【摘要】 目的探讨慢性鼻窦炎(chronic rhinosinusitis,CRS)经鼻内镜手术后嗅觉障碍的转归及相关因素。方法采用T&T标准嗅觉测试法对77例(134侧)CRS患者在鼻内镜手术前以及术后1个月、3个月和6个月分别进行嗅觉功能测试,将测试结果进行统计学分析。结果 70例(125侧)CRS患者完成了随访。鼻内镜手术前104侧(83.2%)存在不同程度的嗅觉障碍,术后1个月、3个月和6个月嗅觉障碍分别减少至84侧(67.2%)、82侧(65.6%)和84侧(67.2%)。患者鼻内镜手术后的嗅觉功能较术前明显改善(P<0.001),而术后1个月、3个月和6个月的平均嗅阈无显著差异(P>0.05)。至术后6个月随访结束时,嗅觉恢复正常20侧(19.2%)、好转53侧(51.0%)、不变29侧(27.9%)、加重2侧(1.9%),总改善率为70.2%。其中,不伴鼻息肉的CRS患者嗅觉恢复最好,改善率80.0%(28/35);伴鼻息肉但未累及嗅裂者次之,改善率73.3%(33/45);嗅裂息肉患者的嗅觉恢复较差,改善率50.0%(12/24)。CRS不伴鼻息肉与息肉未累及嗅裂者进行比较,术后嗅觉恢复无统计学差异(P>0.05);而二者分别与嗅裂息肉患者进行比较,术后嗅觉恢复均有统计学差异(P<0.05)。结论鼻内镜手术对CRS患者的嗅觉障碍有明显改善作用。在手术彻底清除炎性病变、解除嗅裂阻塞的基础上,更应注重对嗅区嗅黏膜的保护;同时,规范化的围手术期处理和术后定期随访也显得十分重要。更多还原

【Abstract】 Objective To evaluate the outcomes of olfactory dysfunction after endoscopic sinus surgery(ESS) in patients with chronic rhinosinusitis(CRS) and the related factors.Methods Olfactory function in 77 patients(134 nostrils) with CRS was tested using the T&T olfactometry kit.The examination and assessment was performed prior to ESS,and at 1 month,3 months and 6 months post-ESS.Results 70 patients(125 nostrils) with CRS were followed up for 6 months postoperatively.In the examination prior to ESS,there were 104 nostrils(83.2%) presented with olfactory impairment,while the findings showed 84 nostrils(67.2%) at 1 month,82 nostrils(65.6%) at 3 months and 84 nostrils(67.2%) at 6 months post-ESS.Compared with the olfactory function prior to ESS,significant improvement was found at 1 month,3 months and 6 months post-ESS(all P<0.001);however,there were no statistically significant differences in averaged detection thresholds of the five odorants during the postoperative follow-up(P>0.05).At 6 months after surgery,20 nostrils(19.2%) returned to normal smell and 53 nostrils(50.1%) improved,while 29 nostrils(27.9%) of olfaction showed no changed and 2 nostrils(1.9%) worse.The overall improvement rate of olfactory function was 70.2%.Of which,the improvement rate was 80.8%(28/35) in patients without nasal polyps,73.3%(33/45) in patients with nasal polyps but not involved olfactory cleft,and 50%(12/44) in patients with olfactory cleft polyps.There was no statistically significant difference in olfactory change between the patients without nasal polyps and the patients with nasal polyps but not involved olfactory cleft(P>0.05);however,the olfaction improvement was significant lower in patients with olfactory cleft polyps than that in two other patient groups(all P<0.05).Conclusions ESS plays a positive role in the improvement of olfactory impairment in patients with CRS.It is important to protect the olfactory mucous on a basis of surgical removal of sinonasal inflammatory lesion and olfactory cleft obstruction.Also,the norming medical treatment pre-and post-ESS,as well as the regular follow-up should be emphasized.更多还原