{"id":4974,"date":"2022-11-03T09:10:00","date_gmt":"2022-11-03T01:10:00","guid":{"rendered":"http:\/\/web.csh.org.tw\/web\/cshmagazine\/?p=4974"},"modified":"2022-11-03T09:10:02","modified_gmt":"2022-11-03T01:10:02","slug":"%e6%b2%bb%e7%99%82%e9%bc%bb%e4%b8%ad%e8%86%88%e5%bd%8e%e6%9b%b2%e3%80%81%e9%bc%bb%e6%81%af%e6%96%87%e8%82%89%e5%8f%8a%e6%85%a2%e6%80%a7%e9%bc%bb%e7%ab%87%e7%82%8e-4k%e5%be%ae%e5%89%b5%e8%9e%ba","status":"publish","type":"post","link":"https:\/\/web.csh.org.tw\/web\/cshmagazine\/?p=4974","title":{"rendered":"\u6cbb\u7642\u9f3b\u4e2d\u8188\u5f4e\u66f2\u3001\u9f3b\u606f\u6587\u8089\u53ca\u6162\u6027\u9f3b\u7ac7\u708e\u20144K\u5fae\u5275\u87ba\u65cb\u5200\u7cfb\u7d71\u82073\u5c0e\u822a\u5b9a\u4f4d\u624b\u8853\u7684\u61c9\u7528"},"content":{"rendered":"\n

\u6587\/\u8033\u9f3b\u5589\u79d1 \u9ec3\u627f\u6968\u91ab\u5e2b<\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

\u9f3b\u4e2d\u8188\u5f4e\u66f2\u3001\u4e0b\u9f3b\u7532\u80a5\u5927\u539f\u56e0<\/strong><\/p>\n\n\n\n

\u3000\u3000\u9f3b\u4e2d\u8188\u5f4e\u66f2\u70ba\u8033\u9f3b\u5589\u79d1\u5e38\u898b\u7684\u75be\u75c5\uff0c\u75c5\u60a3\u4e3b\u8a34\u901a\u5e38\u70ba\u9f3b\u585e\u3001\u5f35\u53e3\u547c\u5438\u3001\u7761\u7720\u547c\u5438\u4e2d\u6b62\u7b49\u7b49\u3002\u60a3\u8005\u5e38\u6703\u8a62\u554f\uff0c\u6c92\u6709\u5916\u50b7\u75c5\u53f2\uff0c\u70ba\u4f55\u70ba\u5f4e\u66f2\uff1f\u5f4e\u66f2\u539f\u56e0\uff0c\u4e3b\u8981\u662f\u5728\u751f\u9577\u767c\u80b2\u6642\uff0c\u69cb\u6210\u9f3b\u4e2d\u8188\u7684\u8edf\u9aa8\u53ca\u786c\u9aa8\u751f\u9577\u901f\u7387\u4e0d\u540c\uff0c\u5982\u540c\u9678\u5730\u677f\u584a\u6548\u61c9\uff0c\u4e92\u76f8\u64e0\u58d3\u800c\u5f4e\u66f2\u3002\u81e8\u5e8a\u4e0a\uff0c\u7d0430%\u7684\u56b4\u91cd\u5f4e\u66f2\u60a3\u8005\uff0c\u5177\u6709\u9f3b\u585e\u3001\u7761\u7720\u969c\u7919\uff0c\u624d\u9700\u8981\u8655\u7406\u3002\u9f3b\u4e2d\u8188\u5f4e\u66f2\u60a3\u8005\uff0c\u5e38\u4f34\u96a8\u4e0b\u9f3b\u7532\u80a5\u5927\u7684\u554f\u984c\u3002\u6240\u8b02\u7684\u4e0b\u9f3b\u7532\uff0c\u5c31\u662f\u7167\u93e1\u5b50\u6642\uff0c\u53ef\u4ee5\u770b\u5230\u5728\u9f3b\u5b54\u8655\uff0c\u5de6\u53f3\u5404\u4e00\u7403\u5713\u5713\u7684\u7c89\u7d05\u8272\u7d44\u7e54\u3002\u4e0b\u9f3b\u7532\u80a5\u5927\u53ef\u5206\u70ba\u9aa8\u982d\u80a5\u539a\u589e\u751f(hypertrophy)\uff0c\u6216\u662f\u9ecf\u819c\u80a5\u539a\u589e\u751f\uff0c\u4e5f\u5c31\u662f\u4fd7\u7a31\u7684\u80a5\u539a\u6027\u9f3b\u708e\u3002\u9aa8\u982d\u80a5\u539a\u589e\u751f\uff0c\u901a\u5e38\u6b78\u985e\u5728\u5148\u5929\u6027\u80a5\u5927\uff0c\u800c\u9ecf\u819c\u80a5\u539a\u589e\u751f\uff0c\u5247\u70ba\u5f8c\u5929\u523a\u6fc0\u9020\u6210\uff0c\u4f8b\u5982\u904e\u654f\u539f\u3001PM2.5\u3001\u9999\u83f8\u53ca2\u624b\u83f8\u7684\u63a5\u89f8\u7b49\u7b49\u3002<\/p>\n\n\n\n

