功能性鼻内镜手术治疗真菌性鼻及鼻窦炎预后相关因素分析

Efficacy and influencing factors of functional endoscopic sinus surgery on fungal rhinosinusitis

目的探讨功能性鼻窦内镜手术(functional endoscopic sinus surgery,FESS)治疗真菌性鼻及鼻窦炎(fungal rhinosinusitis,FRS)的临床结局及其影响因素。方法回顾性分析106例FRS患者的临床特征,总结经FESS治疗FRS的疗效及预后,通过Logistic回归分析和筛选影响预后的关键因素。结果①随访6～72个月,总体疗效为100%,其中痊愈为49.06%,显效为28.30%,有效为22.64%。②鼻窦发病为单窦或多窦、是否伴有鼻息肉与患者的总体疗效相关(OR=4.37,P=0.004;OR=3.90,P=0.036)。多鼻窦发病以及伴有鼻息肉是影响预后的危险因素,性别、年龄、病程、是否有骨质破坏、术后是否使用激素以及术后是否使用抗真菌药等因素与总体疗效不相关(P>0.05)。③术后是否使用激素对患者症状恢复时间的长短有显著性差异。结论 FESS对FRS的治疗安全、有效,多鼻窦发病以及伴有息肉的疗效差于单窦发病及不伴有息肉者。术后激素的使用对整体疗效的改善无显著差异,但能显著缩短病程。

OBJECTIVE To explore the outcome and related factors of functional endoscopic sinus surgery （FESS）for fungal rhinosinusitis（FRS）. METHODSThe clinical data of 106 consecutive patients with FRS treated by FESS were analyzed retrospectively. Then the efficacy and prognosis of FRS was summarized by follow-up observation. Logistic regression and t-test were used to explore the key factors influencing the prognosis. RESULTS 1. Patients were followed up for 4 to 72 months. The total efficiency of the 106 patients was 100%. Of all the patients, fifty-two patients were recovered （49.06%）, thirty patients were markedly improved （28.30%）, and twenty-four patients were improved （22.64%）. 2. The factor single sinus or multiple sinuses involved and the factor with polyp or not were significant prognostic factors and related with the total efficiency. The efficacy of patients with multiple sinuses involved or with polyp was significantly lower than the patients with single sinus involved or without polyp（OR=4.37, P=0.004; OR=3.90, P=0.036）. Gender, age, course of the disease, bone destruction, steroid prescribed, and antifungal medicine prescribed were not related with the total efficiency（P〉0.05）. 3. Steroid prescribed after FESS could significantly shorten the recovery time of FRS. CONCLUSION The FESS is effective and safe for the patients with FRS. The result of the patients with multiple sinuses involved or with polyp is worse than that of the patients with single sinus involved and without polyp. Using steroid after FESS can not significantly improve the total efficiency, but can help to shorten the recovery time.