Department of Otorhinolaryngology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, S/N, 4434-502, Vila Nova de Gaia, Porto, Portugal.
Eur Arch Otorhinolaryngol. 2023 Jul;280(7):3265-3269. doi: 10.1007/s00405-023-07856-7. Epub 2023 Feb 10.
Despite endoscopic sinus surgery (ESS) being the standard best treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), there still remains a high recurrence rate of nasal polyps after ESS. The aim of this study was to analyze the impact of ESS in the treatment of CRSwNP and identify possible predictors for revision surgery.
We conducted a cross-sectional retrospective study of patients with CRSwNP submitted to ESS between the years 2013 and 2021.
We analyzed 517 cases, of which 15.1% were submitted to revision ESS. The presence of hyposmia/anosmia, asthma, intolerance/allergy to non-steroid inflammatory drugs, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and bilateral polyposis were more frequent in patients who needed revision surgery. Initial values of peripheral eosinophilia and Lund-Mackay scores were significantly higher in this sub-group of patients. Lund-Mackay score was the only independent risk factor for revision surgery.
Factors like peripheral eosinophilia and Lund-Mackay score were associated with a higher probability of revision ESS. Applying these concepts to the clinical practice could help predict the evolution of patient's pathology in the post-operative period and identify in advance those cases that may need a multidisciplinary approach.
尽管内镜鼻窦手术（ESS）是治疗慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的标准最佳治疗方法，但 ESS 后鼻息肉仍有很高的复发率。本研究旨在分析 ESS 治疗 CRSwNP 的效果，并确定可能需要再次手术的预测因素。
我们对 2013 年至 2021 年间接受 ESS 的 CRSwNP 患者进行了一项回顾性的横断面研究。
我们分析了 517 例患者，其中 15.1%的患者需要再次 ESS。需要再次手术的患者中，嗅觉减退/丧失、哮喘、对非甾体抗炎药的不耐受/过敏、非甾体抗炎药加重的呼吸道疾病和双侧息肉更为常见。该亚组患者的外周嗜酸性粒细胞计数和 Lund-Mackay 评分初始值明显较高。Lund-Mackay 评分是再次手术的唯一独立危险因素。
外周嗜酸性粒细胞计数和 Lund-Mackay 评分等因素与更高的再次 ESS 概率相关。将这些概念应用于临床实践中，可以帮助预测患者术后病理的演变，并提前识别那些可能需要多学科方法的病例。
