Bonfils Pierre, Avan Paul
Department of Oto-Rhino-Laryngology - Head Neck Surgery, European Hospital Georges Pompidou, University Paris-Descartes, School of Medicine, Paris, France.
Acta Otolaryngol. 2007 Aug;127(8):847-54. doi: 10.1080/00016480601053040.
Bronchial hyperresponsiveness (BHR) is not a risk factor for surgery in patients with nasal polyposis (NP).
Management of NP should be primarily medical, and surgery should not be envisaged before a trial of dual steroid therapy. In patients with severe NP resistant to a strict medical treatment, endoscopic sinus surgery is performed, but no prognostic factor for efficacy of surgery is obvious. Some authors suggest that asthma could be a major risk for ineffectiveness of surgery. The aim of this study was to evaluate whether the presence of BHR can be considered a risk factor for ineffectiveness of surgery.
Surgery (with associated medical treatment) was evaluated over a mean follow-up period of 74 months. A total of 63 subjects without and 131 subjects with BHR were operated according to a standardized protocol.
The present study shows that combined surgery and corticosteroid therapy is effective in the treatment of severe NP, producing significant and long-term improvements in symptoms and in the size of nasal polyps. BHR did not influence the outcome. Moreover, the mean amount of prednisolone and beclomethasone necessary after surgery was similar in the two groups.
支气管高反应性（BHR）并非鼻息肉（NP）患者手术的危险因素。
NP的治疗应以药物治疗为主，在进行双激素治疗试验之前不应考虑手术。对于严格药物治疗无效的重度NP患者，可进行鼻内镜鼻窦手术，但尚无明显的手术疗效预测因素。一些作者认为哮喘可能是手术无效的主要风险因素。本研究的目的是评估BHR是否可被视为手术无效的危险因素。
对手术（联合药物治疗）进行了平均74个月的随访评估。按照标准化方案，对63例无BHR的受试者和131例有BHR的受试者进行了手术。
本研究表明，手术联合皮质类固醇治疗对重度NP有效，可使症状和鼻息肉大小得到显著且长期的改善。BHR不影响治疗结果。此外，两组术后所需泼尼松龙和倍氯米松的平均用量相似。