\u9f3b\u4e2d\u8188\u5f4e\u66f2\u3001\u4e0b\u9f3b\u7532\u80a5\u5927\u5167\u79d1\u6cbb\u7642<\/strong><\/p>\n\n\n\n

\u3000\u3000\u4e00\u822c\u85e5\u7269\u6cbb\u7642\u4ee5\u985e\u56fa\u9187\u5674\u5291\u3001\u6297\u7d44\u7e54\u80fa\u3001\u8840\u7ba1\u6536\u7e2e\u5291\u70ba\u4e3b\u3002\u81e8\u5e8a\u4e0a\uff0c\u5c40\u90e8\u8840\u7ba1\u6536\u7e2e\u5291\u56e0\u70ba\u4f7f\u7528\u8d85\u904e3\u5929\u6703\u9020\u6210\u85e5\u7269\u6027\u9f3b\u708e(rhinitis medicamentosa)\uff0c\u6545\u4e0d\u5efa\u8b70\u9577\u671f\u4f7f\u7528\uff0c\u5e38\u5e38\u5728\u9580\u8a3a\u9047\u5230\u75c5\u4eba\uff0c\u63d0\u5230\u8d8a\u5674\u8d8a\u585e\u7684\u85e5\u7269\uff0c\u5927\u591a\u5c6c\u65bc\u6b64\u985e\u3002\u85e5\u7269\u6cbb\u7642\u6548\u679c\u4e0d\u597d\u7684\u60a3\u8005\uff0c\u5c31\u5fc5\u9808\u4ee5\u5916\u79d1\u65b9\u6cd5\u8655\u7406\u3002<\/p>\n\n\n\n

\u9f3b\u4e2d\u8188\u5f4e\u66f2\u3001\u4e0b\u9f3b\u7532\u80a5\u5927\u5916\u79d1\u6cbb\u7642<\/strong><\/p>\n\n\n\n

\u3000\u3000\u6700\u5e38\u898b\u3001\u6709\u6548\u7684\u624b\u8853\u65b9\u6cd5\u70ba\u9f3b\u4e2d\u8188\u9ecf\u819c\u4e0b\u5207\u9664\u8853(submucosal resection)\u3002 \u60f3\u50cf\u9f3b\u4e2d\u8188\u70ba\u4e09\u660e\u6cbb\u7d50\u69cb\uff0c\u9f3b\u4e2d\u8188\u8edf\u9aa8\u5c31\u50cf\u4e2d\u9593\u7684\u706b\u817f\uff0c\u9f3b\u4e2d\u8188\u9ecf\u819c\u5982\u540c\u5916\u50742\u7247\u9eb5\u5305\u3002\u624b\u8853\u539f\u7406\u662f\u5c07\u9eb5\u5305(\u9ecf\u819c)\u8207\u706b\u817f(\u8edf\u9aa8)\u5206\u958b\uff0c\u628a\u5f4e\u66f2\u9f3b\u4e2d\u8188\u79fb\u9664\uff0c\u518d\u5c072\u7247\u9ecf\u819c\u8cbc\u4e0a\u5373\u53ef\u3002\u7531\u65bc\u4fdd\u7559\u652f\u6490\u9f3b\u4e2d\u8188\u7684\u8edf\u9aa8\u53ca\u786c\u9aa8\uff0c\u6545\u8853\u5f8c\u9f3b\u5b50\u5916\u89c0\u53ca\u5f37\u5ea6\u8207\u8853\u524d\u76f8\u540c\uff0c\u60a3\u8005\u4e0d\u9700\u64d4\u5fc3\u3002<\/p>\n\n\n\n

