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目的探讨国内成人不伴鼻息肉的慢性鼻鼻窦炎(CRSsNP)的基本特征和有效的治疗方法。方法对78例CRSsNP患者进行临床量化评估:鼻窦CT扫描采用Lund-Mackay评分法,计算出病变鼻窦所占百分比;鼻内镜检查采用Lund-Kennedy评分;症状严重度采用视觉类比法评分(VAS法)。结合患者主诉以及客观检查和评分,分析引起病变的解剖异常,制定个性化手术方案,行鼻内镜下鼻腔成型术。术后配合保守治疗和随访,1年后再次进行Lund-Kennedy评分和VAS评分,并进行统计学分析。结果所有患者手术均涉及窦口鼻道复合体和上颌窦区域,病理显示以浆细胞和淋巴细胞浸润为主。痊愈53例,有效25例,无效0例,总有效率为100%,术腔上皮化时间平均5周。前组鼻窦出现病变百分比高于后组鼻窦。除0～3分级手术前后VAS症状评分差异无统计学意义,其它患者手术前后VAS症状评分以及Lund-Kennedy评分均有显著性差异。结论国内成人CRSsNP有自身特点:局部多解剖异常可能对发病有重要作用,窦口鼻道复合体和上颌窦是病变靶点区;细菌感染因素可能重于变态反应因素,单侧与双侧CRSsNP主要发病机制可能不同;EPOS2007指南中提供的评估方法可较客观全面的反映病变及治疗情况,CRSsNP手术治疗占有重要地位,个体化的鼻内镜鼻腔成型术是有效的手术方法。
Objective To investigate the basic characteristics and effective treatment of chronic rhinosinusitis (CRSsNP) in adults without nasal polyps in China. Methods The clinical quantitative assessment of 78 CRSsNP patients was performed. The Lund-Mackay score was used to calculate the percentage of sinus lesions in the sinuses, the Lund-Kennedy score was used in the endoscopic examination, and the visual analog scale (VAS method) ). Combined with the patient’s complaints and objective examination and scoring, analysis of the anatomic abnormalities caused by the disease, the development of personalized surgery program, endoscopic nasal rhinoplasty. Postoperative conservative treatment and follow-up, Lund-Kennedy score and VAS score again after 1 year, and statistical analysis. Results All patients underwent surgery involving the ostiomeatal complex and the maxillary sinus region. The pathological findings were mainly plasma cell and lymphocyte infiltration. 53 cases were cured, effective in 25 cases, 0 cases of ineffective, the total effective rate was 100%, the average time of epithelialization within 5 weeks. The incidence of lesions in the anterior sinuses was higher than that of posterior sinuses. There was no significant difference in VAS symptom scores before and after 0 ~ 3 grading operation. VAS symptom scores and Lund-Kennedy scores of other patients before and after surgery were significantly different. Conclusion Domestic adult CRSsNP has its own characteristics: local multi-anatomical abnormalities may play an important role in the pathogenesis, ostiomeatal complex and maxillary sinus lesions target area; bacterial infection may be more important than the factors of allergy, unilateral and bilateral CRSsNP The main pathogenesis may be different; the assessment method provided in the EPOS2007 guideline can reflect the pathological changes and treatment objectively and comprehensively. CRSsNP surgical treatment plays an important role. Individualized endoscopic nasal surgery is an effective surgical method.