Zhou Huiqin, Zhang Wei, Gong Wanyang, Jin Jing, Liu Kunyu, Xu Yu
Department of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University;Research Institute of Otolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University;Hubei Province Key Laboratory of Allergy and Immunology,Wuhan,430060,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Apr;37(4):252-257. doi: 10.13201/j.issn.2096-7993.2023.04.003.
To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery(FESS) for the treatment of chronic rhinosinusitis with nasal polyps(CRSwNP). CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group(<0.05). No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups(>0.05). Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group(<0.05). Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group(all <0.05). Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.
评估在功能性鼻内镜鼻窦手术(FESS)2周后植入糖皮质激素鼻窦支架治疗慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的疗效。将双侧病变相似的CRSwNP患者随机分为两组,支架组25例,对照组24例。支架组患者在FESS术后2周将糖皮质激素鼻窦支架植入双侧筛窦,而对照组仅进行术后清创。在术后第2、4、8和12周进行随访评估。要求患者使用10分视觉模拟量表评估其鼻部症状的感觉。通过内镜评估疗效。评估鼻窦阻塞、结痂/凝血、息肉形成、中鼻甲位置、粘连、黏膜上皮化和术后干预作为疗效指标。应用GraphPad Prism 9进行统计分析。术后4周和8周,支架组鼻塞和流涕的视觉模拟量表(VAS)评分与对照组相比有显著改善(P<0.05)。两组在头面部闷胀、嗅觉减退或鼻干燥/结痂的VAS评分上无显著差异(P>0.05)。与对照组相比,支架组在术后4周、8周和12周息肉样形成率较低。术后12周,支架组筛窦腔内黏膜上皮化率显著更高。随访期间,支架组术后干预频率显著低于对照组(P<0.05)。此外,术后8周和12周时,支架组中鼻甲外移发生率较低。术后8周,支架组粘连百分比低于对照组(均P<0.05)。FESS术后植入糖皮质激素鼻窦支架可维持鼻窦腔通畅,改善术腔炎症状态,减少术后干预,并促进术腔良性转归。