Marchioni Daniele, Alicandri-Ciufelli Matteo, Mattioli Francesco, Marchetti Alessio, Jovic Gordana, Massone Federica, Presutti Livio
Department of Otolaryngology, Policlinico di Modena, Modena, Italy.
Acta Otolaryngol. 2008 Sep;128(9):1019-26. doi: 10.1080/00016480701827541.
Relapse in patients affected by nasal polyposis and subjected to endoscopic surgery appears to be a relevant feature. Surgical treatment shows a significant increase in quality of life in all the patients aside from surgical technique used. Our results show a better control of relapse of nasal pathology in patients subjected to more radical surgery (group B) vs patients subjected to conservative surgery on middle turbinate (group A). Allergic patients in group B had a smaller number of relapses during the follow-up period compared with allergic patients in group A and this was statistically significant.
Different endoscopic surgical techniques have been applied for the treatment of nasal polyposis. During ethmoidectomy, some authors prefer to remove the middle turbinate while others preserve this structure. To date, there have been no studies comparing the results, in a homogeneous case series of patients operated exclusively for nasal polyposis, between those whose middle turbinate was resected and those whose middle turbinate was preserved. The aim of our study was to compare results in these two groups of patients.
A prospective study was performed. Nasal polyposis was studied on the basis of endoscopic examination and all the patients were classified on the basis of CT of paranasal sinuses using the Kennedy CT staging system. In the study group, only subjects affected by nasal polyposis with stage II-III at endoscopic evaluation and a Kennedy score of III-IV, affected by nasal polyposis, and not responsive to medical treatment were recruited. The presence of allergy was evaluated by skin prick test results and that of asthma by spirometric examination. Recurrence rates and quality of life were evaluated in a 3-year follow-up.
In total, 56 patients were selected and all were observed over a 3-year follow-up period. We identified two groups: group A, 34 patients (60.71%) affected by nasal polyposis who underwent endoscopic surgery with the conservation of middle turbinate; group B, 22 patients (39.29%) affected by nasal polyposis who underwent more radical endoscopic sinus surgery. Analyzing the entire study group, during the 3-year follow-up, 20 (35.71%) of the 56 patients had a relapse of nasal polyposis. Analyzing time to relapse curves in the allergic and non-allergic patients, we obtained a p value of 0.0589, i.e. at the limit of statistical significance. The comparison between preoperative and postoperative Cologne test in the whole study group was statistically significant for a symptomatic improvement (p < 0.001). Trends within the two groups were also evaluated: there was a statistically significant difference in behavior upon time to relapse of the patients in group B vs group A (p = 0.0102). The patients in group A developed nasal recurrence more frequently during the follow-up periods. In patients affected by allergy vs patients not affected by allergy in group A, a statistically significant difference was noted (p = 0.0074); the allergic patients developed nasal recurrence more frequently during the follow-up period. We could not find a statistically significant difference between those patients affected by allergy and those not affected by allergy, as regards the number of relapses in patients in group B.
患有鼻息肉且接受内镜手术的患者复发似乎是一个显著特征。无论采用何种手术技术，手术治疗均显著提高了所有患者的生活质量。我们的结果表明，与接受中鼻甲保守手术的患者（A组）相比，接受更激进手术的患者（B组）对鼻腔病变复发的控制更好。B组中的过敏患者在随访期间的复发次数少于A组中的过敏患者，且具有统计学意义。
不同的内镜手术技术已应用于鼻息肉的治疗。在筛窦切除术中，一些作者倾向于切除中鼻甲，而另一些作者则保留该结构。迄今为止，尚无研究在仅因鼻息肉接受手术的同质病例系列中，比较中鼻甲被切除和中鼻甲被保留的患者的结果。我们研究的目的是比较这两组患者的结果。
进行了一项前瞻性研究。基于内镜检查对鼻息肉进行研究，并使用肯尼迪CT分期系统根据鼻窦CT对所有患者进行分类。在研究组中，仅招募在内镜评估中处于II - III期、肯尼迪评分为III - IV分、患有鼻息肉且对药物治疗无反应的患者。通过皮肤点刺试验结果评估过敏情况，通过肺功能检查评估哮喘情况。在3年的随访中评估复发率和生活质量。
总共选择了56例患者，并在3年的随访期内对所有患者进行了观察。我们确定了两组：A组，34例（60.71%）患有鼻息肉的患者接受了保留中鼻甲的内镜手术；B组，22例（39.29%）患有鼻息肉的患者接受了更激进的鼻内镜鼻窦手术。分析整个研究组，在3年的随访期间，56例患者中有20例（35.71%）鼻息肉复发。分析过敏和非过敏患者复发时间曲线，我们得到的p值为0.0589，即处于统计学意义的临界值。整个研究组术前和术后科隆测试之间的比较在症状改善方面具有统计学意义（p < 0.001）。还评估了两组内的趋势：B组患者与A组患者在复发时间上的行为存在统计学差异（p = 0.0102）。A组患者在随访期间更频繁地出现鼻腔复发。在A组中，过敏患者与非过敏患者之间存在统计学差异（p = 0.0074）；过敏患者在随访期间更频繁地出现鼻腔复发。在B组患者中，我们未发现过敏患者与非过敏患者在复发次数方面存在统计学差异。
