目的 探讨低温等离子射频消融技术用于慢性鼻窦炎伴鼻息肉（chronic sinusitis with nasal polyps,CRSwNP）的手术治疗的可行性。方法 选择2018年1月—2021年6月间48例符合入组标准的CRSwNP患者（试验组）行低温等离子射频消融技术辅助鼻内镜手术,与44例同期行功能性内镜鼻窦手术（functional endoscopic sinus surgery,FESS）的患者（对照组）进行各项指标对比,包括术中出血、术前术后的视觉模拟评分（visual analogue scale,VAS）、Lund-Kennedy总评分、Lund-Mackay评分及SNOT-20评分。结果 两组术中出血量,试验组少于对照组（P<0.01）;术后3个月试验组VAS评分评分低于对照组（P<0.05）,差异具有统计学意义,提示试验组术后痛苦程度较对照组轻。Lund-Kennedy评分,术后6个月及术后1年试验组评分低于对照组（P<0.01）,差异具有统计学意义,提示术后病情控制试验组优于对照组。两组术后3个月的Lund-Mackay评分比较,差异无统计学意义（P=0.373）,提示试验组的手术后影像学改变与对照组相当。SNOT评分两组术前及术后1年相当,术后3个月试验组优于对照组。结论 低温等离子射频消融技术用于CRSwNP的辅助鼻内镜手术治疗,有效、安全,可以达到传统手术效果,术中出血少,术后痛苦少,术后6个月及1年的远期疗效优于不结合使用等离子技术的传统功能性内镜鼻窦手术。
Objective To investigate the feasibility of low-temperature plasma radiofrequency ablation in the surgical treatment of chronic rhinosinusitis with nasal polyps （CRSwNP）. Methods From January 2018 to June 2021, 48 patients with CRSwNP who met the inclusion criteria （experimental group） underwent cryogenic plasma radiofrequency ablation-assisted nasal endoscopic surgery, and another 44 patients underwent functional endoscopic sinus surgery （FESS） at the same time. Intraoperative blood loss volume, preoperative and postoperative visual analogue scale （VAS） score, Lund-Kennedy total score, Lund-Mackay score, and SNOT-20 score were compared between the two groups. Results The amount of intraoperative blood loss in the experimental group was less than that in the control group （P<0.01）. The VAS score of the experimental group was lower than that of the control group 3 months after surgery （P<0.05）, suggesting less postoperative pain in the experimental group. The Lund-Kennedy score of the experimental group was lower than that of the control group 6 months and 1 year after surgery （P<0.01）, suggesting better disease control in the experimental group. There was no significant difference between the two groups in the Lund Mackay score 3 months after surgery （P=0.373）, suggesting similar postoperative imaging changes. The SNOT score was not different between the two groups before surgery and 1 year after surgery, but was higher in the experimental group than in the control group 3 months after surgery. Conclusion Low-temperature plasma radiofrequency ablation is effective and safe in the nasal endoscopic treatment of CRSwNP, which can achieve the effect of traditional surgery, with less intraoperative bleeding, less postoperative pain, and better long-term efficacy 6 months and 1 year after surgery than FESS.
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻鼻窦炎诊断和治疗指南(2012年,昆明)[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):92-94.
[2] Fokkens WJ, Lund VJ, Mullol J, et al.EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012.A summary for otorhinolaryngologists[J].Rhinology, 2012,50(1):1-12.
[3] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.中国慢性鼻窦炎诊断和治疗指南(2018)[J].中华耳鼻咽喉头颈外科杂志,2019,54(2):84-85.
[4] 李源,周兵.实用鼻内镜外科学技术及应用[M].北京:人民卫生出版社,2009:95-99.
[5] 杨钦泰,孙悦奇,吴庆武,等.2020年欧洲鼻窦炎和鼻息肉意见书解读[J].中华耳鼻咽喉头颈外科杂志,2020,55(3):304-308.
[6] 张庆丰. 耳鼻咽喉等离子手术学[M].北京:人民卫生出版社,2014:4-15.
[7] 张庆丰,张楠楠,刘得龙.低温等离子射频辅助下功能性内镜鼻窦手术初步临床观察[J].临床耳鼻咽喉头颈外科杂志, 2011,25(23):1087-1089.
[8] 李土坤. 鼻内镜手术联合低温等离子射频消融术治疗慢性鼻-鼻窦炎效果观察[J].中国医学创新,2018,15(10):28-31.
[9] 李玉瑾,李佩忠,金新.鼻内镜鼻窦手术联合低温等离子下鼻甲射频消融术治疗慢性鼻-鼻窦炎的疗效观察[J].临床耳鼻咽喉头颈外科杂志,2015,29(9):788-791.
[10] 许庚. 慢性鼻窦炎:我的理解与经验[J].中华耳鼻咽喉头颈外科杂志,2019,54(3):217-219.
[11] Hopkins C, Slack R, Lund V, et al.Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis[J]. Laryngoscope, 2009,119(12):2459-2465.
[12] Stein NR, Jafari A, DeConde AS. Revision rates and time to revision following endoscopic sinus surgery: A large database analysis[J].Laryngoscope, 2018,128(1):31-36.
[13] Smish KA, Orlandi RR, Oakley G, et al.Long-term revision rates for endoscopic sinus surgery[J]. Int Forum Allergy Rhinol 2019,9(4):402-408.
[14] Bassiouni A, Naidoo Y, Wormald PJ.When FESS fails: the inflammatory load hypothesis in refractory chronic rhinosinusitis[J]. Laryngoscope, 2012,122(2):460-466.
[15] Jankowski R,Bodino C.Olfaction in patients with nasal polyposis: effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization)[J]. Rhinology, 2003,41(4):220-230.
[16] Jankowski R, Bodino C.Evolution of symptoms associated to nasal polyposis following oral steroid treatment and nasalization of the ethmoid--radical ethmoidectomy is functional surgery for NPS[J]. Rhinology, 2003,41(4):211-219.
[17] Jankowski R, Rumeau C. Nguyen DT, et al.Updating nasalisation: From concept to technique and results[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018,135(5):327-334.
[18] Zhang Y, Gevaert E, Lou H, et al.Chronic rhinosinusitis in Aaia[J]. J Allergy Clin Immunol, 2017,140(5):1230-1239.
[19] Zhang L, Zhang Y, Gao Y, et al.Long-term outcomes of different endoscopic sinus surgery in recurrent chronic rhinosinusitis with nasal polyps and asthma[J]. Rhinology,2020,58(2):126-135.
[20] 迪丽达尔,王德辉,史丽,等.加强药物治疗与功能性内镜鼻窦手术+围手术期综合治疗慢性鼻-鼻窦炎疗效的多中心研究[J].中华耳鼻咽喉头颈外科杂志,2013,48(9):734-740.
[21] 周兵,张罗.不断改进内镜鼻窦外科技术提高慢性鼻窦炎伴鼻息肉的疗效[J].中华耳鼻咽喉头颈外科杂志,2021,59(1):7-10.
