Эффективность эндоскопической риносинусохирургии при антрохоанальных полипах в детском возрасте

Abstract

Antrochoanal polyps (ACP) are benign tumors, mainly originating from the maxillary sinus. The incidence in children is high – up to 35% of all chronic polypous rhinosinusitis. Endoscopic examination of the nasal cavity and computed tomography of the paranasal sinuses (PS CT) are generally used for ACP diagnostics. The medical treatment of ACP is deemed ineffective. Multiple options have been proposed for surgical treatment of ACP, including those used in children. In recent years, the role of FESS in the surgical treatment of ACP has increased. This paper provides an analysis of the efficacy of surgical treatment of 50 children with ACP at the period of 2012-2018 at Children’s Municipal Multidisciplinary Clinical Center for High Medical Technologies named after K. A. Rauhfus. All patients were operated on using endoscopic endonasal access. 40 children (80%) underwent combined access surgery. The efficacy analysis was carried out according to sino-nasal outcome test SNOT-20 (GAV), Lund-Kennedy endoscopic evaluation scores, Lund-Mackay computed tomography results evaluation scale. Our results showed the statistically significant association of improvement of all symptoms according to SNOT-20 (GAV) scale (p < 0,05) after FESS. Moreover, the analysis of nasal endoscopy results showed the pronounced positive changes in the parameters of the „discharge“ and „mucosal edema“ in the postoperative period according to Lund-Kennedy scale (p < 0,05). A statistically significant association of improvement of PS CT signs according to Lund-Mackay scale after FESS is also observed. The most significant changes were observed in the maxillary sinuses, anterior and posterior ethmoid cells, as well as in the osteomeatal complex on both sides, on average by –1 point (p < 0,05). Therefore, FESS has proven its efficacy at ACP in children.