The influence of contoured sinus endoscopy on the recurrence of nasal polyps

Objective:The aim of this stusy is to study the effect of endoscopic surgery quality on the recurrence of nasal polyps. Methods:A total of 32 patients（64 sides） with recurrent nasal polyps were collected from December 2016 to June 2018, all of which were bilateral type Ⅱ diffuse nasal polyps in stage 3. According to the post-operative pathological results, patients were divided into eosinophilic nasal polyps group（EOS） and non-eosinophilic nasal polyps group（NEOS）. All patients underwent sinus CT scan and three-dimensional reconstruction, combined with the sinus CT image performance and intraoperative findings, the quality of the patients' previous endoscopic sinus surgery was analyzed, and the CT L-M scores of sinuses before and after reoperation were compared between the two groups. Endoscopic L-K score, nasal symptoms VAS score, quality of life Snot-20 score. Results:Among 32 patients with recurrent nasal polyps, 17 cases （53.1%） of EOS nasal polyps were confirmed pathologically after surgery, and 15 cases （46.9%） of NEOS nasal polyps were confirmed. After the previous operation, the patient still has 60 sides（93.8%） of ethmoidal cells or ethmoidal septum, 56 sides（87.5%） of bone hyperplasia, 50 sides（78.1%） of bones in frontal recess air-cell or bone air-cell, and nasal cavity adhesion there were 10 sides（15.6%）, residual uncinate process 8（12.5%）, improper treatment of maxillary sinus ostia or atresia were 6（9.4%）, sphenoid sinus not open or atresia were 8（12.5%）, nasal septal deviation untreated were 4 cases（12.5%）, 1 case（3.1%） had recurrence without ethmoidal cells and residual bone interval. Patients both in the EOS group or the NEOS group were followed up with L-M score, L-K score, VAS score, and Snot-20 score after surgery, the result were significantly improved compared with the preoperative results. After follow-up of 1.5-3 years, 25 cases of polyps were completely controlled and 7 cases were partially controlled. Among them, 2 cases of EOS nasal polyps and asthma patients still had some polypoid changes in local mucosa one year after operation and was currently under medication control. Conclusion:Although the recurrence of nasal polyps is closely related to its intrinsic type, the technique of endoscopic surgery is also an important factor affecting the recurrence of nasal polyps. For patients with bilateral symmetric diffuse nasal polyps, high-quality sinus surgery of first time combined with standardized follow-up can reduce the recurrence rate of nasal polyps and prolong the relapse time.