Drake-Lee A B
Queen Elizabeth Hospital, Birmingham, United Kingdom.
Rhinology. 1994 Mar;32(1):1-4.
Polyps are a multifactorial disease that affect the nasal lining and sinus mucosa, and in about one-third of the patients are associated with asthma. Polyps may occur in other respiratory diseases such as cystic fibrosis, primary ciliary dyskinesia and immune deficiencies. Allergy does not predispose to polyp formation, although mast cell reactions appear to be important. This explains why corticosteroids are effective in controlling some cases and helping to prevent recurrence in some others. Polyp formation in the sinuses is due to three factors: (1) the balance between the inflammatory response and the local homoeostatic mechanisms; (2) the relatively poor blood supply of the sinuses; and (3) the complex anatomy of the ethmoids and middle meatus which aggravates the existing oedema. Half the cases resolve on inhaled corticosteroids. Surgery should be tailored to the patient's needs, but on principle the simplest, least invasive operation should be tried first. If the patients are still symptomatic or recurrence is a problem, surgery may be followed by corticosteroids. If inhaled corticosteroids do not control the symptoms, then oral therapy may be required.
鼻息肉是一种多因素疾病，会影响鼻黏膜和鼻窦黏膜，约三分之一的患者与哮喘有关。鼻息肉也可能出现在其他呼吸系统疾病中，如囊性纤维化、原发性纤毛运动障碍和免疫缺陷。过敏并非鼻息肉形成的诱因，尽管肥大细胞反应似乎很重要。这就解释了为什么皮质类固醇在控制某些病例以及帮助预防其他一些病例的复发方面是有效的。鼻窦中息肉的形成归因于三个因素：（1）炎症反应与局部稳态机制之间的平衡；（2）鼻窦相对较差的血液供应；（3）筛窦和中鼻道复杂的解剖结构，这会加重现有的水肿。一半的病例通过吸入皮质类固醇可得到缓解。手术应根据患者的需求进行调整，但原则上应首先尝试最简单、创伤最小的手术。如果患者仍有症状或复发是个问题，手术后可能需要使用皮质类固醇。如果吸入皮质类固醇无法控制症状，那么可能需要口服治疗。
