鼻内镜窦口鼻道复合体手术治疗慢性鼻窦炎的疗效及生存质量观察  

Clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope

作　　者：魏建初[1] 何云生[1] 蔺林 李伯臣 Wei Jianchu;He Yunsheng;Lin Lin;Li Bochen(Department of Otolaryngology、Huzhou Central Hospital, Hitzhou , Zhejiang 313000 , China;Department of Otolaryngology Head and Neck Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China)

机构地区：[1]湖州市中心医院耳鼻咽喉科,浙江313000 [2]复旦大学附属华山医院耳鼻咽喉头颈外科,上海200040

出　　处：《中国基层医药》2019年第8期910-914,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察鼻内镜下窦口鼻道复合体手术治疗慢性鼻窦炎的疗效及其对患者生活质量的影响方法选择2014年3月至2017年5月湖州市中心医院收治的慢性鼻窦炎患者270例为研究对象.采用随机数字表法分为对照组和观察组各135例观察组患者接受鼻内镜下窦口鼻道复合体手术治疗,对照组患者采取局部切除、局部糖皮质激素喷鼻、上颌窦穿刺冲洗等综合治疗:术后随访6个月,观察临床治疗效果,采用生活质竝健康调査量表(SF-36)和鼻-鼻窦炎疾病特异性生活质量量表(SNOT-20)对患者进行评估结果来次随访时,观察组治愈率84.4%.好转率13. 3%.;对照组治愈率45. 2%,好转率20. 0%,观察组临床疗效显著优于对照组(Z=7.291,P<0.001)治疗后3个月,观察组SF-36量表中生理角色评分(69. 5 ±14. 1)分、总体健康评分(62.9 ±11.4)分,以及SNOT-20量表中20个总条目得分(15.5 ±3.4)分和5大条目得分(8. 1 ±3.7)分,均较治疗前明显改善(t=4.881 ,5. 102 ,20.283,14.360,均P<0.05)治疗后6个月,观察组生理功能、生理角色、机体疼痛、活力、社会功能、情绪角色、心理健康和总体健康评分分别为(86. 8 ±11.5)分、(81.0 ±12. 1)分、(82.8 ± 12.7)分、(70.4 ± 11.0)分、(84. 5 ± 13. 0)分、(73. 4 ± 11.6)分、(87.0 ±12. 4)分和(6& 7 ± 16. 4)分,均明显优于对照组的(83. 8 ± 11.4)分、(69. 5 ± 12. 4)分、(78. 5 ± 13. 1 )分、(68.4±11.9)分、(74.4 ±11.7)分、(67.4 ± 11.9)分、(78.9 ± 12. 3)分和(64. 3 ±12.9)分,差异均有统计学意义(1=2.153、7.712、2.738 ,2.012,6.710.4. 195 ,5.388 ,2.450,均 P<0.05);而 20 个总条目得分和 5 大条目得分与3个月时比较差异均无统计学意义(均P >0.()5).结论鼻内镜下窦口鼻道复合体手术治疗慢性鼻窦炎的临床效果尚满意,患者总体症状和生活质量基本恢复正常.但必须抑鼻涕、流黏稠鼻涕、夜间睡眠不好、鼻涕向后流和注意力不集中等5大问题仍未得到彻底解决.Objective To analyze the clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope. Methods A total of 270 patients with chronic sinusitis treated in Huzhou Central Hospital from March 2014 to May 2017 were selected. The patients were randomly divided into control group and observation group according to the digital table, with 135 cases in each group. The observation group received ostimeatal complex surgery under nasal endoscope. The control group was treated with local excision, local glucocorticoid injection , and maxillary sinus puncture and irrigation. The patients were followed up for 6 months after surgery, the clinical effect was observed. The life quality of patients was evaluated with 36 - items short form health survey (SF-36) and si no 一 nasal outcome* test - 20 ( SNOT - 20). Results At the last follow - up, the cure rate of the observation group was 84. 4%, the improvement rate was 13. 3%, the cure rate of the control group was 45. 2%, and the improvement rate was 20. 0%. The clinical efficacy of the observation group was significantly better than that of the c ontrol group ( Z = 7. 291 , P < 0.001 ). Three months after treatment, the physiological role score [( 69. 5 ± 14. 1 ) points ] and general health score [( 62. 9 ± 11.4) points ], the total score of 20 items [( 15. 5 ±3.4) points ] and 5 items [(8.1 ±3.7) points] of SNOT - 20 scale in the observation group were significantly improved (t= 4. 881 ,5. 102,20. 283 , 14. 360,all P <0. 05 ). Tlie scores of physiological function,physiological role,body pain, vigor,s<x ial function,emotioiuil role,mental health and general health in the observation group were ( 86. 8 ± 11.5 ) points,(81.0 ± 12. 1 ) points,(82. 8 ± 12.7) points,(70. 4 ± 11.0) points,(84. 5 ± 13.0) points,(73. 4 ± 11.6) points,( 87. 0 ± 12.4) points and (68. 7 ± 16.4) points, which were significantly better than those in the control group [(83. 8 ± 11.4) points,(69. 5 ± 12.4) points,(78. 5 ± 13.1 ) points,( 68. 4 ± 11.9) points,( 74. 4

关 键 词：耳鼻喉外科手术 内窥镜检查 鼻窦疾病 窦口鼻道复合体 慢性鼻窦炎 临床效果 生活质量 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]