Department of Otolaryngology (A.W.W., J.Y.T., H.S.T., R.M.), Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School; and the, Boston University School of Medicine, Boston, Massachusetts, U.S.A.
Laryngoscope. 2014 Jan;124(1):29-33. doi: 10.1002/lary.24213. Epub 2013 Jul 29.
OBJECTIVES/HYPOTHESIS: Surgical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) is often followed by polyp regrowth with return of symptoms. The purpose of this study is to identify clinical factors that influence the time interval to revision sinus surgery in patients with nasal polyps.
Retrospective cohort study.
Records of 299 individuals who underwent two or more surgeries for the diagnosis of nasal polyps by the senior author (RM) from 1987 through 2011 were reviewed. The time between surgical interventions were compared to patient demographics, comorbidities, endoscopic examination, computed tomography (CT) stage, extent of surgery, and pathologic findings.
The mean time interval between polyp surgeries was 4.87 ± 3.61 years (range 0.7-18.6 years). The median time to revision surgery was shorter in patients who smoked compared to nonsmokers (2.82 vs. 4.31 years, respectively, P = .022) and longer in patients who underwent middle turbinate resection rather than preservation (4.56 vs. 3.93 years, respectively, P = .048). Kaplan-Meier survival analysis confirmed these findings, but the beneficial effect of turbinectomy appeared to dissipate by 8 years. Neither a history of asthma nor advanced CT stage influenced the time to revision surgery.
The time course between sinus surgeries in patients with regrowth of nasal polyps appears to be affected by certain modifiable extrinsic factors, including smoking on the part of the patient and operative technique on the part of the surgeon. The performance of middle turbinate resection during sinus surgery appears to extend the time interval until a revision procedure is required.
目的/假设：慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的手术治疗后，息肉常复发并伴有症状的再次出现。本研究旨在确定影响鼻息肉患者行鼻窦再手术时间间隔的临床因素。
回顾性队列研究。
回顾了 2011 年期间，由资深作者（RM）对 299 例患者进行的两次或以上手术诊断为鼻息肉的病例记录。比较了手术干预之间的时间间隔与患者的人口统计学、合并症、内镜检查、计算机断层扫描（CT）分期、手术范围和病理发现。
鼻息肉手术之间的平均时间间隔为 4.87±3.61 年（范围 0.7-18.6 年）。与不吸烟者相比，吸烟者行再次手术的中位时间更短（分别为 2.82 年和 4.31 年，P=0.022），且接受中鼻甲切除术而非保留术的患者再次手术的时间更长（分别为 4.56 年和 3.93 年，P=0.048）。Kaplan-Meier 生存分析证实了这些发现，但鼻甲切除术的有益效果似乎在 8 年后消失。哮喘病史或 CT 分期晚期均不影响再次手术的时间。
鼻息肉复发患者行鼻窦手术的时间间隔似乎受到某些可改变的外在因素的影响，包括患者的吸烟情况和术者的手术技术。鼻窦手术中进行中鼻甲切除术似乎延长了需要再次手术的时间间隔。
