改良鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的疗效
|
摘要
目的观察改良鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的疗效及安全性。方法回顾性分析2013年1月至2018年1月收治的78例真菌性蝶窦炎患者临床资料,根据治疗方式分为改良鼻内镜下蝶窦开放术组(A组,n=36)和传统手术组(B组,n=42)。观察两组手术情况和临床疗效,比较两组患者术后6个月时鼻黏膜症状(Lund-Kennedy评分)和鼻腔鼻窦改善情况[鼻腔鼻窦测试-20(SNOT-20)评分],及并发症发生情况。结果两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。A组术毕至窦口上皮化时间显著短于B组[(35.31±5.17)d vs(42.59±9.51)d,t=4.472,P=0.000]。两组总有效率均100%,差异无统计学意义(P>0.05);A组治愈率高于B组(91.67%vs 69.05%,χ~2=6.083,P=0.014)。术后6个月时,A组Lund-Kennedy、SNOT-20评分均显著低于B组(P<0.01)。两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论改良鼻内镜下蝶窦开放术可显著缩短患者术后恢复时间,提高治愈率,减轻鼻黏膜症状,提升生活质量,且安全性良好,较传统术式更具优势。
Objective To observe the efficacy and safety of modified nasal endoscopic sphenoidostomyversus traditional surgery in the treatment of fungal sphenoid sinusitis.Methods The clinical data of 78 patients with fungal sphenoid sinusitis admitted from January 2013 to January 2018 were retrospectively analyzed.According to the treatment methods,they were divided intomodified nasal endoscopic sphenoidostomy group(group A,n=36) and traditional surgery group(group B,n=42).The operation and clinical effect were observed.The nasal mucosal symptoms(Lund-Kennedy score) and the improvement of nasal cavity and sinus [sino-nasal outcome test-20(SNOT-20)] were compared at 6 months after operation between two groups.The complications were recorded and compared.Results There were no significant differences in operative time,intraoperative blood loss and total effective rate(100% in both groups)between two groups(all P>0.05).The epithelialization time of sinus ostium in group A was significantly shorter than that in group B [(35.31±5.17)d vs(42.59±9.51)d,t=4.472,P=0.000],and the cure rate was statistically higher than that in group B(91.67% vs 69.05%,χ~2=6.083,P=0.014).At 6 months after operation,the scores of Lund-Kennedy and SNOT-20 in group A were significantly lower than those in group B(P<0.01).There was no significant difference in the incidence of postoperative complications between two groups(P>0.05).Conclusions Modified nasal endoscopic sphenoidostomy can significantly shorten the postoperative recovery time,increase the cure rate,reduce the nasal mucosasymptoms,improve the quality of life and have good safety in the treatment offungal sphenoid sinusitis.It offers more advantages over traditional surgery.
Objective To observe the efficacy and safety of modified nasal endoscopic sphenoidostomyversus traditional surgery in the treatment of fungal sphenoid sinusitis.Methods The clinical data of 78 patients with fungal sphenoid sinusitis admitted from January 2013 to January 2018 were retrospectively analyzed.According to the treatment methods,they were divided intomodified nasal endoscopic sphenoidostomy group(group A,n=36) and traditional surgery group(group B,n=42).The operation and clinical effect were observed.The nasal mucosal symptoms(Lund-Kennedy score) and the improvement of nasal cavity and sinus [sino-nasal outcome test-20(SNOT-20)] were compared at 6 months after operation between two groups.The complications were recorded and compared.Results There were no significant differences in operative time,intraoperative blood loss and total effective rate(100% in both groups)between two groups(all P>0.05).The epithelialization time of sinus ostium in group A was significantly shorter than that in group B [(35.31±5.17)d vs(42.59±9.51)d,t=4.472,P=0.000],and the cure rate was statistically higher than that in group B(91.67% vs 69.05%,χ~2=6.083,P=0.014).At 6 months after operation,the scores of Lund-Kennedy and SNOT-20 in group A were significantly lower than those in group B(P<0.01).There was no significant difference in the incidence of postoperative complications between two groups(P>0.05).Conclusions Modified nasal endoscopic sphenoidostomy can significantly shorten the postoperative recovery time,increase the cure rate,reduce the nasal mucosasymptoms,improve the quality of life and have good safety in the treatment offungal sphenoid sinusitis.It offers more advantages over traditional surgery.
引文
[1] 罗伟,文科,王玲,等.鼻内镜治疗老年慢性鼻窦炎疗效评估[J].成都医学院学报,2017,12(2):198-201.
[2] 程友,薛飞,王天友,等.经鼻蝶入路垂体瘤切除术后并发蝶窦炎的分析及处理[J].山东大学耳鼻喉眼学报,2016,30(1):54-57.
[3] 王媛媛,陈丹,陈璐,等.真菌球型蝶窦炎的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):48-51.
[4] Hong HY,Li YN,Fan YP,et al.Management of sphenoidal sinus lesions by septal-assisted approach:surgical skills and advantages[J].J Huazhong Univ Sci Technol Med Sci,2015,35(4):558-562.
[5] 邹文焘,张家雄,魏明,等.鼻内镜下蝶窦开放术治疗孤立性蝶窦炎疗效分析[J].同济大学学报(医学版),2016,37(5):77-79,84.
