Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China; Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
Rhinology. 2020 Apr 1;58(2):126-135. doi: 10.4193/Rhin19.184.
Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma have poorer outcomes after functional endoscopic sinus surgery (FESS) and higher recurrence rate. The aim of present study was to investigate the long-term clinical outcomes of extended surgical strategies for patients with recurrent CRSwNP and asthma.
Eighty-one patients with CRSwNP and asthma were enrolled in this 5-year prospective study. They were randomly assigned to undergo FESS, radical endoscopic sinus surgery (RESS), or RESS+Draf 3 surgery. Disease severity and clinical outcomes were evaluated using symptoms scoring, endoscopic scoring system, computed tomography staging system, sinus-specific quality of life scores, tissue and peripheral blood eosinophil percentage, and pulmonary function tests. Baseline, 1-year, 3-year, and 5-year follow-up data were compared among the groups.
RESS and RESS+Draf 3 strategies yielded better short-term (1 year) outcomes than did FESS. FESS had a higher short-term recurrence rate, although recurrence rates were similarly high (95.6 - 96.1%) in all the groups at 5 years postoperatively. RESS and RESS+Draf 3 yielded a lower long-term revision surgery rate and a longer time to recurrence post-surgery than FESS, which was negatively correlated with tissue and peripheral blood eosinophil percentage.
CRSwNP with asthma is a systemic disease that inevitably recurs. Radical surgery prolongs recurrence time and improves olfaction, rhinorrhea, and quality of life in the short-term. Combining Draf 3 with RESS did not yield better clinical outcomes than RESS alone; thus, although RESS alone appears to be the best option, these findings need to be confirmed in further studies involving more patients, longer follow-up duration and stricter standardized medication use especially the adequate steroid irrigations.
患有慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）和哮喘的患者，在接受功能性内镜鼻窦手术（FESS）后效果较差，且复发率较高。本研究旨在探讨针对复发性 CRSwNP 和哮喘患者的扩展手术策略的长期临床效果。
本研究为一项 5 年前瞻性研究，共纳入 81 例 CRSwNP 和哮喘患者。他们被随机分为 FESS 组、根治性内镜鼻窦手术（RESS）组或 RESS+Draf 3 手术组。采用症状评分、内镜评分系统、计算机断层扫描分期系统、鼻窦特异性生活质量评分、组织和外周血嗜酸性粒细胞百分比以及肺功能检查来评估疾病严重程度和临床结果。比较各组患者的基线、1 年、3 年和 5 年随访数据。
与 FESS 相比，RESS 和 RESS+Draf 3 策略在短期（1 年）的效果更好。FESS 的短期复发率较高，尽管所有组在术后 5 年的复发率相似（95.6%-96.1%）。与 FESS 相比，RESS 和 RESS+Draf 3 术后的长期再次手术率较低，且术后复发时间更长，这与组织和外周血嗜酸性粒细胞百分比呈负相关。
伴哮喘的 CRSwNP 是一种全身性疾病，必然会复发。根治性手术可在短期内延长复发时间，改善嗅觉、流涕和生活质量。与 RESS 相比，Draf 3 联合 RESS 并未带来更好的临床效果，因此，尽管 RESS 似乎是最佳选择，但还需要在进一步的研究中，纳入更多患者、更长的随访时间和更严格的标准化药物使用，特别是充分的类固醇冲洗来证实这些发现。
