慢性鼻-鼻窦炎伴嗅觉障碍患者鼻内镜手术前后嗅觉变化分析

发布时间：2018-04-25 22:24

本文选题：慢性鼻-鼻窦炎 + 功能性内镜下鼻窦手术　；参考：《临床耳鼻咽喉头颈外科杂志》2016年02期

【摘要】：目的:对74例慢性鼻-鼻窦炎(CRS)伴嗅觉障碍患者鼻内镜手术前后的嗅觉情况进行动态性观察,分析影响鼻内镜手术后嗅觉恢复的因素。方法:采用TT嗅觉测试方法,对74例(148侧)慢性鼻-鼻窦炎患者行术前嗅觉测试,同时行鼻窦CT和鼻内镜检查,根据是否伴有变应性鼻炎分成2组进行对照,分别进行LundMackey鼻窦CT评分及Lund-Kennedy鼻内镜评分,并行标准鼻内镜手术及规范围手术期处理,术后不同时期行嗅觉功能测试,分析嗅觉恢复情况与变应性鼻炎、慢性鼻-鼻窦炎病变程度的关系。结果:1患者嗅觉总体水平术后不同时期情况较术前均有明显提高;患者术后12、24周嗅觉测试较术后4周有明显改善;2Lund-Mackey鼻窦CT评分与术后嗅觉恢复的程度有关(P0.05),术前CT评分越高,术后嗅觉恢复相对较差;3Lund-Kennedy鼻内镜评分的变化与术后嗅觉恢复程度有关(P0.05),术前评分越高,术后嗅觉恢复相对较差;4变应性鼻炎是CRS伴嗅觉障碍术后嗅觉恢复的因素,伴有变应性鼻炎的患者,术后嗅觉恢复较不伴变应性鼻炎患者差;5病程也是影响CRS伴嗅觉障碍术后嗅觉恢复的因素,病程越长,嗅觉恢复越差;6嗜酸粒细胞计数情况与CRS伴嗅觉障碍术后嗅觉恢复有关,嗜酸粒细胞计数值越高,嗅觉恢复越差。结论:鼻内镜手术对CRS患者的嗅觉障碍有明显改善作用。在手术彻底清除炎性病变、解除嗅裂阻塞的基础上,更应注重对嗅区嗅黏膜的保护;同时,规范化的围手术期处理、对变应性鼻炎的治疗和术后定期随访也十分重要。
[Abstract]:Objective: to observe the dynamic state of olfactory in 74 patients with chronic rhinosinusitis and olfactory disorder before and after endoscopic surgery, and to analyze the factors affecting olfactory recovery after endoscopic sinus surgery. Methods: 74 patients with chronic rhinosinusitis were examined by TT olfactory test before operation, CT and endoscopy of nasal sinusitis were performed at the same time, and were divided into two groups according to whether they were accompanied with allergic rhinitis. LundMackey sinus CT score and Lund-Kennedy nasal endoscopy score were performed respectively. Standard endoscopic surgery and standard perioperative management were performed. Olfactory function was tested at different stages after operation. Olfactory recovery and allergic rhinitis were analyzed. Relationship between the severity of chronic rhinosinusitis. Results the overall level of olfactory in patients with 1 / 1 was significantly higher than that before operation in different period after operation, and the CT score of nasal sinuses of 2 Lund-Mackey patients was significantly improved compared with that of 4 weeks after operation (P 0.05). The higher the preoperative CT score was, the higher the score was. The change of nasal endoscopy score of Lund-Kennedy was related to the degree of olfactory recovery. The higher the preoperative score, the worse the recovery of olfactory and allergic rhinitis after operation was the factor of olfactory recovery after CRS with olfactory disorder. In the patients with allergic rhinitis, the worse course of olfactory recovery after operation was also the factor of olfactory recovery after CRS with olfactory disorder. The worse the olfactory recovery was, the worse the eosinophil count was. The higher the eosinophil count was, the worse the olfactory recovery was. Conclusion: endoscopic sinus surgery can significantly improve the olfactory disorders in CRS patients. On the basis of thoroughly removing inflammatory lesions and relieving olfactory fissure obstruction, we should pay more attention to the protection of olfactory mucosa in olfactory area, and the standardized perioperative management is also very important for the treatment of allergic rhinitis and regular follow-up after operation.
【作者单位】：运城市中心医院耳鼻咽喉科;山西医科大学第一医院耳鼻咽喉科;
【分类号】：R765.9

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