内窥镜鼻窦术中对中鼻甲不同处理的手术效果比较

Comparison of results of different surgical modalities for middle turbinate in endoscopic sinus surgery

目的观察内窥镜鼻窦术中对中鼻甲分别实施保留和部分处理后鼻气道阻力评分和主观症状评分的差异。方法选取杭州师范大学医学院附属萧山第一人民医院五官科2016年1月—2017年10月收治的154例进行内窥镜鼻窦术的Ⅱ型以上慢性鼻窦炎患者。根据中鼻甲的处理方式分为2组,每组77例,对照组保留中鼻甲,研究组根据病情进行中鼻甲的部分切除。对比2组治疗有效率、术后清理时间和粘连的发生情况,使用主动前鼻测压法进行鼻气道阻力评分(nasal airway resistance,NAR)和视觉类比法(visual analogue scale test,VAS)进行主观症状评分,统计术前术后2组评分差异。结果研究组、对照组的总有效例数分别为73例(94.81%)、63例(81.82%),差异具有统计学意义(P<0.05)。研究组术后清理时间和粘连发生病例数明显低于对照组,差异具有统计学意义(均P<0.05)。治疗前研究组、对照组NAR评分差异无统计学意义(P>0.05);治疗后2组NAR评分均明显降低,其中研究组降低更明显,差异具有统计学意义(P<0.05)。治疗前研究组、对照组VAS评分差异无统计学意义(P>0.05);治疗后2组VAS评分均降低,其中研究组降低更明显,差异具有统计学意义(P<0.05)。结论在慢性鼻窦炎患者内窥镜手术时采用不同中鼻甲处理方式对NAR和VAS评分有影响,合理切除中鼻甲可有效降低手术清理时间和鼻腔黏膜组织粘连的发生率,且临床效果更佳。

Objective To investigate the difference of nasal airway resistance score and subjective symptom score between preservation and partial resection of middle turbinate in endoscopic sinus surgery.Methods A total of 154 patients with chronic sinusitis of type Ⅱ or higher who were admitted to our ENT from January 2016 to October 2017 were randomly divided into study group and control group with 77 cases in each group.The patients in the control group received preservation of middle turbinate in the endoscopic sinus surgery,while the patients in the study group received partial resection of the middle turbinate.The curative efficacy,postoperative clean-up time,and the incidence of adhesion were compared between the two groups.The differences in nasal airway resistance(NAR) score by the active anterior rhinomanometry and subjective symptom score by visual analogue scale test(VAS) between the two groups were analyzed before and after the treatment.Results The total remission cases in the study group and control group were 73 cases(94.81%) and 63 cases(81.82%),respectively,the difference was statistically significant(P < 0.05).The postoperative clean-up time and incidence of adhesion in the study group were significantly lower than those in the control group,the difference was statistically significant(all P < 0.05).There was no difference in NAR scores before the treatment between the two groups(P > 0.05).After the treatment,the NAR scores in both groups decreased significantly,especially in the study group,the difference between the two groups was statistically significant(P < 0.05).There was no difference in VAS scores between the two groups before surgery(P > 0.05);However,the scores decreased in both two groups after surgery,especially in the study group,the difference between the two groups was statistically significant(P < 0.05).Conclusion Different surgical modalities for middle turbinate in endoscopic sinus surgery can affect NAR and VAS scores in endoscopic sinusitis patients.Rational removal of middle turbinate can effectively reduce the cleaning time and the incidence of nasal mucosal adhesion,and the clinical effect is better.