功能性鼻内镜手术与轮廓化鼻内镜手术治疗难治性鼻窦炎的疗效分析

发布时间：2018-08-03 10:28

【摘要】：目的:探讨不同手术方式即功能性鼻内镜手术(FESS)和轮廓化鼻内镜手术(RSS)对难治性鼻窦炎的手术疗效。方法:回顾分析56例慢性鼻窦炎患者的临床资料,患者均为反复药物治疗或手术治疗效果不佳的难治性鼻窦炎患者。依据手术方式的不同将其分为FESS组和RSS组,分别统计2组患者术前的症状VAS评分、外周血嗜酸粒细胞比例、血清总IgE水平、皮肤点刺试验、嗅觉功能、鼻内镜Lund-Kennedy评分及鼻窦CT Lund-Mackay评分等。所有患者术后均鼻内镜随访≥1年,统计2组患者术后1年的症状VAS评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分等。将2组数据进行统计学分析,总结不同手术方式术后主、客观指标的差异。结果:2组患者在年龄、性别及合并哮喘或特异性体质等临床特征上差异均无统计学意义(P0.05)。有既往手术史者RSS组更多,2组差异有显著性(P0.05)。术前2组患者症状VAS评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分比较,提示RSS组患者鼻窦炎症较重。2组患者术后1年与术前比较症状VAS评分(P0.01)、鼻内镜Lund-Kennedy评分(P0.01)、鼻窦CT Lund-Mackay评分(P0.01)均有显著降低,提示2种手术方式都可减轻鼻窦炎症。通过2种手术方式的比较发现,2组患者术后症状VAS评分差异无统计学意义(U=211.5,P0.05),RSS组较FESS组鼻内镜Lund-Kennedy评分(U=152.0,P0.05)、鼻窦CT Lund-Mackay评分(U=94.0,P0.01)等鼻内镜客观评价指标术后均有显著降低。有手术史的难治性鼻窦炎患者采用轮廓化手术方式术后1年鼻内镜Lund-Kennedy评分(U=26.0,P0.01)、鼻窦CT Lund-Mackay评分(U=25.0,P0.01)等指标较功能性手术方式有显著降低。结论:RSS手术较FESS手术能更有效地缓解鼻窦炎症,减轻症状,具有更好的手术效果,尤其对于既往有手术史的难治性鼻窦炎患者,是一种值得推荐的手术方式。
[Abstract]:Objective: to investigate the operative effects of functional endoscopic sinus surgery (FESS) and contoured endoscopic sinus surgery (RSS) in the treatment of refractory sinusitis. Methods: the clinical data of 56 patients with chronic sinusitis were retrospectively analyzed. The patients were divided into FESS group and RSS group according to the different operation methods. The VAS score of symptoms, the proportion of eosinophils in peripheral blood, the serum total IgE level, the skin prick test, the olfactory function of the two groups were counted respectively. Nasal endoscopic Lund-Kennedy score and sinus CT Lund-Mackay score. All the patients were followed up for more than one year. The VAS score, Lund-Kennedy score and CT Lund-Mackay score of nasal sinus were calculated. The data of two groups were analyzed statistically, and the differences of subjective and objective indexes were summarized. Results there were no significant differences in age, sex, asthma or specific constitution between the two groups (P0.05). There were significant differences between the two groups in RSS group with previous surgical history (P0.05). VAS score, Lund-Kennedy score of nasal endoscope and CT Lund-Mackay score of paranasal sinus were compared between the two groups before operation. It was suggested that the VAS score, Lund-Kennedy score and CT Lund-Mackay score of sinusitis in RSS group were significantly lower than those in the control group (P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01, P0.01 and P0.01, respectively. It was found that there was no significant difference in VAS scores between the two groups after operation (U211.5% P0.05). Compared with the FESS group, the Lund-Kennedy score of nasal endoscope and the Lund-Mackay score of nasal sinuses CT were significantly lower than those of FESS group (P 0.01, P 0.01). In patients with refractory sinusitis with a history of surgery, the Lund-Kennedy score of nasal endoscope (UX 26.0 卤P0.01) and CT Lund-Mackay score (UT 25.0% P0.01) were significantly lower than those of functional surgery in patients with refractory sinusitis. Conclusion FESS surgery is more effective than FESS surgery in relieving sinusitis and symptoms, and has a better effect, especially for refractory sinusitis patients who have a history of surgery.
【作者单位】：首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学);首都儿科研究所附属儿童医院耳鼻咽喉科;
【基金】：国家自然科学基金项目(No:81100705) 卫生行业科研专项项目(No:201202005)联合资助
【分类号】：R765.9

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