修正性鼻内镜鼻窦手术与初次鼻内镜鼻窦手术治疗慢性鼻-鼻窦炎疗效比较  

Comparison of clinical outcomes between revision and primary endoscopic sinus surgery for chronic rhinosinusitis

作　　者：王安琪[1] 王士礼[1] 蔡昌枰[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院耳鼻咽喉科,上海200025

出　　处：《上海交通大学学报（医学版）》2014年第3期361-364,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的通过比较修正性鼻内镜鼻窦手术(RESS)与初次鼻内镜鼻窦手术(PESS)后的主客观疗效,了解既往鼻窦手术史是否会影响RESS的术后疗效,RESS是否能取得与PESS术同样的临床疗效。方法采用视觉模拟量表(VAS)、鼻腔鼻窦结局测试20条(SNOT-20)、医学结局研究简表36项健康调查(SF-36)、慢性鼻-鼻窦炎(CRS)诊断和治疗指南(2012年,昆明)以及Lund and Kennedy内镜评分系统对45例RESS患者和59例初次鼻内镜鼻窦手术患者进行主客观疗效评价,并将结果进行比较。结果两组患者VAS评分、SNOT-20评分和SF-36评分术后均得到显著改善(P<0.05),两组患者手术有效率、手术前后生活质量评分和改善情况以及Lund and Kennedy内镜评分差异均无统计学意义(P>0.05)。结论在正确掌握适应证及充分合理的围手术期综合治疗处理前提下,结合熟练正确的手术操作可消除既往鼻部手术史对RESS疗效的不良影响,RESS能够取得与PESS相似的主客观疗效。Objective To investigate whether previous sinus surgeries will have adverse affects on the revision endoscopic sinus surgery （RESS）, and whether the surgical outcomes of RESS is similar to that of the primary endoscopic sinus surgery （PESS） by comparing the postoperative results of PESS and RESS for chronic rhinosinusitis patients. Methods The quality of life status of patients underwent PESS （59 patients） and RESS （45 patients） was surveyed by visual analog scale （VAS）, sino-nasal outcome test-20 （SNOT-20）, medical outcome study short form 36-items health survey（SF-36）, and Lund and Kennedy endoscopic scores. The results were analyzed. Results The postoperative mean VAS, SNOT- 20, and SF-36 scores were significantly higher than preoperative mean scores in both RESS and PESS groups （P 〈 0. 05）. The effective rate, preoperative and postoperative quality of life scores, and postoperative Lund and Kennedy endoscopic scores were not statistically different between two groups （P 〉0. 05）. Conclusion The subjective and objective outcomes of RESS and PESS are not statistically different. Strict indications, perfect surgical technique, sufficient and reasonable perioperative care are essential to avoiding the adverse effects of prior sinus surgeries. RESS can have the similar outcomes as PESS.

关 键 词：慢性鼻-鼻窦炎 修正性鼻内镜鼻窦手术 初次鼻内镜鼻窦手术 生活质量 内镜检查 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]