慢性鼻-鼻窦炎内镜手术疗效影响因素分析

Logistic regression analysis on influence factors of chronic sinusitis after endoscopic sinus surgery

目的探讨鼻内镜手术治疗慢性鼻一鼻窦炎（chronicrhinosinusitis，CRS）的临床疗效和影响因素。方法收集鼻内镜手术治疗的337例CRS患者的临床资料，包括：性别、年龄、文化程度、病程、住院天数、药物治疗史、吸烟、饮酒、前期手术史、变应性鼻炎（allergicrhinitis，AR）病史、临床分类、视觉模拟量表（visualanaloguescale，VAS）评分、鼻内镜检查评分、鼻息肉多发与否、CT检查评分、患病侧别、鼻腔粘连和术后随访依从性，术后6个月根据1997年海口标准进行鼻内镜手术疗效评定，采用SPSS18．0软件对结果进行χ2检验和Logistic回归分析。结果CRS患者鼻内镜手术后痊愈298例（88．4％），好转29例（8．6％），无效10例（3．0％）。CRS不伴鼻息肉组患者的临床疗效优于CRS伴鼻息肉组的患者，差异有统计学意义（χ2=10．932，P〈0．01）。经多因素Logistic回归分析得出，CRS临床分类、是否伴AR、VAS评分、鼻内镜检查评分、CT检查评分、鼻息肉多发与否、术后是否并发鼻腔粘连和术后随访依从性是影响临床疗效的最主要因素。结论CRS患者的疗效除手术本身影响因素外，还受到如临床分类、是否伴AR等多种因素影响。

Objective To explore the clinical effect and the influence factors after endoscopic surgery for chronic sinusitis. Methods The clinical data of 337 patients with chronic sinusitis treated by endoscopic surgery were analyzed, including gender, age, culture level, course of the disease, the days of hospitalization, medical history, smoking, drinking, early surgery history, allergic rhinitis （AR） history, clinical classification, visual analogue scale （VAS） score, nasal endoscopy score, nasal polyps, CT examination score, side, nasal adhesion and postoperative follow-up compliance. The clinical effect of endoscopic sinus surgery was evaluated 6 months after operation according to the 1997 Haikou standard. SPSS 18.0 software and conducted chi-square test and logistic regression analysis were used to analyze the data. Results Three hundred and thirty-seven chronic sinusitis patients were followed up after endoscopic surgery. It was found that 298 cases （88.4%） cured, 29 cases （8.6%） improved, 10 cases （3.0%） invalid. The clinical curative effect of the patients with chronic rhinosinusitis without nasal polyp was better than that of the patients with chronic rhinosinusitis with nasal polyp, the difference was statistically significant （χ2 = 10. 932, P 〈 0. 01 ）. After many factors Logistic regression analysis, the most important effect factor in the clinical curative effect were clinical type, AR or not, VAS score, nasal endoscopic examination score, CT examination score, multiple nasal polyp or not, postoperative nasal adhesion or not and postoperative follow-up compliance. Conclusion The clinical effective of endoscopic sinus surgery is influenced by not only surgery itself, but also by clinical classification, whether and not with AR and so on.