\u3000\u3000\u4e0b\u9f3b\u7532\u624b\u8853\u65b9\u5f0f\u53ef\u5206\u70ba\u4e09\u7a2e\uff0c\u5206\u5225\u70ba\u50b3\u7d71\u9f3b\u7532\u5207\u9664\u624b\u8853\uff0c\u5c04\u983b(radio-frequency)\u624b\u8853\u53ca\u5fae\u5275\u87ba\u65cb\u5200(microdebrider)\u624b\u8853\u3002\u50b3\u7d71\u5207\u9664\u624b\u8853\u56e0\u70ba\u50b7\u53e3\u5927\u3001\u75bc\u75db\u611f\u5f37\u70c8\u53ca\u8853\u5f8c\u51fa\u8840\u91cf\u591a\uff0c\u73fe\u4eca\u5df2\u5c11\u65bd\u4f5c\u3002\u5c04\u983b\u624b\u8853\u56e0\u71d2\u707c\u9f3b\u9ecf\u819c\u7d44\u7e54\uff0c\u6545\u5bb9\u6613\u5f62\u6210\u8853\u5f8c\u7d50\u75c2\u53ca\u9f3b\u8154\u7570\u5473\uff0c\u4e14\u5bb9\u6613\u5fa9\u767c\uff0c\u56e0\u6b64\u4e5f\u8f03\u5c11\u4f7f\u7528\u30024K\u5fae\u5275\u87ba\u65cb\u5200\u87a2\u5e55\u7cfb\u7d71\uff0c\u7531\u65bc\u4f7f\u75284K\u5167\u8996\u93e1\u4e3b\u6a5f\u53ca\u87a2\u5e55\uff0c\u63d0\u5347\u624b\u8853\u8996\u91ce\u5c0d\u6bd4\u5ea6\u53ca\u6e05\u6670\u5ea6\uff0c\u80fd\u5c07\u9f3b\u8154\u7d50\u69cb\u770b\u5f97\u76f8\u7576\u6e05\u695a\uff0c\u518d\u642d\u914d2.9mm\u53e3\u5f91\u4e0b\u9f3b\u7532\u5fae\u5275\u5200\u5c07\u80a5\u5927\u9f3b\u8089\u7d44\u7e54\u6e05\u9664\uff0c\u539f\u7406\u5c31\u5982\u540c\u62bd\u8102\u822c\u7c21\u55ae\u3002\u9664\u4e86\u53ef\u4ee5\u5b8c\u6574\u4fdd\u7559\u9f3b\u9ecf\u819c\u5916\uff0c\u5fa9\u767c\u6a5f\u6703\u4f4e\uff0c\u8853\u5f8c\u75bc\u75db\u611f\u8f15\u5fae\uff0c\u50b7\u53e3\u51fa\u8840\u91cf\u4e5f\u5c11\uff0c\u6545\u70ba\u76ee\u524d\u4e3b\u6d41\u7684\u624b\u8853\u65b9\u5f0f\u3002\u624b\u8853\u6642\u9593\u7d0430\u5206\u9418\uff0c\u60a3\u8005\u53ef\u9078\u64c7\u9580\u8a3a\u6216\u662f\u4f4f\u9662\u624b\u8853\u3002<\/p>\n\n\n\n

\u6162\u6027\u9f3b\u7ac7\u708e\u539f\u56e0\u53ca\u5206\u985e<\/strong><\/p>\n\n\n\n

