Shi X Q, Tang H H, Zheng H L, Chen Z M, Xiao L Y, Huang Y Q
Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital, Shanghai 200433, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Aug 7;56(8):824-829. doi: 10.3760/cma.j.cn115330-20200809-00655.
To assess the efficacy of a bioabsorbable steroid-eluting sinus stent in improving surgical outcomes when placed in the frontal sinus ostium (FSO) following full endoscopic sinus surgery (ESS) in patients with whole group chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with whole group CRSwNP who had similar lesions on bilateral sinus between September 2019 and March 2020 in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital were chosen. Patients with CRSwNP who underwent extended ESS were randomly assigned to receive a steroid-eluting sinus stent in one FSO whereas the contralateral side received surgery alone. Endoscopic evaluations recorded at 30, 90 days postoperative were graded by an independent assessment panel to assess the need for interventions in the FSO. Semi-quantitative data with CT and endoscopic score were performed by rank sum test. The need for postoperative intervention and the patency rate of FSO were analyzed using the McNemar test. Thirty-one patients with whole group CRSwNP met all eligible criteria, including 17 males and 14 females, with the age of (44.5±11.8) years(x¯±s). Stents were successfully placed in one FSO of all patients. At 30 days post-ESS, the assessment panel reported that steroid-eluting stents reduced the need for postoperative interventions by 41.0% (χ=5.314,=0.021), the need for oral steroid interventions by 40.0% (χ=4.133,=0.042) and the need for surgical interventions by 74.8% (χ=4.292,=0.038) compared to control sinuses with no stents. Clinical surgeons also reported greater diameter of FSO compared to control sinuses at 30 days post-ESS (74.2% 48.4%, χ=4.351, =0.037). These results at 90 days post-ESS were consistent with those at 30 days post-ESS. Bioabsorbable steroid-eluting sinus stents in the FSO can reduce polyp formation, adhesion, and the need for postoperative interventions in FSO of CRSwNP patients and improve the early postoperative outcomes.
评估一种可生物吸收的类固醇洗脱鼻窦支架在全组慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者接受全内镜鼻窦手术(ESS)后置于额窦开口(FSO)时改善手术效果的疗效。选取2019年9月至2020年3月在上海长海医院耳鼻咽喉头颈外科双侧鼻窦有相似病变的全组CRSwNP患者。接受扩大ESS的CRSwNP患者被随机分配,一侧FSO接受类固醇洗脱鼻窦支架,而对侧仅接受手术。术后30天、90天记录的内镜评估由独立评估小组进行分级,以评估FSO干预的必要性。采用秩和检验对CT和内镜评分的半定量数据进行分析。使用McNemar检验分析术后干预的必要性和FSO的通畅率。31例全组CRSwNP患者符合所有入选标准,其中男性17例,女性14例,年龄为(44.5±11.8)岁(x¯±s)。所有患者的一个FSO均成功置入支架。ESS术后30天,评估小组报告,与未置入支架的对照鼻窦相比,类固醇洗脱支架使术后干预需求降低41.0%(χ=5.314,P=0.021),口服类固醇干预需求降低40.0%(χ=4.133,P=0.042),手术干预需求降低74.8%(χ=4.292,P=0.038)。临床外科医生还报告,ESS术后30天FSO直径比对照鼻窦更大(74.2%对48.4%,χ=4.351,P=0.037)。ESS术后90天的这些结果与术后30天一致。FSO中可生物吸收的类固醇洗脱鼻窦支架可减少CRSwNP患者FSO处息肉形成、粘连及术后干预需求,并改善术后早期效果。