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

任军; 皇甫辉

doi:10.13201/j.issn.1001-1781.2016.02.005

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

任军^1, ,,
皇甫辉²

- 1. 运城市中心医院耳鼻咽喉科(山西运城, 044000);
- 2. 山西医科大学第一医院耳鼻咽喉科

详细信息

通讯作者: 任军,E-mail:rjun1126@sina.com

中图分类号: R765.4

收稿日期: 2015-09-18

Analysis of olfactory rehabilitation after endoscopic sinus surgery in patients with chronic sinusitis and nasal polyps

REN Jun^1, ,,
HUANGFU Hui²

- 1. Department of Otorhinolaryngology, Yuncheng Central Hospital, Yuncheng, 044000, China;
- 2. Department of Otorhinolaryngology, the First Hospital of Shanxi Medical University

More Information

Corresponding author: REN Jun, E-mail: rjun1126@sina.com

Received Date: 18 September 2015

摘要

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T&T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Lund-Mackey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(P<0.05),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(P<0.05),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。
- 慢性鼻-鼻窦炎 /
- 功能性内镜下鼻窦手术 /
- 嗅觉障碍
Abstract: Objective:To evaluate the influence of endoscopic sinus surgery on olfactory disorder caused by chronic sinusitis and nasal polyps, by testing the olfactory function of seventy-four patients before and after endoscopic sinus surgery,and evaluate the outcomes of olfactory dysfunction after endoscopic sinus surgery in patients with choinc rhinosinusitis and the related factors.Method:The olfactory function of the seventy-four patients with chronic sinusitis and nasal polyps were tested by the T&T olfactory testing method at pre-operation and four weeks,twelve weeks,twenty-four weeks of post-operation.Patients were divided into two groups, according to whether combined with allergic rhinitis.Data were achieved by the scores of endoscopic appearances of Kennedy,and CT staging system of Lund-Mackey.Parallel processing standard endoscopic operation and processing specification during peri operation period. Analysing the degree of olfactory rehabilitation in chronic sinusitis and nasal polyps with allergic rhinitis.Result:①Compared with the level of olfactory function,significant improvement was found at first month;however, the olfactory function level 4 weeks after operations was significantly statistically different with that 12 weeks and 24 weeks after operations;②Lund-Mackey sinus CT higher score is related to the worse degree of postoperative nasal olfactory rehabilitation(P<0.05).③The higher scores of endoscopic appearances of Kennedy is related to the worse degree of postoperative nasal olfactory rehabilitation (P<0.05).④Allergic rhinitis is one of the factors of olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation, the olfactory rehabilitation of patients with allergic rhinitis is worse than that in the patients with no allergic rhinitis.⑤Course of disease is one of the factors of chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation.Longer the course of disease,worse the olfactory rehabilitation.⑥Eosinophil count was related to olfactory rehabilitation in chronic rhinosinusitis with olfactory dysfunction olfactory rehabilitation.Higher Eosinophil count, worse the olfactory rehabilitation.Conclusion:FESS plays a positive role in the improvement of olfactory impairment in patients with CRS.It is important to protect the olfactory mucous during surgical removal of sinonasal lesions.The standard intraoperative procedure, treatment on allergic rhinitis and regular follow-up after operation are also very important.
- chronic rhinosinusitis /
- functional endoscopic sinus operation /
- olfactory dysfunction

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