标题：轮廓化鼻内镜手术联合中药鼻腔冲洗治疗难治性慢性鼻-鼻窦炎疗效观察

      作者：孙宝珠 1，段广廷 2，许艳芳 2    1.开封市祥符区中医院耳鼻喉科，河南 开封 475100；2.开封市中心医院耳鼻喉科，河南 开封 475000

      卷次： 2023年34卷24期

      【摘要】 目的 观察轮廓化鼻内镜手术(CENS)联合中药鼻腔冲洗治疗难治性慢性鼻-鼻窦炎(CRS)患者的临床疗效。方法 选取2020年1月至2023年1月开封市祥符区中医院收治的114例难治性CRS患者纳入研究，按随机数表法分为功能性鼻内镜手术(FESS)组、CENS组和联合组各38例。FESS组采用FESS术治疗+生理盐水鼻腔冲洗；CENS组采用CENS术治疗+生理盐水鼻腔冲洗；联合组采用CENS术治疗+中药鼻腔冲洗。治疗两周后比较三组患者的临床疗效，以及治疗前后的主观症状评分、炎性因子[γ-干扰素(IFN-γ)、白介素(IL)-5、IL-17水平]、鼻通气及嗅觉水平，同时比较三组患者的不良反应发生情况和术后随访1年的复发率。结果 治疗两周后，联合组和CENS组患者的临床总有效率分别为94.74%、92.11%，明显高于FESS组的73.68%，差异有统计学意义(P<0.05)；鼻塞、鼻涕、喷嚏及鼻痒的主观症状评分不同组别·时间点交互比较差异均有统计学意义(P<0.05)；治疗一周、两周后，三组患者的鼻塞、鼻涕、喷嚏及鼻痒主观症状评分均呈逐渐降低趋势，且联合组明显低于CENS组和FESS组，CENS组明显低于 FESS组，差异均有统计学意义(P<0.05)；鼻腔分泌物炎性因子 IFN-γ、IL-5、IL-17水平不同组别·时间点交互比较差异均有统计学意义(P<0.05)；治疗一周、两周后，三组患者鼻腔分泌物的 IFN-γ、IL-5及 IL-17水平均逐渐下降，且联合组明显低于CENS组和 FESS组，CENS组明显低于 FESS组，差异均有统计学意义(P<0.05)；鼻腔容积、嗅觉功能评分不同组别·时间点交互比较差异均有统计学意义(P<0.05)；治疗一周、两周后，三组患者的鼻腔容积、嗅觉功能评分均逐渐升高，且联合组明显高于CENS组和FESS组，CENS组明显高于FESS组，差异均有统计学意义(P<0.05)；治疗期间，联合组、CENS组和FESS组患者的不良反应发生率分别为 7.89%、10.53%、15.79%，组间比较差异无统计学意义(P>0.05)；术后随访 1年，联合组、CENS组和 FESS组患者的复发率分别为2.63%、10.53%、28.95%，且联合组复发率P<0.05)。结论 CENS联合中药鼻腔冲洗治疗难治性CRS患者的临床疗效更好，可减轻鼻腔内部炎症反应，改善临床症状，从而促进嗅觉及鼻腔功能恢复，且复发率较低，具有较高的安全性。
      【关键词】 难治性慢性鼻-鼻窦炎；轮廓化鼻内镜手术；鼻腔分泌物；炎性反应；疗效；安全性
      【中图分类号】 R765.4 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3587—06

Clinical effect of contour endoscopic nasal surgery combined with traditional Chinese medicine nasal irrigation inthe treatment of refractory chronic rhinosinusitis.
SUN Bao-zhu 1, DUAN Guang-ting 2, XU Yan-fang 2. 1. Departmentof Otolaryngology, Kaifeng Xiangfu District Hospital of Traditional Chinese Medicine, Kaifeng 475100, Henan, CHINA; 2.Department of Otolaryngology, Kaifeng Central Hospital, Kaifeng 475000, Henan, CHINA
【Abstract】 Objective To observe the clinical efficacy of contour endoscopic nasal surgery (CENS) com-bined with traditional Chinese medicine nasal irrigation in the treatment of refractory chronic rhinosinusitis (CRS).Methods A total of 114 patients with refractory CRS admitted to Kaifeng Xiangfu District Hospital of Traditional Chi-nese Medicine from January 2020 to January 2023 were selected and randomly divided into functional endoscopic sinussurgery (FESS) group, CENS group, and combined group by random number table method, with 38 cases in each group.FESS group applied FESS operation plus nasal irrigation with normal saline, CENS group applied CENS and normalsaline for nasal irrigation, and the combined group used CENS and traditional Chinese medicine nasal irrigation. After2 weeks of treatment, the clinical efficacy was compared among the three groups, as well as subjective symptoms scores,inflammatory factors [levels of γ-interferon (IFN-γ), interleukin-5 (IL-5), IL-17], nasal ventilation and olfactory levelsbefore and after treatment, adverse reactions, and recurrence rate after 1 year of follow-up. Results After 2 weeks oftreatment, the total clinical effective rate was 94.74% in combined group and 92.11% in CENS group, respectively,which was significantly higher than 73.68% of FESS group (P<0.05). The subjective symptom scores of nasal conges-tion, nasal discharge, sneezing, and nasal itchiness had statistically significant differences among different groups andtime points (P<0.05); after 1 week and 2 weeks of treatment, the subjective symptom scores of nasal congestion, nasaldischarge, sneezing, and nasal itchiness showed a gradually decreasing trend in the three groups, and the scores were sig-nificantly lower in the combined group than the CENS group and the FESS group, and also in the CENS group than theFESS group (P<0.05). The levels of inflammatory factors IFN-γ, IL-5, and IL-17 in nasal secretions showed statistical-ly significant differences among different groups and time points (P<0.05); after 1 week and 2 weeks of treatment, thelevels of IFN-γ, IL-5, and IL-17 in nasal secretions were gradually decreased in the three groups, and the levels weresignificantly lower in the combined group than the CENS group and the FESS group, and also in the CENS group thanthe FESS group (P<0.05). The nasal volume and olfactory function scores showed significantly significant differencesamong different groups and time points (P<0.05); after 1 week and 2 weeks of treatment, the nasal volume and olfactoryfunction scores were gradually increased in the three groups, and the scores were significantly higher in the combinedgroup than the CENS group and the FESS group, and also in the CENS group than the FESS group (P<0.05). Duringtreatment, the incidences of adverse reactions in combined group, CENS group, and FESS group were 7.89%, 10.53%,and 15.79%, respectively, and there was no statistically significant differences among the three groups (P>0.05). After1 year of follow-up, the recurrence rates of the combined group, CENS group, and FESS group were 2.63%, 10.53%,and 28.95%, respectively, and the rate was significantly increased successively in the combined group, CENS group, andFESS group (P<0.05). Conclusion CENS combined with traditional Chinese medicine nasal irrigation has better clini-cal efficacy in the treatment of refractory CRS patients, which can reduce the inflammation in the nasal cavity, improveclinical symptoms, and promote the recovery of smell and nasal function, with low recurrence rate and high safety.
      【Key words】 Refractory chronic rhinosinusitis; Contour endoscopic nasal surgery; Nasal secretions; Inflammato-ry response; Curative effect; Safety