Correlation Between The Degree Of Ethmoid Sinus Opening And Postoperative Recurrence Of Chronic Sinusitis With Nasal Polyps

Objective: To investigate the correlation between the degree of ethmoid sinus opening in Funtional Endoscopic Sinus Surgery and the postoperative recurrence of chronic sinusitis with nasal polyps（CRSw NP）,as well as the correlation between the postoperative recurrence of CRSw NP patients and various influencing factors.Methods: CRSwNP patients who underwent surgery in the Department of Otolaryngology,the First Affiliated Hospital of Dali University from September 2017 to September 2019 were collected,screen 50 patients who meet the inclusion and exclusion criteria,and record the CT of paranasal sinuses from 3 to 6 months after operation and 13 basic data such as the opening degree of ethmoid sinus,age,gender,unilateral/bilateral,drinking history,smoking history,allergic rhinitis,asthma and Modification of the Lund-Kennedy endoscopic scoring were recorded at the same time.According to the opening degree of ethmoid sinus during operation,50 patients were divided into three groups.Group A: complete opening of anterior ethmoid sinus;Group B: The ethmoid sinus was fully opened in the anterior group and partially opened in the posterior group;Group C: Complete opening of ethmoid sinus.The follow-up time was2 years.After 2 years,according to the definition of CRSw NP recurrence,the recurrence of patients was recorded under nasal endoscopy to determine whether the degree of ethmoid sinus opening had an impact on the postoperative recurrence of CRSw NP patients.Then,the 13 parameters recorded above were analyzed and screened out statistically significant variables（P < 0.05）.These variables were analyzed by multivariate logistic regression to find the correlation between postoperative recurrence of CRSw NP and various influencing factors.Results: the relationship between the degree of ethmoid sinus opening and the postoperative recurrence of CRSw NP: in all 50 cases of CRSw NP,the postoperative recurrence rates of ethmoid sinus opening in group A,group B and group C were60.87%（14 / 23）,16.67%（3 / 18）and 11.11%（1 / 9）respectively;Among the 36 patients with CRSw NP in the initial recurrence group,the postoperative recurrence rates of ethmoid sinus opening in group A,group B and group C were 52.63%（10 / 19）,13.33%（2 / 15）and 50.00%（1 / 2）respectively;Among the 14 patients with CRSw NP in the recurrence again group,the postoperative recurrence rates of ethmoid sinus opening in group A,group B and group C were 100.00%（4 / 4）,33.33%（1 / 3）and0.00%（0 / 7）,respectively（P < 0.05）.Univariate analysis of influencing factors of postoperative recurrence of CRSw NP: allergic rhinitis,opening degree of ethmoid sinus,pathology of eosinophilic chronic rhinosinusitis with nasal polyps（e CRSw NP）and Modification of the Lund-Kennedy endoscopic scoring were high,and the difference was statistically significant（P < 0.05）.There were no significant differences in age,gender,unilateral / bilateral,smoking history,drinking history,asthma,neutrophil count,lymphocytes,peripheral blood eosinophils（EOS）and primary / relapse（P >0.05）.Logistic regression analysis of influencing factors of postoperative recurrence of CRSw NP: Patients with allergic rhinitis had a higher risk of postoperative recurrence.The risk of postoperative recurrence in group B with ethmoid sinus opening was 0.173 times higher than that in group A,and the risk of postoperative recurrence in group C with ethmoid sinus opening was 0.077 times higher than that in group A.Conclusion: 1.Whether for initial recurrence or recurrence again,the postoperative recurrence rate of CRSw NP patients with fully open ethmoid sinus（Group C）was significantly lower than that of patients with only open anterior ethmoid sinus（group A）or the ethmoid sinus was fully opened in the anterior group and partially opened in the posterior group（group B）.2.Allergic rhinitis,opening degree of ethmoid sinus,e CRSw NP and high Modification of the Lund-Kennedy endoscopic scoring were the single factors affecting the recurrence of CRSw NP.