所改善，现在生活不适感减轻。研究的因素显示发作频率降低、呼吸困难明显减轻、抗哮喘药物需求减少，尤其是口服皮质类固醇药物需求减少，以及功能性呼吸测试有显著改善。氨甲酰胆碱试验证实了这些数据，甚至显示30%的患者非特异性支气管高反应性具有完全可逆性。该系列样本量有限，我们无法确定阿司匹林不耐受是否可逆；也许只是反应阈值发生了变化。在仅患有鼻息肉的20名受试者中，术后未记录到哮喘病例。哮喘病情的改善可能部分取决于呼吸免疫过敏科医生和耳鼻喉科专家对患者的全面诊断和治疗。然而，手术操作的性质似乎至关重要，我们必须强调对鼻窦进行根治性袋形缝合术的必要性。
