杨明 鲍希安 朱皓华 邹飞 邹文 苗春雨

*基金项目：江西省卫生健康委科技计划项目（202311213）

【摘要】 目的：探究“桥”式保留中鼻甲扩展式内镜鼻窦手术（extended endoscopic sinus surgery，EESS）在嗜酸性粒细胞（eosinophil，EOS）型慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）中的临床效果。方法：选取2021年7月—2023年5月于南昌市第一医院就诊的EOS型CRSwNP患者60例，随机分为对照组和观察组，各30例。对照组采用功能性内镜鼻窦手术（functional endoscopic sinus surgery，FESS）治疗，观察组采用“桥”式保留中鼻甲EESS治疗。观察两组临床疗效、鼻腔功能及嗅觉功能、术中出血量及术后并发症发生情况。结果：观察组术中出血量明显少于对照组，临床总有效率明显高于对照组（P<0.05）；观察组术后鼻腔容积、鼻腔最小横截面积均明显大于对照组，鼻气道阻力、嗅觉功能评分及并发症发生率明显均低于对照组（P<0.05）。结论：“桥”式保留中鼻甲EESS应用于EOS型CRSwNP中的临床效果显著，可明显减少术中出血量，改善患者的鼻腔功能及嗅觉功能，并降低术后并发症发生率。

【关键词】 慢性鼻窦炎 鼻息肉 鼻窦手术 嗅觉功能

Observation on the Curative Effect of "Bridge" Reserved Middle Concha EESS in EOS-type Chronic Rhinosinusitis with Nasal Polyps/YANG Ming， BAO Xian， ZHU Haohua， ZOU Fei， ZOU Wen， MIAO Chunyu. //Medical Innovation of China， 2024， 21（13）： 0-014

[Abstract] Objective： To explore the effect of "bridge" reserved middle concha extended endoscopic sinus surgery （EESS） in eosinophil （EOS） chronic rhinosinusitis with nasal polyps. Method： A total of 60 patients with EOS-type CRSwNP treated in the First Hospital of Nanchang City from July 2021 to May 2023 were selected and randomly divided into control group and observation group， with 30 patients in each group. The control group was treated with functional endoscopic sinus surgery （FESS）， and the observation group was treated with "bridge" reserved middle concha EESS. The clinical efficacy， nasal cavity function and olfactory sensation， intraoperative bleeding volume and postoperative complications of the two groups were observed. Result： The intraoperative bleeding volume in the observation group was significantly less than that in the control group， and the total clinical effective rate was significantly higher than that in the control group （P<0.05）. After surgery， nasal cavity volume and nasal minimal cross-sectional area in the observation group were significantly higher than those in the control group， and nasal airway resistance， olfactory sensation score and complication rate were significantly lower than those in the control group （P<0.05）. Conclusion： The application of "bridge" reserved middle concha EESS in EOS-type CRSwNP has significant clinical effect， which can significantly reduce the intraoperative bleeding volume， improve the nasal cavity function and olfactory sensation of patients， and reduce the incidence of postoperative complications.

[Key words] Chronic rhinosinusitis Nasal polyps Sinus surgery Olfactory function

First-author's address： Department of Otolaryngology， the First Hospital of Nanchang City， Nanchang 330008， China

doi：10.3969/j.issn.1674-4985.2024.13.003

慢性鼻窦炎是临床耳鼻咽喉科较为常见的一种炎性病症，其发病部位主要是鼻窦黏膜和中鼻道，常以鼻塞、流涕、嗅觉减退等为主要临床症状，而鼻息肉是该病常见的并发症状[1]。慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with nasal polyps，CRSwNP）的致病因素较多，发病机制较为复杂[2]，而且男性患病率明显高于女性[3]。目前，功能性内镜鼻窦手术（functional endoscopic sinus surgery，FESS）是国内治疗该病最为常用的手术方式[4]。扩展式内镜鼻窦手术（extended endoscopic sinus surgery，EESS）是一种在传统FESS的基础上进行了诸多改进的手术方式，EESS具有窦口更加开放、病灶切除范围更加广泛等优点[5]，极大地降低了该病的复发率，但是术后患者鼻腔生理功能往往由于手术原因而受到较大的影响，主要影响患者的通气功能及嗅觉。因此有研究在EESS的基础上提出保留中鼻甲的手术方式，也就是“桥”式保留中鼻甲EESS术，该种手术方式只切除患者的上鼻甲，而保留中鼻甲和下鼻甲，因此可减小手术对患者鼻腔功能和嗅觉的不良影响[6]。……