\u3000\u3000\u9f3b\u7ac7\u708e\uff0c4\u7a2e\u5e38\u898b\u75c7\u72c0\u5305\u542b\u9f3b\u585e\u3001\u9ec3\u9f3b\u6d95\u3001\u55c5\u89ba\u4e0d\u597d\u53ca\u81c9\u90e8\u60b6\u8139\u611f\u3002\u5c0f\u5b69\u7531\u65bc\u9f3b\u6d95\u5012\u6d41\u523a\u6fc0\u6c23\u7ba1\uff0c\u6240\u4ee5\u6162\u6027\u54b3\u55fd\u4e5f\u662f\u5e38\u898b\u75c7\u72c0\u4e4b\u4e00\u3002\u9f3b\u7ac7\u708e\u4f9d\u75c7\u72c0\u6642\u9593\u4f86\u505a\u5206\u985e\uff0c\u75c7\u72c01\u500b\u6708\u4ee5\u4e0b\uff0c\u6b78\u985e\u5728\u6025\u6027\u9f3b\u7ac7\u708e\uff0c\u5982\u8d85\u904e3\u500b\u6708\u4ee5\u4e0a\uff0c\u5247\u6b78\u985e\u5728\u6162\u6027\u9f3b\u7ac7\u708e\u3002\u9f3b\u7ac7\u708e\u5f62\u6210\u7684\u539f\u56e0\u53ef\u5206\u70ba2\u5927\u985e\u3002\u4e00\u985e\u70ba\u74b0\u5883\u56e0\u7d20\uff0c\u5305\u542b\u75c5\u6bd2\u3001\u7d30\u83cc\u53ca\u904e\u654f\u539f(\u9999\u83f8\u30012\u624b\u83f8\u3001\u5875\u87ce\u7b49)\u7684\u63a5\u89f8\uff0c\u9577\u671f\u66b4\u9732\u4e0b\uff0c\u9f3b\u7ac7\u9ecf\u819c\u767c\u708e\u816b\u8139\uff0c\u81ea\u7136\u5bb9\u6613\u767c\u708e\u3002\u53e6\u4e00\u985e\u70ba\u5bbf\u4e3b(host)\u56e0\u7d20\uff0c\u4e5f\u5c31\u662f\u500b\u4eba\u9ad4\u8cea\u3002\u5148\u5929\u9f3b\u7ac7\u958b\u53e3\u767c\u80b2\u8f03\u7a84\uff0c\u9f3b\u7ac7\u9ecf\u819c\u767c\u708e\u6642\u5bb9\u6613\u963b\u585e\u958b\u53e3\uff0c\u5f62\u6210\u9f3b\u7ac7\u708e\u3002<\/p>\n\n\n\n

\u3000\u3000\u6b64\u5916\uff0c\u5148\u5929\u9f3b\u9ecf\u819c\u5c4f\u969c(mucosal\u3000barrier\uff09\u57fa\u56e0\u8abf\u63a7\u4e0d\u826f\uff0c\u9020\u6210\u9f3b\u9ecf\u819c\u7d30\u80de\u9593\u7dca\u5bc6\u53ca\u9ecf\u5408\u9023\u7d50(tight junction, adherence junction)\u6bd4\u4e00\u822c\u4eba\u8106\u5f31\uff0c\u6613\u906d\u53d7\u5fae\u751f\u7269\u653b\u64ca\u800c\u8b93\u7d30\u83cc\u53ca\u75c5\u6bd2\u7a7f\u900f\u3002\u6162\u6027\u9f3b\u7ac7\u708e\u81e8\u5e8a\u8868\u73fe\u578b(phenotype)\u53ef\u5206\u70ba2\u7a2e\uff0c\u6162\u6027\u9f3b\u7ac7\u708e\u5408\u4f75\u9f3b\u606f\u8089\u589e\u751f(CRSwNP)\u6216\u662f\u6162\u6027\u9f3b\u7ac7\u708e\u4e0d\u5408\u4f75\u9f3b\u606f\u8089\u589e\u751f(CRSsNP)\u3002\u6839\u64da\u5206\u5b50\u6a5f\u8f49\u578b(endotype)\u53ef\u5206\u70ba\u7b2c1\u578b\u3001\u7b2c2\u578b\u53ca\u7b2c3\u578b\u767c\u708e\u53cd\u61c9\u3002\u5176\u4e2d\uff0c\u4ee5\u6162\u6027\u9f3b\u7ac7\u708e\u5408\u4f75\u9f3b\u606f\u8089\u7b2c2\u578b\u767c\u708e\u53cd\u61c9\u60a3\u8005\u6700\u96e3\u4ee5\u6cbb\u7642\uff0c\u76ee\u524d\u91ab\u5b78\u4e0a\u81f4\u529b\u65bc\u627e\u51fa\u6b64\u985e\u75c5\u60a3\uff0c\u53ef\u52a0\u5165\u751f\u7269\u88fd\u5291(biologics)\u4f5c\u70ba\u8f14\u52a9\u6cbb\u7642\uff0c\u6548\u679c\u76f8\u7576\u826f\u597d\u3002\u81e8\u5e8a\u4e0a\uff0c\u4f55\u7a2e\u7279\u5fb5\u6bd4\u8f03\u5c6c\u65bc\u9019\u985e\u60a3\u8005\uff1f\u904e\u53bb\u6709\u6c23\u5598\u75c5\u53f2\u3001\u75c7\u72c0\u4e0a\u82e5\u6709\u55c5\u89ba\u55aa\u5931\u3001\u62bd\u8840\u514d\u75ab\u7403\u86cb\u767dE(IgE)\u5927\u65bc100\u6216\u55dc\u9178\u6027\u7403(eosinophil)\u5927\u65bc250\uff0c\u9f3b\u606f\u8089\u7d44\u7e54\u5728\u9ad8\u500d\u986f\u5fae\u93e1\u4e0b\u8d85\u904e10\u9846\u55dc\u9178\u6027\u7403\uff0c\u5c31\u6703\u504f\u5411\u662f\u6b64\u985e\u60a3\u8005\u3002<\/p>\n\n\n\n

