2型慢性鼻窦炎伴鼻息肉术后年龄相关结局与生物治疗需求
Age-related outcome and biological treatment need after surgery for chronic rhinosinusitis with nasal polyposis type 2.
文献信息
| PMID | 42966786 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ramez Salameh |
| 作者单位 | Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. ramezslmh2@gmail.com. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 由2型炎症驱动的慢性鼻窦炎伴鼻息肉（CRSwNP）在所有年龄段均常见，但老年患者的手术结局仍缺乏充分描述。本研究评估了年龄≥65岁的2型CRSwNP患者接受内镜鼻窦手术（ESS）的安全性和有效性，并在生物治疗时代与较年轻患者进行比较。
方法： 在Tel Aviv Sourasky医学中心开展了一项回顾性队列研究，纳入2021年1月至2023年12月期间接受ESS的120例2型CRSwNP患者。患者被分层为0组（<65岁，n=94）和1组（≥65岁，n=26）。主要结局包括术后并发症发生率以及≥12个月时通过SNOT-22评估的主观改善。次要结局包括息肉复发、需要全身性糖皮质激素以及生物制剂启用。
结果： 两组均获得显著的症状改善，SNOT-22 MCID值相当（22.65±24.36 vs. 19.38±21.27；p=0.973）。老年患者显示出显著更大的鼻息肉消退（p=0.006），老年队列中无复发至术前分级。并发症发生率低且相当，包括需要干预的出血（2.1% vs. 3.8%；p=0.619）和粘连形成（18.1% vs. 19.2%；p=0.894），两组均无重大并发症。术后全身性类固醇使用（4.3% vs. 3.8%；p=0.853）和生物制剂启用率（12.0% vs. 15.4%；p=0.738）在两个队列中均同样较低。
结论： ESS在老年2型CRSwNP患者中安全且高度有效，与较年轻患者相比产生相当的症状缓解和更优的息肉消退。仅年龄本身不应排除手术候选资格，生物制剂应保留用于术后失败。
英文摘要
BACKGROUND: CRSwNP driven by type 2 inflammation is common across all ages, yet surgical outcomes in elderly patients remain poorly characterized. This study evaluated the safety and efficacy of ESS in patients aged ≥ 65 years with type 2 CRSwNP and compared outcomes with younger counterparts in the era of biologic therapy.
METHODS: A retrospective cohort study was conducted at Tel Aviv Sourasky Medical Center, including 120 patients with type 2 CRSwNP who underwent ESS between January 2021 and December 2023. Patients were stratified into Group 0 (< 65 years, n = 94) and Group 1 (≥ 65 years, n = 26). Primary outcomes included postoperative complication rates and subjective improvement via SNOT-22 at ≥ 12 months. Secondary outcomes included polyp recurrence, need for systemic corticosteroids, and biologic initiation.
RESULTS: Both groups achieved significant symptomatic improvement, with comparable SNOT-22 MCID values (22.65 ± 24.36 vs. 19.38 ± 21.27; p = 0.973). Elderly patients demonstrated significantly greater nasal polyp regression (p = 0.006), with no recurrence to preoperative grade in the older cohort. Complication rates were low and equivalent, including bleeding requiring intervention (2.1% vs. 3.8%; p = 0.619) and synechia formation (18.1% vs. 19.2%; p = 0.894), with no major complications in either group. Postoperative systemic steroid use (4.3% vs. 3.8%; p = 0.853) and biologic initiation rates (12.0% vs. 15.4%; p = 0.738) were similarly low across both cohorts.
CONCLUSION: ESS is safe and highly effective in elderly type 2 CRSwNP patients, yielding equivalent symptom relief and superior polyp regression compared to younger patients. Age alone should not preclude surgical candidacy, with biologics reserved for post-surgical failure.