三级护理教学医院中慢性鼻-鼻窦炎伴鼻息肉患者的鼻内镜鼻窦手术结局及复发危险因素
Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyposis and Risk Factors of Recurrence in a Tertiary Care Teaching Hospital.
作者信息
Aldajani Ahmad, Alroqi Ahmad, Alrashidi Ali, Alsaif Anas, Almeshari Saif, Aldwaighri Mohammed, Alromaih Saud, Aloulah Mohammad O, Alrasheed Abdulaziz S, Aldousary Surayie, Alsaleh Saad
机构信息
Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
出版信息
Ther Adv Allergy Rhinol. 2024 Sep 3;15:27534030241274764. doi: 10.1177/27534030241274764. eCollection 2024 Jan-Dec.
BACKGROUND
Endoscopic sinus surgery (ESS) has become the gold standard for treating patients with chronic rhinosinusitis (CRS) refractory to medical therapy. It is considered a relatively safe and effective procedure in all age groups, with overall success rates ranging from 76% to 97.5%. However, failure of primary endoscopic sinus surgery (PESS) occurs at a rate ranging from 2% to 24%. Patients who are still symptomatic after PESS and optimal medical therapy are candidates for revision endoscopic sinus surgery (RESS).
OBJECTIVES
to study the outcomes of ESS and assess the risk factors of recurrence of nasal polyps, as well as to compare the outcomes of PESS and RESS at a tertiary care teaching hospital.
DESIGN
A retrospective cross-sectional study.
METHODS
This study is conducted on patients with CRS with nasal polyps (CRSwNP) who underwent ESS at King Saud University Medical City (KSUMC) between May 2015 and December 2021. During this period, ESS was performed 470 times for CRSwNP. The Sinonasal Outcome Test 22 (SNOT-22) questionnaire, the Lund-Kennedy (LK) score, the Lund-MacKay (LM) score, and the polyp grading system were used to evaluate subjective and objective outcomes. They were scored preoperatively and from 6 to 12 months postoperatively.
RESULTS
Out of the 470 endoscopic sinus surgeries, 321 (68.3%) were PESS and 149 (31.7%) were RESS. Asthma, aspirin sensitivity, and Samter's triad were observed more in the RESS group. The LK and LM scores were significantly different between primary and revision sinus surgeries, revealing that PESS patients had better postoperative LK and LM scores. The RESS patients had significantly worse postoperative SNOT-22 scores compared to PESS patients.
CONCLUSION
Lund-MacKay, Lund-Kennedy, and SNOT-22 scores improved after ESS for both primary and revision ESS patients, with better outcomes observed after PESS compared to RESS. The presence of asthma, aspirin sensitivity, Samter's Triad, high-grade nasal polyps, and older age were identified as risk factors for CRSwNP recurrence, which may require RESS.
背景
内镜鼻窦手术（ESS）已成为治疗药物治疗无效的慢性鼻窦炎（CRS）患者的金标准。在所有年龄组中，它被认为是一种相对安全有效的手术，总体成功率在76%至97.5%之间。然而，初次内镜鼻窦手术（PESS）的失败率在2%至24%之间。PESS及最佳药物治疗后仍有症状的患者是再次内镜鼻窦手术（RESS）的候选者。
目的
研究ESS的疗效，评估鼻息肉复发的危险因素，并比较三级护理教学医院中PESS和RESS的疗效。
设计
一项回顾性横断面研究。
方法
本研究对2015年5月至2021年12月在沙特国王大学医学城（KSUMC）接受ESS的慢性鼻窦炎伴鼻息肉（CRSwNP）患者进行。在此期间，对CRSwNP进行了470次ESS。使用鼻窦结局测试22（SNOT-22）问卷、Lund-Kennedy（LK）评分、Lund-MacKay（LM）评分和息肉分级系统来评估主观和客观结果。在术前以及术后6至12个月进行评分。
结果
在470例内镜鼻窦手术中,321例（68.3%）为PESS，149例（31.7%）为RESS。RESS组中哮喘、阿司匹林敏感性和Samter三联征的观察结果更多。初次和再次鼻窦手术之间的LK和LM评分有显著差异，表明PESS患者术后的LK和LM评分更好。与PESS患者相比，RESS患者术后的SNOT-22评分明显更差。
结论
ESS后，初次和再次ESS患者的Lund-MacKay、Lund-Kennedy和SNOT-22评分均有所改善，与RESS相比，PESS后的疗效更佳。哮喘、阿司匹林敏感性、Samter三联征、高级别鼻息肉和年龄较大被确定为CRSwNP复发的危险因素，可能需要进行RESS。
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