Vlaminck Stephan, Acke Frederic, Prokopakis Emmanuel, Speleman Kato, Kawauchi Hideyuki, van Cutsem Jean-Christophe, Hellings Peter W, Jorissen Mark, Seys Sven, Bachert Claus, Zele Thibaut Van, Lambrecht Bart N, Gevaert Philippe
Department of Otorhinolaryngology, AZ St-Johns Hospital, Bruges, Belgium.
Department of Otorhinolaryngology, University Hospital, Ghent, Belgium.
Am J Rhinol Allergy. 2021 Jul;35(4):449-457. doi: 10.1177/1945892420961964. Epub 2020 Oct 5.
Chronic rhinosinusitis with nasal polyps (CRSwNP) often requires surgery, but recurrence even after surgery is common. Recurrence rates largely vary in literature and asthma seems to be a comorbid factor.
In this study, we aim to estimate disease recurrence during a long-term follow-up, together with the investigation of possible predicting and/or influencing parameters.
Out of 196 patients operated for CRSwNP between 01/2000 and 01/2006, 133 patients had a follow-up of at least 10 years and could be included. The inflammatory profile at surgery was determined on nasal tissue and sinonasal secretions, and included analysis of eosinophils, eosinophilic-rich mucus (ERM) typically containing Charcot-Leyden crystals (CLC), and fungal hyphae (FH). During follow-up, recurrence, received treatments and comorbidities were collected.
Out of the 133 included patients, local eosinophilia was present in 81% and ERM in 60%. Recurrence during follow-up was observed in 62%, and was associated with local eosinophilia and ERM (both p < 0.001). Asthma was present in 28% at inclusion, and 17% developed asthma after surgery during follow-up. The presence of asthma, at inclusion as well as developed during follow-up, was significantly associated with recurrence of CRSwNP (p = 0.001 for group comparison).
Recurrence after CRSwNP surgery is common when a long-term follow-up is taken into account. ERM detected in sinonasal secretions at surgery seems to be a predictive factor for recurrence and need for revision surgery. Asthma is a frequently found comorbid factor in CRSwNP, develops even at higher age despite surgical treatment for CRSwNP, and is also associated with a higher recurrence rate. Sustained medical care after surgery is mandatory.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）通常需要手术治疗，但术后复发很常见。复发率在文献中差异很大，哮喘似乎是一个合并因素。
在本研究中，我们旨在评估长期随访期间的疾病复发情况，并调查可能的预测和/或影响参数。
在2000年1月至2006年1月期间接受CRSwNP手术的196例患者中，133例患者进行了至少10年的随访并可纳入研究。通过对鼻组织和鼻窦分泌物进行检测来确定手术时的炎症特征，包括嗜酸性粒细胞、通常含有夏科-莱登结晶（CLC）的富含嗜酸性粒细胞的黏液（ERM）以及真菌菌丝（FH）的分析。在随访期间，收集复发情况、接受的治疗和合并症。
在纳入的133例患者中，81%存在局部嗜酸性粒细胞增多，60%存在ERM。随访期间62%的患者出现复发，且与局部嗜酸性粒细胞增多和ERM相关（均p < 0.001）。纳入时28%的患者患有哮喘，随访期间17%的患者术后出现哮喘。纳入时以及随访期间出现的哮喘与CRSwNP的复发显著相关（组间比较p = 0.001）。
考虑到长期随访时，CRSwNP手术后复发很常见。手术时在鼻窦分泌物中检测到的ERM似乎是复发和需要再次手术的预测因素。哮喘是CRSwNP中常见的合并因素，即使在较高年龄，尽管接受了CRSwNP手术治疗仍会出现，并且也与较高的复发率相关。术后持续的医疗护理是必要的。
