Chirurgická léčba nosní polypózy -dlouhodobé výsledky

Surgical Treatment of Nasal Polyposis - Long-term Results

The objective of the submitted paper was to evaluate long-term results of treatmentof nasal polyposis in a group of patients of the ENT Clinic from October 1989 till December 1994. Itis a retrospective study. A total of 2456 patients were followed up, incl. 100 women and 146 men. Themean age was 46.1 years (44.5 in men and 48.3 in women), the range being 17 to 78 years. As to agedistribution the groups from 40 -60 years were most numerous. The criterium for inclusion in thegroup was a minimal follow-up period of three years after surgery. Surgery was the main therapyused. It was based on the principle of functional endoscopic sinus surgery, using Messerklinger´s technique. The use of systemic or local corticoid administration as a therapeutic methodduring the period of investigation was not evaluated due to the small number of patients. From thepatients those with a finding of a typical antrochoanal polyxp were excluded. For evaluation of therhinoscopic finding the authors used the part of the Levin and May classification pertaining to theevaluation of the extent of affection of the nasal cavity in nasal polyposis. For evaluation of the CTof the nasal cavity the classification of the extent of affection as suggested by Lund and Kennedywas used. The therapeutic results were evaluated with regard to persistence or reappaearance ofsubjective complaints of the patient and according to the rhinoscopic finding of recurrence of nasalpolyps or the necessity of surgical revision regardless of the patient’s subjective complaints.Among subjective complaints of the patients dominated the concurrent presence of three symptoms- deterioration of the nasal patency, nasal secretion and impaired smell. The first complaintsdeveloped as a rule between the age of 30 and 50 years regardless of sex. Only in 48.8 % patients atthe ENT Clinic the first operation was performed. Affection of the nasal cavity was investigated inthe majority (80.2 %) bilaterally. In 56 % the evaluation of the extent of affection of the nasal cavityaccording to Levin did not exceed the value of 4 in bilateral affections. When evaluating the affectionof paransal sinuses bilateral affection predominated - 95.2 %. When evaluating the extent of affectionof the cavities 38.2 % of the patients had values of 13 - 16 according to Lund. Relapses of subjectivecomplaints were recorded in 25.2 % patients of the investigated group. The complaint most difficultto control was dysosmia. Recurrence of the local finding of the polyp in the nasal cavity was recordedin 17.5 % patients. Surgical revision was made in 11.4 % of the patients. Haemorrhage which calledfor premature termination of the operation occurred in 5.6 %. In 0.8 % it was necessary to make anexternal operation to arrest haemorrhage. A more serious complication - liquorrhoea developed inone patient (0.4 %).

Key words:
nasal polyposis, surgical treatment, functional endoscopic surgery, paranasalsinuses.