鼻内镜下改良上颌窦开口扩大术治疗难治性上颌窦炎的临床观察

发布时间：2018-12-22 07:58

【摘要】：[目的]探讨鼻内镜下改良上颌窦开口扩大术对治疗难治性上颌窦炎的临床效果；为难治性上颌窦炎手术治疗方法提供更多的选择；[方法]对18例难治性上颌窦炎患者采用鼻内镜下改良上颌窦开口扩大术,术后进行定期随访,观察术后临床疗效及复发情况。采用Lund-Kennedy内镜黏膜评分系统进行鼻内镜检查量化评估,针对息肉、水肿、鼻漏、瘢痕、结痂5项指征进行疗效评定,分析治疗有效率和复发率。术前、术后生活质量评价采用SNOT-20中文版,对患者治疗前、治疗后6个月进行鼻窦炎生活质量评价,包括鼻部症状、鼻窦炎相关症状、睡眠情况及情感4个大方面,共20个条目。对各条目积分和总积分进行统计学分析,比较术前、术后的差异性。术前、术后主要症状则采用视觉模拟量表(visual analogue scale,VAS)来评价,包括鼻塞、鼻流涕、头面部胀痛和嗅觉减退,对术前、术后各症状积分进行统计学分析,比较其差异性。患者主观判断症状改善程度,要求患者按主观判断从治疗起始至术后6个月,对自身症状改善程度分级,即显著改善、改善、无改善,分析总体疗效。[结果]18例进行鼻内镜下改良上颌窦开口扩大术为主的综合治疗难治性上颌窦炎患者.,术后6个月鼻内镜下评价显示：18例患者中,治愈15例(83.3%),好转2例(11.1%),无效1例(5.6%),治疗总有效率(94.4%)。术后6个月SNOT-20中各条目评分及总积分均显著降低。其中13个条目及总积分P0.05,差异具有统计学意义。术后6个月患者主要症状中鼻塞、鼻流涕、头面部胀痛,P0.05,差异具有统计学意义。患者主观评估总体疗效为显著改善10例(55.5%),改善7例(38.9%),无改善1例(5.6%)。[结论]鼻内镜下改良上颌窦开口扩大术对难治性上颌窦炎患者的疗效显著。具有一定的临床推广应用价值,为难治性上颌窦炎的手术治疗方法提供更多的选择。
[Abstract]:To explore the clinical effect of modified maxillary sinus opening enlargement under nasal endoscope in the treatment of refractory maxillary sinusitis, and to provide more options for the surgical treatment of refractory maxillary sinusitis. [methods] Eighteen patients with refractory maxillary sinusitis were treated with modified endoscopic maxillary sinus opening enlargement. The Lund-Kennedy endoscopic mucosal scoring system was used for quantitative evaluation of nasal endoscopy, and the effective rate and recurrence rate were analyzed for polyps, edema, rhinorrhea, scar and scab. The quality of life (QOL) was evaluated by SNOT-20 before and 6 months after treatment, including nasal symptoms, sinusitis related symptoms, sleep status and emotion. There are 20 entries. Statistical analysis was carried out on each item integral and total integral to compare the difference before and after operation. Before and after operation, the main symptoms were evaluated by visual analogue scale (visual analogue scale,VAS), including nasal congestion, nasal runny, head and face distending pain and olfactory decline. The scores of symptoms before and after operation were statistically analyzed and the differences were compared. In order to judge the degree of improvement of symptoms subjectively, the patients were required to grade their symptoms from the beginning of treatment to 6 months after operation, that is, significant improvement, no improvement, and analysis of the overall curative effect. [results] A total of 18 patients with refractory maxillary sinusitis were treated with modified maxillary sinus opening enlargement under nasal endoscope. Six months after operation, 15 cases (83.3%) were cured. Improvement was achieved in 2 cases (11.1%) and ineffective in 1 case (5.6%). The total effective rate was 94.4%. At 6 months after operation, the scores and total scores of each item in SNOT-20 were significantly decreased. Among them 13 entries and total score P0.05, the difference is statistically significant. Six months after operation, the main symptoms of the patients were nasal congestion, nasal runny, head and face distended pain, P 0.05, the difference was statistically significant. The overall effect of subjective evaluation was significantly improved in 10 cases (55.5%), 7 cases (38.9%) and 1 case (5.6%). Conclusion the modified maxillary sinus opening enlargement under nasal endoscope is effective in patients with refractory maxillary sinusitis. It has certain clinical application value and provides more choice for the surgical treatment of refractory maxillary sinusitis.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R765.9

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