修正性鼻內鏡手術治療慢性鼻—鼻竇炎鼻內鏡術后復發的處理措施研究

羅文廣 童敏 張克春

摘 要：目的 探討修正性鼻內鏡手術治療慢性鼻-鼻竇炎鼻內鏡術后復發的治療措施。方法 回顧分析2015年6月～2018年6月在我院采用修正性鼻內鏡手術治療的120例慢性鼻-鼻竇炎鼻內鏡術后復發患者臨床資料，觀察手術治療療效（手術前后臨床癥狀評分、Lund-Kennedy鼻內鏡檢查評分、并發癥發生情況），探討提高修正性鼻內鏡手術效果的相關措施。結果 慢性鼻-鼻竇炎鼻內鏡術后復發原因主要包括病變竇腔開放不全、解剖變異未矯正、術腔增生粘連、骨炎和變應性炎癥；治療總有效率為95.00%；術后臨床癥狀（鼻塞、鼻涕、頭痛、水腫）評分、Lund-Kennedy鼻內鏡檢查評分均低于術前，差異有統計學意義（P<0.05）；隨訪2個月，6例患者發生并發癥，其中鼻中隔血腫3例，眶周皮下淤血1例，鼻淚管損傷1例，并發癥發生率為5.00%。結論 慢性鼻-鼻竇炎鼻內鏡術后復發較多，臨床采用修正性鼻內鏡手術式應做好術前充分準備，圍術期應給予針對性護理，并熟練掌握鼻內鏡手術操作技巧，以確保手術效果，提高臨床治療療效。

關鍵詞：慢性鼻-鼻竇炎；鼻內鏡術；復發

中圖分類號：R765.41 文獻標識碼：B DOI：10.3969/j.issn.1006-1959.2018.23.054

文章編號：1006-1959（2018）23-0183-03

Abstract：Objective To investigate the treatment of the recurrent chronic rhino-sinusitis after endoscopic surgery with modified endoscopic surgery.Methods The clinical data of 120 patients with recurrent chronic rhino-sinusitis after endoscopic surgery treated by modified endoscopic surgery.From June 2015 to June 2018 in our hospital were retrospectively analyzed.We observed the curative effect of surgical treatment （clinical symptom score， Lund-Kennedy nasal endoscopy score， complications before and after operation） in order to explore the related measures to improve the effect of modified endoscopic sinus surgery.Results The main causes of ecurrent chronic rhino-sinusitis after endoscopic surgery included inoperable sinus cavity， uncorrected anatomic variation， hyperplastic adhesion， osteositis and allergic inflammation. The total effective rate was 95.00%.The scores of clinical symptoms （nasal obstruction， nasal snot， headache， edema） and Lund-Kennedy nasal endoscopy were significantly lower than those before operation （P<0.05）.With a follow up for 2 months，complications occurred in 6 cases，including nasal septum hematoma in 3 cases， periorbital subcutaneous congestion in 1 case and nasolacrimal duct injury in 1 case.The incidence of complications was 5.00%.ConclusionThe recurrence of chronic rhino-sinusitis after endoscopic surgery is more frequent.The clinical application of modified endoscopic sinus surgery should be well prepared before operation， the perioperative period should be given targeted nursing care， and the operation skills of nasal endoscopic surgery should be mastered skillfully in order to ensure the operation effect， improve the clinical treatment effect.

Key words：Chronic rhino-sinusitis；Endoscopic surgery；Recurrence

慢性鼻-鼻竇炎（chronic rhino-sinusitis，CRS）是臨床常見的多發病，病情遷延不愈，容易反復發作，嚴重影響患者的健康[1]。目前鼻內鏡微創手術是治療慢性鼻-鼻竇炎的有效手段，但是仍有約20%左右的患者術后病情不能獲得持久緩解。鼻竇炎復發的病因較為復雜，而復發性慢性鼻-鼻竇炎臨床治療難度更是較大。因此，臨床分析復發性慢性鼻-鼻竇炎原因，并給予針對性的措施，提高修正性鼻內鏡手術效果具有重要的臨床價值。本文作者結合2015年6月～2018年6月在我院采用修正性鼻內鏡手術治療的120例慢性鼻-鼻竇炎鼻內鏡術后復發患者臨床資料，分析復發的原因并總結提高修正性鼻內鏡手術效果相關措施，為臨床提供一定的參考依據，現報告如下。……