慢性鼻-鼻窦炎伴或不伴鼻息肉患者鼻内镜手术的疗效及影响因素分析

Efficacy and associated factors of endoscopic sinus surgery on patients with chronic rhinosinusitis with or without nasal polyps

目的探讨慢性鼻-鼻窦炎（CRS）伴或不伴鼻息肉患者鼻内镜手术的疗效及其影响因素。方法纳入126例伴鼻息肉和154例不伴鼻息肉的CRS患者,行鼻内镜手术治疗后随访6个月,比较两组患者的疗效、并发症和生活质量,并分析疗效的影响因素。结果两组疗效和并发症发生率差异无统计学意义（P〉0.05）;治疗后CRS伴或不伴鼻息肉患者的生活质量SF-36问卷躯体健康、躯体角色功能、心理健康、情绪角色功能、精力和总体健康得分均较前显著升高（P〈0.05）,CRS不伴鼻息肉患者的情绪角色功能显著高于CRS伴鼻息肉患者（t=-4.107,P〈0.001）;治疗后规律冲洗鼻腔（P〈0.001,OR=0.456,95%CI：0.727~0.913）和规律使用激素（P=0.029,OR=0.645,95%CI：0.325~0.752）对疗效有显著影响。结论鼻内镜手术对CRS伴或不伴鼻息肉患者的疗效和安全性无差别,但不伴鼻息肉的患者术后情绪角色功能恢复更佳,CRS的疗效还受到术后是否规律行鼻腔冲洗和激素的影响,因此临床应重视术后处理。

Objective To explore the efficacy and associated factors of endoscopic sinus surgery on patients with chronic rhinosinusitis（ CRS） with or without nasal polyps. Method A total of 126 CRS patients with nasal polyps and 154 without nasal polyps were included and treated by endoscopic sinus surgery,then were follow up for 6 months. The efficacy,complications and quality of life were compared betw een the two groups,and the factors of efficacy were analyzed. Results There was no significant difference in efficacy and complication rate betw een the two groups（ P〈0. 05）; after treatment,physical health,physical role functioning,mental health,emotional role function,energy,and general health in quality of life questionnaire SF-36 were increased（ P〈0. 05）,emotional role function was significantly higher in patients with CRS without nasal polyps than that in patients with nasal polyps（ t =- 4. 107,P〈0. 001）;after treatment,the law of nasal irrigation（ P〈0. 001,OR = 0. 456,95% CI： 0. 727-0. 913） and the regular use of hormones（ P = 0. 029,OR = 0. 645,95% CI： 0. 325-0. 752） had a significant impact on the outcome. Conclusion There is no difference in efficacy and safety for endoscopic sinus surgery betw een the patients with CRS with and without nasal polyps,but without nasal polyps patients recover better emotional role function,the efficacy of CRS is also subject to the law whether postoperative nasal irrigation and row hormones,and therefore should pay attention to the postoperative clinical treatment.