钟庄龙 罗庆 钟纯

[摘要] 目的 探讨保留并修正中鼻甲的鼻内镜鼻窦开放手术治疗慢性鼻窦炎伴鼻息肉的疗效，术后囊泡组织中增殖细胞抗原（Ki67）与血管内皮生长因子（VEGF）的表达及意义。 方法 对2019年1～10月我院收治的62例慢性鼻窦炎伴鼻息肉患者，随机分组采用部分切除中鼻甲的鼻内镜鼻窦开放手术（对照组）与保留并修正中鼻甲的鼻内镜鼻窦开放手术（研究组），对Lund-Kennedy内镜黏膜形态评分、视觉模拟量表（VAS）评分、鼻-鼻窦炎疾病特异性生活质量量表（SNOT-20）评分及疗效进行分析，根据以上结果进行病情控制评估，检测术后囊泡组织中Ki67与VEGF的表达。 结果 两组疗效术后4个月控制率比较差异无统计学意义（P>0.05），但在完全控制率比较上差异有统计学意义（P<0.05）;两组术前Lund-Kennedy内镜黏膜形态评分差异无统计学意义（P>0.05），但术后12周评分差异有统计学意义（P<0.05）;术前及术后12周视觉模拟量表（VAS）评分差异均无统计学意义（P>0.05）;术前两组鼻-鼻窦炎疾病特异性生活质量量表（SNOT-20）评分比较差异无统计学意义（P>0.05），两组术后12周与术前比较，均有明显好转，对照组除鼻涕倒流（咽喉）条目外，其余条目差异均有统计学意义（P<0.05），术后12周两组之间鼻涕倒流（咽喉）條目评分比较差异有统计学意义（P<0.05），其余条目比较差异均无统计学意义（P>0.05）;术后囊泡组织中Ki67与VEGF的表达均呈下降趋势，术后12周两组比较有统计学意义（P<0.05）。结论 保留并修正中鼻甲能更好地恢复生理功能，术腔上皮化进程更快，并取得更好的疗效，且术后囊泡组织中Ki67及VEGF表达更少。

[关键词] 慢性鼻窦炎伴鼻息肉;鼻内镜鼻窦手术;中鼻甲;Ki67;VEGF

[中图分类号] R765.9          [文献标识码] B          [文章编号] 1673-9701（2020）15-0090-06

Expression and significance of Ki67 and VEGF in vesicle tissue after endoscopic sinus surgery for correction of middle turbinate

ZHONG Zhuanglong1   LUO Qing2   ZHONG Chun1   YANG Qiming1   HE Yanchun1

1.Department of Otolaryngology Head and Neck Surgery， Jiangxi Pingxiang People's Hospital， Pingxiang   337000， China; 2.Department of Otolaryngology Head and Neck Surgery， the First Affiliated Hospital of Nanchang University， Nanchang   330000， China

[Abstract] Objective To investigate the therapeutic efficacy of endoscopic sinus surgery for chronic sinusitis with nasal polyps， which aims to preserve and correct the middle turbinate， and the expression and significance of proliferating cell antigen Ki67 and vascular endothelial growth factor（VEGF） in postoperative vesicle tissue. Methods 62 patients with chronic sinusitis and nasal polyps admitted to our hospital from January to October 2019 were randomly divided into two groups： The control group given endoscopic sinus surgery with partial excision of middle turbinate and the study group endoscopic sinus surgery with preservation and correction of middle turbinate. Lund-Kennedy endoscopic mucosal morphology scores， visual analogue scale（VAS） scores， nasal-sinusitis disease-specific quality of life scale the sino-nasal outcome test-20（SNOT-20） scores and therapeutic efficacy were analyzed. On the basis of the above results， disease control assessment was carried out， and the expression of Ki67 and VEGF in postoperative vesicle tissue was detected. Results There was no statistically significant difference in control rate between the two groups 4 months after operation（P>0.05）， but there was statistically significant difference in complete control rate（P<0.05）. There was no statistically significant difference in preoperative Lund-Kennedy endoscopic mucosal morphology scores between two groups（P>0.05）， but there was statistically significant difference in the scores 12 weeks after the operation（P<0.05）. There was no statistically significant difference in VAS scores before and 12 weeks after operation（P>0.05）. There was no statistically significant difference in the scores of SNOT-20 between the two groups before operation（P>0.05）. Compared with those before the operation， two groups changed for the better， all items except the snot reflux（throat） item 12 weeks after operation showed differences and the differences were statistically significant（P<0.05） in control group， the difference between the two groups in the scores of snot reflux（throat） item 12 weeks after operation was statistically significant（P<0.05）， while the differences of all other items were not statistically significant（P>0.05）. The expression of Ki67 and VEGF in the vesicle tissue showed a downward trend after operation in both groups， and there was statistically significant difference between that of the two groups 12 weeks after operation（P<0.05）. Conclusion Preservation and correction of middle turbinate can better restore physiological function， accelerate the process of epithelialization of the operative cavity and achieve better curative effect， and reduce the expression of Ki67 and VEGF in postoperative vesicle tissue.

[Key words] Chronic sinusitis with nasal polyps; Endoscopic sinus surgery; Middle turbinate; Ki67; VEGF

慢性鼻窦炎伴鼻息肉患者在临床耳鼻咽喉科属常见病和多发病，随着鼻内镜技术的不断发展，其治疗疗效已经得到临床证实，但中鼻甲的保留与切除尚无统一定论。鼻内镜术后术腔囊泡形成是术腔上皮化进程中一个过程，囊泡组织中的成分也是一个动态的过程，在其演变过程中，可能上皮化，也可能转变成息肉组织。为探讨中……