功能性鼻内镜手术与轮廓化鼻内镜手术治疗难治性鼻窦炎的疗效分析

Analysis of surgical outcomes of functional endoscopic sinus surgery and radical sinus surgery for refractory rhinosinusitis

目的:探讨不同手术方式即功能性鼻内镜手术(FESS)和轮廓化鼻内镜手术(RSS)对难治性鼻窦炎的手术疗效。方法:回顾分析56例慢性鼻窦炎患者的临床资料,患者均为反复药物治疗或手术治疗效果不佳的难治性鼻窦炎患者。依据手术方式的不同将其分为FESS组和RSS组,分别统计2组患者术前的症状VAS评分、外周血嗜酸粒细胞比例、血清总IgE水平、皮肤点刺试验、嗅觉功能、鼻内镜Lund-Kennedy评分及鼻窦CT Lund-Mackay评分等。所有患者术后均鼻内镜随访≥1年,统计2组患者术后1年的症状VAS评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分等。将2组数据进行统计学分析,总结不同手术方式术后主、客观指标的差异。结果:2组患者在年龄、性别及合并哮喘或特异性体质等临床特征上差异均无统计学意义(P>0.05)。有既往手术史者RSS组更多,2组差异有显著性(P<0.05)。术前2组患者症状VAS评分、鼻内镜Lund-Kennedy评分、鼻窦CT Lund-Mackay评分比较,提示RSS组患者鼻窦炎症较重。2组患者术后1年与术前比较症状VAS评分(P<0.01)、鼻内镜Lund-Kennedy评分(P<0.01)、鼻窦CT Lund-Mackay评分(P<0.01)均有显著降低,提示2种手术方式都可减轻鼻窦炎症。通过2种手术方式的比较发现,2组患者术后症状VAS评分差异无统计学意义(U=211.5,P>0.05),RSS组较FESS组鼻内镜Lund-Kennedy评分(U=152.0,P<0.05)、鼻窦CT Lund-Mackay评分(U=94.0,P<0.01)等鼻内镜客观评价指标术后均有显著降低。有手术史的难治性鼻窦炎患者采用轮廓化手术方式术后1年鼻内镜Lund-Kennedy评分(U=26.0,P<0.01)、鼻窦CT Lund-Mackay评分(U=25.0,P<0.01)等指标较功能性手术方式有显著降低。结论:RSS手术较FESS手术能更有效地缓解鼻窦炎症,减轻症状,具有更好的手术效果,尤其对于既往有手术史的难治性鼻窦炎患者,是一种值得推荐的手术方式。

Objective：To study the surgical outcomes of functional endoscopic sinus surgery and radical sinus surgery for refractory rhinosinusitis.Method：A retrospective analysis of 56 cases with refractory rhinosinusitis was performed,who were enrolled in Beijing Tongren hospital from January 2011 to April 2013.According to different surgical methods,all patients were classified into functional endoscopic surgery group（FESS group）and radical sinus surgery group（RSS group）.All patients were followed up for more than one year after surgery.Symptom visual analog scale（VAS）,peripheral blood eosinophil percentage,serum total IgE,skin prick test（SPT）,olfactory function,Lund-Kennedy score and Lund-Mackay score were all examined and analyzed in two groups before and after surgery.SPSS 17.0was used to do data statistic analysis.Result：There was no significant difference between two groups in age,gender,complicated with allergic rhinitis and asthma（P〉0.05）.However,there was significant difference between two groups in the number of patients with previous surgery（χ^2=4.051,P〈0.05）.Preoperative VAS symptom score,Lund-Kennedy score and Lund-Mackay score were higher in RSS group than in FESS group.All patients were followed up for at least one year.VAS symptom score,Lund-Kennedy score and Lund-Mackay score in two groups were compared before and after surgery respectively.VAS symptom score（W =-4.783,P〈0.01;W =-2.981,P〈0.01）,Lund-Kennedy score（W =-4.526,P〈0.01;W =-2.685,P〈0.01）,Lund-Mackay score（W =-4.151,P〈0.01;W =-3.725,P〈0.01）were significantly lower after surgery.There was no significant difference in VAS symptom scores between two groups postoperatively（U=211.5,P〉0.05）.However,Lund-Kennedy score（U=152.0,P〈0.01）and Lund-Mackay score（U=94.0,P〈0.01）were lower in RSS group postoperatively.Among patients with surgery history,Lund-Kennedy score（U=26.0,P〈0.01）and Lund-Mackay score（U=25.0,P〈0.01）were also lower in RSS group at one year follow-up.Conclusion：Radical sinus surgery was more effective in relieving symptoms and reducing inflammation of sinus,compared with functional sinus surgery,especially in refractory sinusitis patients with previous surgery.