DIP内镜评分方案在评价行鼻内镜手术的慢性鼻-鼻窦炎患者病情方面的应用

Applicaiton of DIP endoscopic scoring system in evaluating condition of patients with chronic rhinosinusitis undergoing nasal endoscopic surgery

目的探讨DIP内镜评分方案在慢性鼻-鼻窦炎(CRS)行鼻内镜手术中的价值。方法选取2013年9月-2015年2月该院收治行鼻内镜手术的82例CRS患者为研究对象,术前进行Lund-Mackay CT评分、鼻腔鼻窦结局测量20条(SNOT-20)及视觉模拟量表(VAS)评分,术中录制鼻内镜检查录像。术后3个月再次进行SNOT-20和VAS评分,再次录制鼻内镜录像。由两名医生作为评分者对所有录像进行DIP及Lund-Kennedy内镜评分,采用组内相关系数(ICC)来比较两者的信度,分析各评分结果之间的相关性。结果术后SNOT-20、VAS评分、DIP及Lund-Kennedy内镜评分均明显低于术前(P<0.05)。术前DIP内镜评分与Lund-Kennedy内镜评分、Lund-Mackay CT评分均成正相关(P<0.05),与SNOT-20及VAS评分均无明显的相关性(P>0.05)。术后DIP内镜评分与Lund-Kennedy内镜评分成正相关(P<0.05),与SNOT-20及VAS评分均无明显的相关性(P>0.05)。手术前后DIP内镜评分的评分者信度及重测信度的ICC均高于Lund-Kennedy内镜评分。结论 DIP内镜评分在CRS患者鼻内镜手术前后均有较高的信度,与其他客观评估结果呈正相关,而与主观评分结果无明显相关,故需从主观和客观两个方面来综合评估CRS的病情及疗效。

Objective To investigate the value of DIP endoscopic scoring system in patients with chronic rhinosinusitis（CRS） undergoing nasal endoscopic surgery. Methods 82 patients with chronic rhinosinusitis undergoing nasal endoscopic surgery from September 2013 to February 2015 were enrolled in the study. The scores of sino-nasal outcome test-20（SNOT-20）,visual analogue scale（VAS） and Lund-Mackay CT were evaluated before nasal endoscopic surgery.And endoscopic videos were recorded during surgery. The scores of SNOT-20 and VAS were evaluated in 3months after surgery, and endoscopic videos were recorded again. DIP and Lund-Kennedy endoscopic scoring were used according to the videos by two doctors as raters. Intraclass correlation coefficient（ICC） was performed to compare the reliability, and the correlation among the ratings was analyzed. Results The scores of SNOT-20, VAS, DIP and Lund-Kennedy endoscopic scoring after surgery were significantly lower than that before surgery（P〈0.05）. Preoperative score of DIP endoscopic scoring was positively correlated with scores of Lund-Mackay CT and Lund-Kennedy endoscopic scoring（P〈0.05）, and there were no significant correlation preoperative score of between DIP endoscopic scoring and SNOT-20, VAS score（P〈0.05）. Postoperative score of DIP endoscopic scoring was posi-tively correlated with Lund-Kennedy endoscopic scoring（P〈0.05）, and there were no significant correlation be-tween postoperative score of DIP endoscopic scoring and SNOT-20, VAS score（P〈0.05）. ICC of inter-rater and rest-test reliability of DIP endoscopic scoring were all higher than that of Lund-Kennedy endoscopic scoring.Conclusions DIP endoscopic scoring system shower higher reliability before and after nasal endoscopic surgery, and its score is positively correlated with other objective assessment systems while there are no significant correlative between its score and results of subjective assessment systems. So it required comprehensive evaluation for the condition and curative effect of CRS patients from subjective and objective aspect.