手术与生物制剂在慢性鼻窦炎伴鼻息肉中的作用：一篇叙述性综述。

文献信息

中文摘要

背景： 生物制剂治疗通过靶向慢性2型炎症背后的介质和效应物，推动了重度慢性鼻窦炎伴鼻息肉（CRSwNP）管理的进展。本综述探讨生物制剂对CRSwNP中内镜鼻窦手术（ESS）的影响。
方法： 我们进行了截至2025年3月31日的全面文献检索。
结果： 作为整体管理的一部分，ESS联合局部抗炎治疗在改善重度CRSwNP患者的症状和生活质量方面非常有效。手术资格标准尚未标准化，且不同地区之间的手术率存在很大差异。尽管术后定期使用局部皮质类固醇治疗，部分患者疾病仍保持活动，息肉复发，可能需要反复手术。生物制剂的引入为重度CRSwNP患者提供了额外的治疗选择。大多数2型主导的慢性鼻窦炎患者在开始生物制剂治疗后症状迅速缓解，尽管确实存在无应答者，且部分患者可能仍需要ESS以逆转组织重塑并恢复黏液纤毛功能。在考虑生物制剂治疗的患者中，手术的范围和时机是一个活跃的研究领域。有证据表明，近期或同期进行ESS和/或既往手术的彻底性与更好的疾病控制相关。
结论： 对于常规药物治疗反应不足的重度CRSwNP患者，ESS联合局部皮质类固醇治疗仍是标准方法。新出现的证据正在界定生物制剂可能与手术协同，或在某些情况下作为手术替代方案的场景。

英文摘要

BACKGROUND: Biologic treatments have helped progress the management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) by targeting the mediators and effectors underlying chronic type 2 inflammation. This review considers the impact of biologics on endoscopic sinus surgery (ESS) in CRSwNP.
METHODS: We conducted a comprehensive literature search through March 31, 2025.
RESULTS: ESS as part of holistic management with topical anti-inflammatory treatment is very effective at improving symptoms and quality of life in patients with severe CRSwNP. The criteria for eligibility for surgery are not standardized and there is wide variation in surgery rates between regions. Despite regular post-operative topical corticosteroid therapy, in some patients the disease remains active, polyps recur, and repeated surgeries may be required. The introduction of biologics has provided additional treatment options for patients with severe CRSwNP. Most type 2-dominant patients with chronic rhinosinusitis get rapid symptom relief from the initiation of biologics, although non-responders do exist, and some patients may still require ESS to reverse tissue remodeling and restore mucociliary function. The extent and timing of surgery in patients being considered for biologic therapy is an area of active research. There is evidence that recent or concurrent ESS and/or prior completeness of surgery portends greater disease control.
CONCLUSIONS: ESS, with topical corticosteroid therapy, remains the standard approach for severe CRSwNP in patients with inadequate response to conventional medical treatments. Emerging evidence is delineating the settings in which biologics may be synergistic, or in certain circumstances an alternative, to surgery.