[6] 朱新华,刘月辉,汪美群,等.真菌性蝶窦炎的诊断及治疗[J].山东医药,2009,49(42):46-47.
[7] 中华医学会耳鼻咽喉科学分会,中华耳鼻喉科杂志编辑委员会.慢性鼻窦炎鼻息肉临床分型分期及内窥镜鼻窦手术疗效评定标准[J].中华耳鼻咽喉头颈外科杂志,1998,33(3):134.
[8] 刘俊秀,金兴,丁玉静,等.功能性鼻窦内镜手术后不同换药方案对疼痛和Lund-Kennedy评分影响的比较研究[J].中国微创外科杂志,2018,18(3):249-251.
[9] 武鹏,王珍珍,张露,等.DIP内镜评分系统在慢性鼻-鼻窦炎中的应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(2):151-154.
[10] Hsu YW,Ho CY,Yen YS.Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery[J].Laryngoscope,2014,124(1):57-61.
[11] 于焕新,刘钢.经鼻蝶入路鞍区手术后并发蝶窦炎的临床分析[J].中华耳鼻咽喉头颈外科杂志,2015,50(12):1005-1008.
[12] 陈翊民,邱连升,邱金梅.孤立性蝶窦疾病的诊断及其鼻内镜手术治疗[J].临床耳鼻咽喉头颈外科杂志,2014,28(11):760-763.
[13] Lim HS,Yoon YH,Xu J,et al.Isolated sphenoid sinus fungus ball:A retrospective study conducted at a tertiary care referral center in Korea[J].Eur Arch Otorhinolaryngol,2017,274(6):2453-2459.
[14] 黄谦,周兵,崔顺九,等.经鼻内镜治疗蝶窦炎性疾病的手术方式和策略[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1265-1270.
[15] 李军,吴彦桥,李晓明,等.经中鼻甲基板入路蝶窦开放术治疗孤立性蝶窦病变[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1317-1319.
[16] Marcolini TR,Safraider MC,Socher JA,et al.Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus:retrospective study of 46 cases[J].Int Arch Otorhinolaryngol,2015,19(2):124-129.
[2] 程友,薛飞,王天友,等.经鼻蝶入路垂体瘤切除术后并发蝶窦炎的分析及处理[J].山东大学耳鼻喉眼学报,2016,30(1):54-57.
[3] 王媛媛,陈丹,陈璐,等.真菌球型蝶窦炎的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):48-51.
[4] Hong HY,Li YN,Fan YP,et al.Management of sphenoidal sinus lesions by septal-assisted approach:surgical skills and advantages[J].J Huazhong Univ Sci Technol Med Sci,2015,35(4):558-562.
[5] 邹文焘,张家雄,魏明,等.鼻内镜下蝶窦开放术治疗孤立性蝶窦炎疗效分析[J].同济大学学报(医学版),2016,37(5):77-79,84.
[6] 朱新华,刘月辉,汪美群,等.真菌性蝶窦炎的诊断及治疗[J].山东医药,2009,49(42):46-47.
[7] 中华医学会耳鼻咽喉科学分会,中华耳鼻喉科杂志编辑委员会.慢性鼻窦炎鼻息肉临床分型分期及内窥镜鼻窦手术疗效评定标准[J].中华耳鼻咽喉头颈外科杂志,1998,33(3):134.
[8] 刘俊秀,金兴,丁玉静,等.功能性鼻窦内镜手术后不同换药方案对疼痛和Lund-Kennedy评分影响的比较研究[J].中国微创外科杂志,2018,18(3):249-251.
[9] 武鹏,王珍珍,张露,等.DIP内镜评分系统在慢性鼻-鼻窦炎中的应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(2):151-154.
[10] Hsu YW,Ho CY,Yen YS.Reconstructed bone chip detachment is a risk factor for sinusitis after transsphenoidal surgery[J].Laryngoscope,2014,124(1):57-61.
[11] 于焕新,刘钢.经鼻蝶入路鞍区手术后并发蝶窦炎的临床分析[J].中华耳鼻咽喉头颈外科杂志,2015,50(12):1005-1008.
[12] 陈翊民,邱连升,邱金梅.孤立性蝶窦疾病的诊断及其鼻内镜手术治疗[J].临床耳鼻咽喉头颈外科杂志,2014,28(11):760-763.
[13] Lim HS,Yoon YH,Xu J,et al.Isolated sphenoid sinus fungus ball:A retrospective study conducted at a tertiary care referral center in Korea[J].Eur Arch Otorhinolaryngol,2017,274(6):2453-2459.
[14] 黄谦,周兵,崔顺九,等.经鼻内镜治疗蝶窦炎性疾病的手术方式和策略[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1265-1270.
[15] 李军,吴彦桥,李晓明,等.经中鼻甲基板入路蝶窦开放术治疗孤立性蝶窦病变[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1317-1319.
[16] Marcolini TR,Safraider MC,Socher JA,et al.Differential diagnosis and treatment of isolated pathologies of the sphenoid sinus:retrospective study of 46 cases[J].Int Arch Otorhinolaryngol,2015,19(2):124-129.