鼻内镜下双径路手术治疗真菌性鼻窦炎的疗效观察

Observation the effect of double path endoscopic surgery in the treatment of fungal sinusitis

目的：分析鼻内镜下双径路手术在真菌性鼻窦炎治疗中的疗效，并与单纯鼻内镜下中鼻道开窗术进行比较。方法分析真菌性鼻窦炎患者的临床资料。依据患者接受的手术方式不同分为两组，观察组：鼻内镜下中鼻道开窗联合尖牙窝小视窗双径路术；对照组：单纯鼻内镜下中鼻道开窗术。结果共纳入观察组35例，对照组37例。治疗后观察组患者症状评分显著低于对照组患者[（1．09±0．83）分比（1．47±0．77）分；t ＝2．015，P ＝0．048]；观察组治疗有效率显著高于对照组患者（94．29％比75．68％；χ2＝4．813，P ＝0．028）。观察组患者治疗后7 d C-反应蛋白（t ＝4．971，P ＜0．01）、TNF-α（t ＝9．19，P ＜0．01）、IL-1β（t ＝5．635，P ＜0．01）、白细胞（t ＝3．25，P ＝0．002）及 IL-6（t ＝3．86，P ＝0．002）均显著低于对照组（P ＜0．05）。两组患者术前血浆1-3-β-D 葡聚糖水平差异无统计学意义（P ＞0．05）；两组患者术前血浆1-3-β-D 葡聚糖水平差异无统计学意义（P ＞0．05），术后2 d（t ＝5．978，P ＜0．01）、4 d（t ＝6．335，P ＜0．01）、6 d（t ＝9．348，P ＜0．001）及8 d（t ＝8．226，P ＜0．01）时差异有统计学意义。观察组术后1年累积复发率显著低于对照组（8．57％比27．03％；Log-rank χ2＝4．061，P ＝0．044）。结论真菌性鼻窦炎治疗中，采用鼻内镜下中鼻道开窗联合尖牙窝小视窗双径路术可以更有效清除病灶，其近远期疗效均优于单纯鼻内镜下中鼻道开窗术。

Objective To analyze the curative effect of double path endoscopic surgery in the treatment of fungal sinusitis,and to compare with the effect of simple in endoscopic nasal passages windowing.Methods The clinical data of fungal sinusitis patients were analyzed.According to the different surgery way,the patients were divid-ed into two groups.The observation group：nasal endoscopic nasal passages open a window in the joint of fangs nest small windows double path;Control group：simple in nasal endoscopic fenestration.Results The observation group had 35 cases and the control group had 37 cases.After treatment,the symptoms score of the observation group was sig-nificantly lower than the control group [（1 .09 ±0.83）points vs （1 .47 ±0.77）points;t =2.01 5,P =0.048].The effective rate of the observation group was significantly higher than the control group （94.29% vs 75.68%;χ2 =4.81 3,P =0.028）.7 days after treatment,the C -reactive protein（t =4.971 ,P 〈0.01 ）,TNF alpha（t =9.1 9,P 〈0.001 ）,beta IL -1 （t =5.635,P 〈0.01 ）,white blood cells （t =3.25,P =0.002）and IL -6（t =3.86,P =0.002） in the observation group were significantly lower than the control group （P 〈0.05）.The preoperative plasma level of 1 -3 -β-glucan D between the two groups had no statistical difference （P 〉0.05）.2（t =5.978,P 〈0.01 ）,4（t =6.335,P 〈0.01 ）,6（t =9.348,P 〈0.01 ）,and 8 days（t =8.226,P 〈0.01 ）postoperatively,1 -3 -β-glucan D levels were significantly lower than the control group,the differences were statistically significant （P 〈0.05）.The postoperative recurrence rate of the observation group was significantly lower than the control group （8.57% vs 27.03%,the Log -rank χ2 =4.061 ,P =0.044）.Conclusion In fungal sinusitis treatment,the use of endoscopic nasal passages open window joint fangs nest small windows double path can more effectively remove lesions,its forward curative effect is superior to pure in nasal endoscopic fenestration.