鼻内化与功能性内镜鼻窦手术治疗伴鼻息肉的慢性鼻窦炎的疗效比较：一项10年回顾性研究
Comparative outcomes of nasalisation vs functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyposis: a 10-year retrospective study.
文献信息
| PMID | 42708439 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Dubravko Manestar |
| 作者单位 | Clinic of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, Croatia. |
| 期刊 | Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale |
| SCI 分区 | Q1 |
| IF | 2.4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
目的： 比较功能性内镜鼻窦手术（FESS）与鼻内化（根治性筛窦切除术）在伴鼻息肉的慢性鼻窦炎（CRSwNP）中的疗效，并确定最能从鼻内化中获益的亚组。
方法： 我们回顾性分析了2012年至2022年的480例手术（374例FESS，106例鼻内化）。鼻内化患者的基线疾病比FESS患者更严重（平均鼻塞症状评估[NOSE]评分：76.88 ± 6.18 vs 73.55 ± 7.25；平均视觉模拟量表[VAS]嗅觉评分：6.53 ± 1.1 vs 8.8 ± 1.15；平均Lildholdt评分：2.09 ± 0.76 vs 1.57 ± 0.83；所有p < 0.001）。在术前及术后1、3、6、12和24个月记录主观（NOSE、VAS）和客观（Lildholdt）评分。
结果： 尽管基线状态更差，鼻内化在主观和客观指标上显示出更大的改善，并且在弥漫性广泛性息肉病中特别有效。配对t检验证实术后显著改善（所有p < 0.001；Cohen's d > 0.8）。在24个月时，鼻内化显示出更优的结果：NOSE（24.5 ± 5.5 vs 41 ± 6）、VAS嗅觉（1.95 ± 1.05 vs 3.95 ± 1.15）（均p < 0.001）；Lildholdt评分相似（0.5 ± 0.6 vs 0.53 ± 0.65；p = 0.68）。
结论： 这项回顾性研究的初步结果表明，在更严重的CRSwNP病例中进行鼻内化可获得更好的长期临床结果。这些结果促使我们通过一项前瞻性研究进行进一步调查，该研究将包括全面的嗅觉测试、生活质量测量以及更完整的方法学和改进的变量，以解决当前数据集的局限性。
英文摘要
OBJECTIVE: To compare outcomes of functional endoscopic sinus surgery (FESS) and nasalisation (radical ethmoidectomy) in chronic rhinosinusitis with nasal polyposis (CRSwNP), and to identify subgroups benefiting most from nasalisation.
METHODS: We retrospectively analysed 480 surgeries (374 FESS, 106 nasalisation) from 2012 to 2022. Nasalisation patients had more severe baseline disease than FESS patients (mean Nasal Obstruction Symptom Evaluation [NOSE] score: 76.88 ± 6.18 vs 73.55 ± 7.25; mean Visual Analogue Scale [VAS] olfaction score: 6.53 ± 1.1 vs 8.8 ± 1.15; mean Lildholdt score: 2.09 ± 0.76 vs 1.57 ± 0.83; all p < 0.001). Subjective (NOSE, VAS) and objective (Lildholdt) scores were recorded preoperatively and at one, 3, 6, 12, and 24 months postoperatively.
RESULTS: Despite worse baseline status, nasalisation showed greater improvements in subjective and objective measures, and was particularly effective in diffuse extensive polyposis. Paired t-tests confirmed significant postoperative enhancements (all p < 0.001; Cohen's d > 0.8). At 24 months, nasalisation showed superior outcomes: NOSE (24.5 ± 5.5 vs 41 ± 6), VAS olfaction (1.95 ± 1.05 vs 3.95 ± 1.15) (both p < 0.001); Lildholdt scores were similar (0.5 ± 0.6 vs 0.53 ± 0.65; p = 0.68).
CONCLUSIONS: The preliminary results of this retrospective study showed that nasalisation in more severe cases of CRSwNP yielded better long-term clinical outcomes. These results motivate for further investigation through a prospective study that will include comprehensive olfactory testing, quality of life measures, and a more complete methodology with refined variables to address the limitations of the current data set.