慢性鼻窦炎_张罗, (比) 克劳斯·巴赫特主编_9787117342193

本书共54章, 21万字, 130幅图。全书系统介绍了关于慢性鼻窦炎在发病机制、临床表现、诊断和治疗方面取得的新进展, 包括流行病学、微生物学、免疫学和遗传学等方面的基础研究; 在分类和诊断中引入了CRS的表型和内型; 在医疗、内镜手术和生物治疗引入了基于循证医学和精确医学的新策略; 专门讨论了过敏、哮喘、过敏性真菌性鼻窦炎和全身性疾病对鼻窦炎的作用。

Chronic thinosinusitis （CRS） is a common disease， causing symptoms and impacting on quality of life of patients. Since 1980s， we have learned to understand CRS as a physical problem， a problem of drainage and ventilation， of ciliary activity to clean the sinuses. The proposed surgical approach by Messerklinger and Stammberger as well as Wigand and Hosemann incorporated these ideas， and many authors and guidelines adopted it. This approach was right in great parts， but did not yet appreciate the fact that sinus disease is so variable， and immunology does play a significant role much more than anticipated at that time point. Itis clear today that the Messerklinger technique does not work in severe type 2 nasal polyposis， and one needs a better understanding of the immunology of the disease-and consequently the recognition of endotypes-to be able to address the diversity of CRS disease and tailor management and therapy to a variety of very different disease endotypes. Our understanding of the pathophysiology of CRS has developed from a physical problem to a mucosal problem.
　　Today， with the advent of biologics specifically for type 2 disease and specific surgical approaches for severe recurrent nasal polyposis， a differentiation of CRS into endotypes is overly due. These approaches are currently tailored for the severe nasal polyp patient， who so far found no or little support in the current guidelines for diagnosis， understanding of disease， let alone treatment. This will change within very few years， as we saw in severe asthma with great benefits for the patients formerly left untreated due to lack of understanding but also availability of treatment approaches. Today， we do see the benefits of biologics， offering great advantages to severe airway disease patients when properly endotyped; for asthma， these medications are life-saving and allowing the patient to live a normal life without limitations and the society to regain an active member. It is due time to adapt these principles also for CRS， often characterized by comorbidities such as asthma， but often by itself limiting the performance of patients and their quality of ife to a great deal. The adaptation of endotypes should make a great difference to this dilemma. Surgical techniques responding to those needs also need to be further developed， adopted for the different needs of the patients according to their pheno- but specifically endotype. In any case， the ENT surgeon will need to learn immunology， to understand disease endotypes， to master diagnosis and advanced treatment options for a larger spectrum of disease. The biologics will support this development， by supporting the endotyping and offering so far unexperienced treatment possibilities for the patients most suffering at the moment and hopeless so far. For them with the highest unmet needs， the new development will bring the long-awaited relief.
　　This "mucosal concept" is the reason to write a new book for guidance of our colleagues who struggle to cure and appropriately treat our severe CRS patients.

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