\u6162\u6027\u9f3b\u7ac7\u708e\u5167\u79d1\u6cbb\u7642\u8207\u751f\u7269\u88fd\u5291<\/strong><\/p>\n\n\n\n

\u3000\u3000\u6839\u64da\u6700\u65b0\u6b50\u6d32\u9f3b\u7ac7\u708e\u9f3b\u606f\u8089\u6cbb\u7642\u6307\u5f15(European Position Paper on Rhinosinusitis and Nasal Polyps 2020-EPOS\n2020)\uff0c\u6162\u6027\u9f3b\u7ac7\u708e\u9069\u7576\u5167\u79d1\u6cbb\u7642(appropriate medical therapy-AMT)\u4ee5\u9f3b\u7528\u985e\u56fa\u9187\u3001\u9f3b\u6c96\u6d17\u70ba\u4e3b\u8981\u6cbb\u7642\u65b9\u5f0f\uff0c\u6297\u751f\u7d20\u89d2\u8272\u9010\u6f38\u964d\u4f4e\u3002\u800c\u7b2c2\u578b\u767c\u708e\u53cd\u61c9\u6162\u6027\u9f3b\u7ac7\u708e\u60a3\u8005\uff0c\u7531\u65bc\u767c\u708e\u7d30\u80de\u4ee5\u55dc\u9178\u6027\u7403\u5c45\u591a\uff0c\u7d30\u80de\u6fc0\u7d20(cytokine)\u4ee5interleukin(IL)-4,5,13\u70ba\u4e3b\uff0c\u5efa\u8b70\u53ef\u52a0\u4e0a\u751f\u7269\u88fd\u5291\u4f5c\u70ba\u6cbb\u7642\u3002\u6839\u64da\u7d71\u8a08\uff0c\u5728\u53f0\u7063\u6162\u6027\u9f3b\u7ac7\u708e\u5408\u4f75\u9f3b\u606f\u8089\u7b2c2\u578b\u767c\u708e\u53cd\u61c9\u60a3\u8005\u7d042~3\u6210\uff0c\u897f\u65b9\u570b\u5bb6\u537b\u9054\u52308\u6210\u3002\u7136\u800c\uff0c\u7531\u65bc\u98f2\u98df\u897f\u5316\uff0c\u9020\u6210\u53f0\u7063\u8d8a\u4f86\u8d8a\u591a\u4ee5\u55dc\u9178\u6027\u7403\u70ba\u4e3b\u7684\u7b2c2\u578b\u767c\u708e\u60a3\u8005\uff0c\u9019\u7a2e\u73fe\u8c61\uff0c\u7a31\u4e4b\u70ba\u55dc\u9178\u6027\u7403\u8f49\u79fb(eosinophil shift)\u3002<\/p>\n\n\n\n

\"\"

\uff08\u5716\uff093D\u78c1\u5c0e\u5f0f\u822a\u7cfb\u7d71<\/figcaption><\/figure><\/div>\n\n\n\n

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