复发性鼻窦炎鼻息肉修正性手术及综合治疗效果剖析.docVIP

复发性鼻窦炎鼻息肉修正性手术及综合治疗效果剖析 　　[摘 要] 目的：探讨对复发性鼻窦炎鼻息肉采用修正性鼻内镜手术（Revision endoscopic sinus surgery，RESS）配合激素综合治疗的临床效果。方法：观察我院2011年10月―2014年10月43例复发性鼻窦炎鼻息肉患者接受RESS及激素治疗的疗效及12个月并发症发生率，比较术前、术后6个月VEGF、COX-2阳性率变化。结果：43例患者总有效率为93.0%，术中出血量为（216.53±57.14）mL，术后6个月VEGF、COX-2阳性率均显著下降，与术前比较差异有统计学意义（P0.05）。结论：对复发性鼻窦炎、鼻息肉采用修正性手术关键在于系统规范的治疗方案及术中对解剖位置的掌握，手术后长期系统综合治疗可降低VEGF及COX-2表达，降低复发率。 　　[关键词] 复发性鼻窦炎鼻息肉；修正性手术；功能性鼻内窥镜 　　中图分类号：R 765.9 文献标识码：B 文章编号：2095-5200（2016）04-047-03 　　DOI：10.11876/mimt201604018 　　An analysis of the revision surgery for recurrent sinusitis and nasal polyps and its comprehensive effect WANG Min. （Department of ENT，Yanan University Affiliated Hospital ，Yanan 716000 China） 　　[Abstract] Objective： To explore the clinical effect of Revision Endoscopic Sinus Surgery， RESS in combination with hormone on curing recurrent sinusitis and nasal polyps. Methods： Observe the effect of RESS and hormone treatment on 43 patients suffering recurrent sinusitis and nasal polyps hospitalized from October 2011 to October 2014， calculate the incidence of complications in 12 months and compare the positive rate of VEGF and COX-2 before and after surgery. Results： The overall effective rate stood at 93%； the amount of blood loss during operation was 216.53±57.14 mL； the positive rates of VEGF and COX-2 both decreased remarkably and had significant differences from those before the surgery. Conclusions： The key to cure recurrent sinusitis and nasal polyps through RESS is a systematic and standardized treatment scheme and a mastery of the anatomical position. A long-term， systematic and comprehensive treatment after surgery can reduce the expression of VEGF and COX-2， thereby lowering the recurrence rate. 　　[Key words] recurrent sinusitis and nasal polyps；revision surgery；functional nasal endoscope 　　鼻窦炎、鼻息肉是耳鼻喉科常见疾病，鼻内镜手术联合激素治疗是改善患者预后的有效手段，但仍有10%～20%的患者会出现鼻息肉复发，需再次手术治疗[1]。修正性手术需针对复发性鼻息肉再次或多次手术，但首次手术对鼻腔、鼻窦正常结构的破坏可导致常用手术标志变形或辨认模糊，往往导致再手术难度增加、风险上升，眶周血肿、脑脊液鼻漏甚至失明等严重并发症发生率上升且手术效果受限[2-3]。本