慢性鼻窦炎伴鼻息肉内镜术后高浓度糖皮质激素浸润明胶海绵鼻腔填塞的疗效

Analysis of the efficacy of high-concentration glucocorticoid-soaked gelatin sponge nasal packing after endoscopic surgery for chronic rhinosinusitis with nasal polyps

摘要

目的 探究功能性内镜鼻窦手术(functional endoscopic sinus surgery, FESS)术后鼻腔分别填塞高低两种浓度糖皮质激素浸润明胶海绵对慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps, CRSwNP)术腔良性转归的影响。方法 选取2023年11月6日至2025年3月24日成飞医院耳鼻咽喉科收治的60例行FESS手术治疗的CRSwNP患者为研究对象。采用简单随机化方法将患者均分为两组:高浓度激素组(A组)、低浓度激素组(B组)。2组患者行相同的手术操作及术后处理。在术后2、4、8、12周及半年对患者进行门诊随访复查。采用视觉模拟评分法(visual analogue scale, VAS)对患者鼻塞、流涕、嗅觉减退、头面部胀满感进行主观症状评分；并记录客观内镜评分(Lund Kennedy评分)；术后并发症发生率；术后干预率。每组30例，均完成随访。结果 独立样本t检验(未校正)显示，术后2、4、8、12周A组VAS评分均低于B组(P均<0.05)。经Bonferroni校正多重比较(6次比较，α'=0.0083)，仅术后4周两组VAS评分差异仍有统计学意义(t=3.479，未校正P=0.001，校正后P=0.006)；术后2、8、12周的差异未达到校正后显著性水平。内镜评分方面，初步t检验(未校正)提示A组各时间点均低于B组(均P<0.05)，但Bonferroni校正后差异均无统计学意义。术后半年时两组患者VAS及内镜评分均无统计学意义。A组在4、8、12周的术后干预率低于B组(χ²=4.593、4.444、4.320，均P<0.05)，在术后2周及半年时干预率差异无统计学意义(χ²=1.196，1.196；P>0.05)。两组术后并发症发生率差异无统计学意义(χ²=0.098，P>0.05)。结论 FESS术后鼻腔填塞高浓度糖皮质激素浸润明胶海绵可显著改善患者术后4周主观症状，但未改善内镜评分。该方案能降低术后早期(4~12周)再干预率，且不良反应与对照组差异无统计学意义。其安全、经济，可促进早期恢复，值得临床推广。

Abstract

Objective The present study aimed to investigate the efficacy of nasal packing with gelatin sponges soaked in two different concentrations of glucocorticoids following functional endoscopic sinus surgery (FESS) on the outcome of chronic rhinosinusitis with nasal polyps (CRSwNP) in patients. Methods A total of sixty patients diagnosed with CRSwNP were enrolled in the study and underwent FESS at the Otorhinolaryngology Department between 6 November 2023 and 24 March 2025. The subjects were divided into two groups through a randomization process. Group A, the high-concentration group, received gelatin sponges soaked with triamcinolone acetonide injection (40 mg/mL) into the diseased sinus ostia, while Group B, the low-concentration group, received sponges soaked with triamcinolone nasal spray (1.1 mg/mL). Both groups underwent identical surgical procedures and postoperative management. Patients were subjected to follow-up assessments at 2, 4, 8, and 12 weeks postoperatively, in addition to 6 months. The subjective symptoms including nasal obstruction, rhinorrhea, hyposmia, and facial fullness/pressure were assessed using the visual analogue scale (VAS). Furthermore, the following parameters were recorded: objective endoscopic scores (Lund Kennedy score), incidence of postoperative complications, and rate of postoperative intervention. The study comprised two groups, with each group consisting of 30 patients. All patients completed the follow up process. Results Unadjusted t tests showed that VAS scores in Group A were lower than those in Group B at 2, 4, 8, and 12 weeks postoperatively (all P<0.05). Following the implementation of the Bonferroni correction for multiple comparisons (six comparisons, α'=0.0083), the difference in VAS scores between the two groups remained statistically significant only at the 4-week postoperative stage (t=3.479, unadjusted P=0.001, adjusted P=0.006); the variations observed at 2, 8, and 12 weeks did not attain the corrected significance level. With Regard to the endoscopic scores, the application comparison to unadjusted t-tests revealed that Group A exhibited lower scores in comparison to Group B at all designated time points (P<0.05). However, subsequent to the implementation of the Bonferroni correction, none of the observed differences attained statistical significance. At the 6-month postoperative stage, no statistically significant differences were observed in either VAS or endoscopic scores between the two groups. The rate of postoperative intervention in Group A was lower than that in Group B at 4, 8, and 12 weeks (χ²=4.593, 4.444, and 4.320, respectively; all P<0.05). However, no statistically significant differences were observed at 2 weeks or 6 months postoperatively (χ²=1.196 and 1.196, respectively; P>0.05). A subsequent analysis revealed no statistically significant difference in the incidence of postoperative complications between the two groups (χ²=0.098, P>0.05). Conclusion In patients undergoing FESS, postoperative nasal packing with gelatin sponge impregnated with high-concentration glucocorticoids significantly improves subjective symptom scores at the 4-week but does not significantly improve endoscopic scores. This regimen reduces the rate of early re-intervention (within 4-12 weeks postoperatively), with no significant difference in adverse events compared with the control group. As a safe, economical intervention that facilitates early recovery, this approach merits widespread clinical adoption.

关键词

慢性鼻窦炎 / 鼻息肉 / 曲安奈德 / 高浓度 / 预后

Key words

Chronic rhinosinusitis / Nasal polyps / Triamcinolone / Concentration / Prognosis

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基金资助

成都市医学科研课题(2024589)