| Objective:By comparing the clinical efficacy of endoscopic sinus surgery(ESS)combined with bioabsorbable corticosteroid-eluting sinus stents(BCES)with endoscopic sinus surgery(ESS)alone in the treatment of Chronic rhinosinusitis with nasal polyps(CRSwNP)and chronic rhinosinusitis without nasal polyps(CRSsNP)that are ineffective with conservative treatment,To explore the clinical value of BCES in patients with Chronic rhinosinusitis(CRSwNP and CRSsNP),and to provide a new reference for the clinical treatment of CRS.Methods:From June 2021 to December 2022,181 inpatients with CRS who met the diagnostic and inclusion criteria were selected as the study subjects,of which 30 patients who failed to cooperate with follow-up or had incomplete data during the study were excluded,and finally 151 CRS patients were included,and the collected CRS patients were classified into CRSwNP(97 cases)and CRSsNP(54 cases)according to whether they were accompanied by nasal polyps.The advantages and disadvantages of BCES are introduced by the first surgeon,and according to the patient’s self-selection wishes,the patients who implant the stent are used as the experimental group,and the patients who refuse to implant the stent are used as the control group.Among them,CRSwNP was divided into group A and group B,and group A:endoscopic sinus surgery combined with BCES;Group B: Endoscopic sinus surgery alone.CRSsNP was divided into group C and group D,and group C: endoscopic sinus surgery combined with BCES;Group D: Endoscopic sinus surgery alone.All patients were collected with subjective symptom scores on the Visual analogue scale(VAS)and Sino-nasal outcome test-22(SNOT-22),Lund-Kennedy nasal endoscopy and Lund-Mackay sinus CT objective sign scores,with Lund-Kennedy and Lund-Mackay scores completed by the first surgeon;All patients had open sinuses in the whole group,nasal polyp resection in patients with chronic rhinosinusitis with nasal polyps(CRSwNP),deviation correction of nasal septum and plasma ablation of lower turbinates depending on the patient’s condition,oral mucus stimulation and roxithromycin in all patients after surgery,and adherence to daily nasal irrigation.2 weeks,1month and 3 months after surgery,the severity of symptoms of patients with sinusitis was recorded with VAS score and SNOT-22 score,and subjective symptom scores were performed;Nasal endoscopy by an outpatient physician with Lund-Kennedy objective sign score;CT of the sinuses by an radiologist with Lund-Mackay objective sign score.SPSS 25.0 software was used for statistical analysis,and ANOVA and t-test were selected for comparison between groups.The recovery of nasal,sinus orifice and sinus mucosa and the improvement of quality of life of patients with CRS after surgery were evaluated,and the treatment effect was determined.Results:1.There were no statistical differences in age,gender,smoking history and present medical history among all subjects included in this study(P>0.05);2.Evaluation of postoperative subjective symptoms: postnasal drip and anosmia in group A and Group B were not significantly improved 2 weeks after surgery,but were significantly improved from 1 month to 3 months after surgery,nasal congestion,mucopurulent mucus,facial pain or pressure were improved compared with the operation(P<0.05);In group C and group D patients,the experimental group and control group showed improvement in postnasal drip,reduced sense of smell,nasal congestion,mucopurulent mucus,facial pain or pressure(P<0.05).3.There were no significant differences in VAS score,SNOT 22 score,postnasal drip,hypoolfaction,nasal congestion,mucopurulent mucus and facial pain or pressure between groups A and B,C and D at 2 weeks,1 month and 3 months after surgery(P>0.05).4.Evaluation of postoperative objective signs: There were no statistically significant differences in Lund-Kennedy score and Lund-Mackay score between group A and Group B at 2weeks after surgery(P>0.05),but there were statistically significant differences in Lund-Kennedy score and Lund-Mackay score at 1 month and 3 months after surgery(P<0.05).There were no significant differences in Lund-Kennedy score and Lund-Mackay score between group C and group D at 2 weeks,1 month and 3 months after surgery(P>0.05).5.There was no significant difference in intervention rate between group A and group B at 2 weeks after surgery(P>0.05).The intervention rate of 1 month and 3 months after operation was compared,the difference between the two groups was statistically significant(P<0.05).In group C and group D,the postoperative intervention rate was not statistically significant at 2 weeks,1 month and 3 months after surgery(P>0.05).6.The effective rate of postoperative disease control in group A and group B was statistically significant(P<0.05).There was no statistical significance in the postoperative disease control effective rate between group C and group D(P>0.05).Conclusions:1.After endoscopic sinus surgery for patients with Chronic rhinosinusitis(CRSwNP and CRSsNP),the postoperative subjective symptoms of patients were significantly improved with or without implantation of bioabsorbable corticosteroid-eluting sinus stents.2.Endoscopic sinus surgery combined with bioabsorbable corticosteroid-eluting sinus stents improved postoperative sinus stricture,nasal adhesion,polyp recurrence,persistent inflammatory response and postoperative recurrence rate in patients with CRSwNP.3.Endoscopic sinus surgery has a good postoperative effect on patients with chronic rhinosinusitis without nasal polyps,and there is no significant effect on whether to use bioabsorbable corticosteroid-eluting sinus stents. |
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