钱越 戴复 柳娴 王粟

【摘要】 目的：分析低溫等离子辅助鼻内镜手术在慢性鼻窦炎伴鼻息肉（chronic sinusitis with nasal polyps，CRSwNP）患者中的疗效及对手术创伤的控制效果。方法：将2015年1月-2021年1月本院收治的CRSwNP患者85例按照手术方式的不同分为鼻内镜组（n=41）与低温等离子辅助组（n=44）。鼻内镜组给予鼻内镜手术治疗，低温等离子辅助组给予低温等离子辅助鼻内镜手术治疗。比较两组鼻腔通气功能、嗅觉功能、Lund-Kennedy、Lund-Mackay评分及术后并发症发生情况。结果：低温等离子辅助组术后鼻腔容积高于鼻内镜组，鼻阻力低于鼻内镜组（P<0.05）。两组手术前后嗅觉功能相比，差异均无统计学意义（P>0.05）。术后，两组Lund-Kennedy、Lund-Mackay评分较术前均下降，且低温等离子辅助组均低于鼻内镜组（P<0.05）;术后，两组WBC、CRP、IL-6水平较术前均上升，但低温等离子辅助组均低于鼻内镜组（P<0.05）。结论：采用低温等离子辅助鼻内镜手术对CRSwNP患者进行治疗，能改善患者鼻腔通气功能和嗅觉功能，有较好的治疗效果，降低患者手术创伤程度，值得临床推广。

【关键词】 低温等离子 鼻内镜手术 慢性鼻窦炎 鼻息肉 手术创伤

Efficacy of Low Temperature Plasma Assisted Endoscopic Sinus Surgery for Patients with CRSwNP and Its Control Effect on Surgical Trauma/QIAN Yue， DAI Fu， LIU Xian， WANG Su. //Medical Innovation of China， 2021， 18（30）： 00-005

[Abstract] Objective： To analyze the effect of low temperature plasma assisted endoscopic sinus surgery for patients with chronic sinusitis and nasal polyps （CRSwNP） and its control effect on surgical trauma. Method： A total of 85 patients with CRSwNP treated in our hospital from January 2015 to January 2021 were divided into nasal endoscopy group （n=41） and low temperature plasma assisted group （n=44） according to different surgical methods. The nasal endoscopy group was treated with endoscopic sinus surgery， and the low temperature plasma assisted group was treated with low-temperature plasma assisted endoscopic sinus surgery. The nasal ventilation function， olfactory function， Lund-Kennedy and Lund-Mackay scores， and incidence of postoperative complications were compared between two groups. Result： After operation， the volume of nasal cavity in the low temperature plasma assisted group was higher than that in the nasal endoscopy group， and the nasal resistance was lower than that in the nasal endoscopy group （P<0.05）. There were no significant differences in preoperative and postoperative olfactory function between two groups （P>0.05）. After operation， the Lund-Kennedy and Lund-Mackay scores in two groups were lower than those before operation， and the low temperature plasma assisted group were lower than those in the nasal endoscopy group （P<0.05）. After operation， the levels of WBC， CRP and IL-6 in two groups were higher than those before operation， but the low temperature plasma assisted group were lower than those in the nasal endoscopy group （P<0.05）. Conclusion： Low temperature plasma assisted endoscopic sinus surgery for patients with CRSwNP can improve nasal ventilation function and olfactory function， has good therapeutic effect and reduce the degree of surgical trauma， which is worthy of clinical promotion.

[Key words] Low temperature plasma Endoscopic nasal surgery Chronic sinusitis Nasal polyps Surgical trauma

First-authors address： Anting Hospital of Jiading District， Shanghai 201805， China

doi：10.3969/j.issn.1674-4985.2021.30.001

慢性鼻竇炎（chronic sinusitis，CRS）是鼻窦黏膜的慢性炎症性疾病，病程超过12周，是耳鼻咽喉头颈外科临床常见慢性炎症性疾病，中国人群CRS总体患病率为8%。而伴有鼻息肉的CRS，即慢性鼻窦炎伴鼻息肉（chronic sinusitis with nasal polyps，CRSwNP）的临床症状重，药物和手术治疗效果差，易复发，是鼻科临床常见难治性疾病[1]。有研究提示其主要是由多种致病因素导致，其中以CRSwNP最为棘手，尚未有较好的特效药[2]。鼻内镜手术是临床治疗CRSwNP最常用的术式，但近年来研究显示，单独使用鼻内镜手术对CRSwNP进行治疗，虽然有一定的有效性，但复发率较高[3-5]，因此，寻找一种辅助鼻内镜手术的方式尤为重要。低温等离子刀头所有操作温度低于70 ℃，能降低组织的损伤程度[6]。两者联合治疗虽然有一定的临床效果，但两者联合使用对CRSwNP患者手术创伤的控制效果尚未有研究报道。……