鼻内镜下中下鼻道上颌窦联合开窗术治疗真菌球性上颌窦炎的随机对照试验  

Endoscopic Sinius Surgery Combined with Middle and Inferior Meatus Fenestration for Fungal Ball Maxillary Sinusitis: A Randomized Controlled Trial

作　　者：施清圆[1] 董守豪 吴丽萍[1] 陈晓云[1] 张露[1] 张春鸿[1] 方潇碧[1] 庄建华 林加祥 廖志苏[1] 

机构地区：[1]温州医学院附属第一医院耳鼻咽喉科,温州325000 [2]温州市鹿城区人民医院,温州325000

出　　处：《中国循证医学杂志》2013年第7期801-806,共6页Chinese Journal of Evidence-based Medicine

基　　金：温州市鹿城区科学技术局资助项目(编号:S1111)

摘　　要：目的比较鼻内镜下上颌窦中鼻道开窗术及中、下鼻道上颌窦联合开窗术治疗真菌球性上颌窦炎的临床疗效。方法采用前瞻性随机对照试验方法,将2010年1月至2011年3月在温州医学院附属第一医院耳鼻咽喉科住院的80例被确诊为真菌球性上颌窦炎患者分为两组,每组各40例。试验组采用鼻内镜下中、下鼻道上颌窦联合开窗术治疗,对照组采用鼻内镜下上颌窦中鼻道开窗术治疗,并随访至2013年2月28日。术前主观评估采用VAS、SNOT-20问卷调查;客观评估采用Lund-Mackay CT评分和Lund-Kennedy评分。并在术后3月、6月、1年及2年时对两组患者再次进行相同指标评估。结果试验组术后6月、1年及2年的VAS评分、SNOT评分及Lund-Kennedy评分结果均明显优于对照组,其差异有统计学意义(P<0.05)。对照组术后1年Lund-Mackay评分高于试验组(P<0.01)。根据海口标准对手术疗效进行评估,试验组治愈36例,好转4例,总有效率为100.0%,对照组治愈28例,好转7例,总有效率为87.5%,试验组的疗效优于对照(P=0.021)。结论鼻内镜下上颌窦中、下鼻道联合开窗术治疗真菌球性上颌窦炎的临床疗效明显优于鼻内镜下上颌窦中鼻道开窗术,且复发率更低。Objective To compare endoscopic sinius surgery plus middle meatus fenestration with endoscopic sinius surgery plus middle and inferior meatus fenestration for fungus ball maxillary sinusitis.Methods Applying a prospective randomized controlled trial,80 patients with fungal ball maxillary sinusitis from January,2010 to March,2011 were collected and then divided into two groups,including experiment（40 cases） and control groups（40 cases）.The trial group received endoscopic sinius surgery plus middle and inferior meatus fenestration,which the control group received endoscopic sinius surgery plus middle meatus fenestration.Then a follow-up was conducted from the end of surgery to February 28th,2013.All patients took subjective and objective assessment before and after the surgery,including VAS,SNOT-20,Lund-Mackay CT system scores and Lund-Kennedy endoscopic mucosal score.Results with the trial group was superior to the control group in VAS score,SNOT rating and Lund-Kennedy mucosa score 6 months,1 year,and 2 years after surgery（P0.01）.Lund-Mackay CT score of the control group was significantly higher than the trial group after 1 year of surgery（P0.01）.According to the Haikou standard to assess the efficacy of surgery,we found that the total effectiveness rate of the trial group（100.0%;recovery： 36 cases;improved： 4 cases） was higher than that of the control group（87.5%;recovery： 28 cases;improved： 4 cases）,with a significant difference（P=0.021）.Conclusion Endoscopic sinius surgery plus middle and inferior meatus fenestration with a lower reoccurrence rate is superior to endoscopic sinius surgery plus middle meatus fenestration for fungus ball maxillary sinusitis in clinical efficacy.

关 键 词：真菌球性上颌窦炎 鼻内镜鼻窦手术 中、下鼻道开窗术 随机对照试验 疗效评价 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]