Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps: Clinical outcome and predictive factors of recurrence
Endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps: Clinical outcome and predictive factors of recurrence
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DOI：
10.2500/ajra.2017.31.4402
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Cerejeira, Rui
中科院分区：
文献类型：
--
作者：
Veloso-Teles, Rafaela;Cerejeira, Rui
背景：慢性鼻窦炎伴鼻息肉（CRSwNP）是一种高发的鼻腔和鼻旁窦疾病，但其确切病因仍不清楚，并且仍然是一个难以治疗的疾病。假设：内镜鼻窦手术（ESS）是治疗难治性 CRSwNP 的有效方法。有自变量可以预测 CRSwNP 患者的手术结果。目的：评估 ESS 在 CRSwNP 治疗中的疗效，并建立疾病复发的预后因素。方法：85 例 CRSwNP 患者接受 ESS，并选择至少 9 个月的随访。从病历中收集患者人口统计数据、职业有机物暴露（例如棉花、燃气、木屑）和无机粉尘暴露（例如漂白剂、金属、水泥）、合并症、既往鼻部手术、术前和术后症状、耳鼻喉检查结果、计算机断层扫描结果以及医疗和手术治疗信息。进行统计学分析。结果：术后所有鼻科症状均有改善，有统计学意义，其中鼻塞恢复率最好，嗅觉减退最差。主要和次要并发症发生率分别为1.2%和15.3%。 31% 的患者出现疾病复发，但只有 7% 需要再次手术干预。多变量逻辑回归分析将职业粉尘暴露（p = 0.001）和非免疫球蛋白 E (IgE) 介导的哮喘（p = 0.012）确定为 CRSwNP 复发的独立预测变量，这与其他测试变量不同：年龄、性别、IgE 介导的哮喘、过敏性鼻炎、吸烟习惯、鼻息肉内镜分级、Lund-Mackay 评分和术后局部皮质激素使用。调整后的逻辑模型具有良好的区分能力，曲线下的受试者工作特征面积为 0.82（95% 置信区间，0.73-0.91；p < 0.001）。结论：ESS 被证明是 CRSwNP 的有效治疗方法，但复发率相当高。这些结果表明职业粉尘暴露和非 IgE 介导的哮喘与疾病复发之间存在重要相关性。
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent disease of the nasal cavity and paranasal sinus, but its exact etiology is still unclear and remains a difficult-to-treat condition.Hypothesis: Endoscopic sinus surgery (ESS) is an effective treatment for medically recalcitrant CRSwNP. There are independent variables that can predict surgical outcomes in patients with CRSwNP.Objectives: To evaluate ESS efficacy in CRSwNP treatment and to establish prognostic factors for disease recurrence.Methods: Eighty-five patients with CRSwNP submitted to ESS, and a minimum follow-up of 9 months was selected. Patient demographics, occupational organic exposure (e. g., cotton, fuel gas, wood dust) and inorganic dust exposure (e. g., bleach, metals, cement), comorbidities, previous nasal surgeries, pre-and postoperative symptoms, ear, nose and throat examination findings, computed tomography results, and medical and surgical treatment information were collected from medical records. Statistical analysis was performed.Results: All rhinologic symptoms improved after surgery, in a statistically significant way, with the best recovery rate for nasal obstruction and the worst for hyposmia. The major and minor complications rates were 1.2 and 15.3%, respectively. Disease recurrence occurred in 31% of the patient, but only 7% required surgical reintervention. Multivariate logistic regression analysis identified occupational dust exposure (p = 0.001) and non-immunoglobulin E (IgE) mediated asthma (p = 0.012) as independent predictive variables in CRSwNP recurrence, unlike the other tested variables: age, sex, IgE-mediated asthma, allergic rhinitis, smoking habits, nasal polyps endoscopic grade, Lund-Mackay score, and postoperative topical corticoid use. The adjusted logistic model presented a good discriminatory capacity with a receiver operating characteristic area under the curve of 0.82 (95% confidence interval, 0.73-0.91; p < 0.001).Conclusion: ESS proved to be an effective treatment in CRSwNP but with a considerable rate of recurrence. These results indicated an important correlation of occupational dust exposure and non-IgE-mediated asthma with disease recurrence.