The treatment of chronic rhinosinusitis (nasal polyps), due to the development of endoscopic sinus surgery, minimizes surgical trauma, removes lesions completely, and reduces recurrence. The use of standard treatment before and after surgery is also a key factor in improving the cure rate. Surgery is only one of the means of treatment, the success or failure of surgery, in addition to the level of skill and proficiency of the operator, also has a close relationship with the standardized treatment before and after surgery.
I. Diagnostic criteria of chronic rhinosinusitis (nasal polyps)
1, nasal congestion, mucous, purulent nasal discharge.
2, head and facial distension, decreased or absent sense of smell.
3.Nasal cavity examination: mucopurulent discharge from middle nasal tract and olfactory fissure, congestion and edema of middle nasal tract mucosa or presence of nasal polyps.
4.Impactological examination: CT scan shows sinus-oral nasal tract complex or nasal mucosa lesion.
Second, pre-surgical treatment
Pre-surgical treatment is one of the key factors for smooth and successful surgery. Pre-surgery is part of the perioperative period (one week before surgery ~ 3-6 months after surgery), time: one week; purpose: to create conditions for surgery and reduce intraoperative bleeding; content: 1, systemic antibiotics, systemic steroid hormones (severe cases). 2, local steroid hormones, such as coleus, endosulfan, and renolcort, to control local inflammation and allergic reactions caused by nasal sinus mucosal edema. 3, systemic Antihistamine drugs (for those with allergic reactions), such as keratan.
Third, the treatment of the surgical period
1, the choice of anesthesia local anesthesia is used for mild lesions, the patient is awake, and is conducive to the determination of the skull base and eye symptoms. General anesthesia can be used to overcome the shortcomings of previous general anesthesia with more bleeding, and is used for recurrent or complicated cases.
2.Surgical principles
(1) Correction of anatomical abnormalities of the nasal cavity and sinuses and lesions that affect ventilation;
(2) Open the diseased sinuses;
(3) Removal of irreversible lesions;
(4) Selective treatment of middle turbinate;
(5) Preserve the mucosa in the sinuses as much as possible;
(6) Emphasis on the principle of minimally invasive, the opening of the sinus opening should be moderate, not the larger the better; especially the opening of the maxillary sinus, except for fungal infection, need not be completely open;
(7) Five patency at the end of surgery: olfactory fissure patency; nasal cavity patency; posterior nostril patency; sinus opening nasal tract complex patency; sinus opening patency.
IV. Post-surgical treatment
1.Treatment during hospitalization
(1) Local treatment: 48 hours after surgery, all nasal fillings are withdrawn and nasal contraction is started. 72 hours, the accumulated blood and crusts in the nasal cavity and sinuses are started to be cleared every other day. Nasal rinsing, 1~2 times a day, with warm saline or herbal medicine, helps to remove the blood crusts for short-term postoperative trauma repair and avoid and reduce the trouble and damage of endoscopic instrument cleaning.
(2) Local medication: local steroid hormone, 2 times daily.
(3) Systemic medication: systemic intravenous antibiotics and steroid hormones, mucus thinner, coagulation and dry hard formation of black crusts in the nasal cavity is seen during this period when cleaning the nasal cavity, gentle movements when cleaning to avoid causing further epithelial damage. On the seventh day, the maxillary sinus is flushed with saline and can be discharged.
2.Treatment after discharge
The post-discharge treatment is critical, going through such a long process as the operative cavity cleaning stage, the mucosal transition to competition stage and the epithelialization completion stage.
(1) Local treatment: check the nasal endoscope every 1~2 weeks. About one month after the surgery, edema and even vesicle formation occurs when the nasal cavity is opened, which is due to the obstruction of lymphatic drainage. Pay attention to protect the normal mucosa as much as possible when clearing. after 3 months, according to the patient’s specific condition, the nasal endoscope can be checked once a month until the nasal mucosa is epithelialized.
(2) Systemic antibiotics: Oral antibiotics should be continued for 2 to 3 weeks after discharge. antibiotic therapy is very important to control infectious sinusitis. The course of anti-inflammatory therapy with macrolides (14 yuan ring) is not less than 12 weeks
(3) Topical steroid hormones for 3 to 6 months
(4) Mucus pro-discharge for more than 3 months
(5) Chinese herbal medicine treatment for 2~3 months, xinqin granules, nasal abscess, etc.
(6) Nasal irrigation for 6 months or more.
In conclusion, the treatment of chronic rhinosinusitis nasal polyps is a comprehensive treatment process. Relying on surgery alone without paying attention to preoperative and postoperative treatment, it will not achieve the expected curative effect. Pre-operative and post-operative treatment is an important means of treating chronic rhinosinusitis nasal polyps, which has attracted widespread attention. Standardized and comprehensive treatment is an important means to improve the cure rate of chronic rhinosinusitis nasal polyps and prevent recurrence.