功能性內視鏡鼻竇手術後鼻腔容積的改變

Nasal Volume Changes after Functional Endoscopic Sinus Surgery

涂智文(Chih-Wen Twu) ； 江榮山(Rong-San Jiang) ； 張凱明(Kai-Ming Chang)

《台灣耳鼻喉頭頸外科雜誌》 38卷5期 (2003/10) Pp. 216-221

https://doi.org/10.6286/2003.38.5.216

摘要

背景：鼻塞是鼻竇炎患者常有的主訴，而慢性鼻竇炎患者在接受功能性內視鏡鼻竇手術後，其鼻塞改善的程度因人而異，臨床上不易客觀地評估，本實驗嘗試用聲反射鼻量計來評估慢性鼻竇炎患者接受鼻竇內視鏡手術後鼻腔最小截面積及容積的變化。
方法：本研究共收集自2000年2月至2003年3月間，33名有鼻塞症狀且接受雙側功能性內視鏡鼻竇手術的慢性鼻竇炎患者，在手術前1天及手術6 個月之後，以聲反射鼻量計分別記錄噴灑鼻去充血噴劑前後鼻腔第二狹窄處的截面積(MCA2)，從鼻接管末端到3 cm處的鼻腔容積(V03)，從鼻接管末端2 cm處到5 cm處的鼻腔容積(V25)，從鼻接管末端4 cm處到7 cm處的鼻腔容積(V47)，比較其手術前後的變化。門診追蹤時並給予問卷評估其主觀性的鼻塞改善程度。任何病患若同時接受鼻中隔或下鼻甲手術則排除在本研究之外。
結果：33名慢性鼻竇炎患者中有男性19名，女性14名，年齡從13歲到80歲，平均47.7歲，共接受66側功能性鼻竇內視鏡手術，其中有28 側為單純鼻竇炎，另外38側則合併有鼻息肉產生。手術後追蹤時間從6個月到28個月，平均追蹤期間為15.5個月。主觀性的鼻塞改善程度，有22.7%完全改善無鼻塞；有47.0%大大改善，偶有鼻塞；有13.6%稍許改善；有16.7%沒有改善。以paired t-test分析可見在手術後，MCA2只在合併鼻息肉的慢性鼻竇炎患者於噴灑鼻去充血劑後有顯著增加。無鼻息肉的慢性鼻竇炎患者手術後不論有無噴灑鼻去充血劑的情形，V25及V47皆比手術前有顯著增加，但V03則無明顯差異。合併鼻息肉的慢性鼻竇炎患者手術後不論有無噴灑鼻去充血劑，V25及V47皆比手術前有顯著增加，但V03則只有在噴灑鼻去充血劑後有顯著增加。
結論：本研究顯示慢性鼻竇炎患者接受功能性內視鏡鼻竇手術後，主觀的鼻塞感大部分可獲得改善，且鼻腔中段及後段容積會有顯著增加，但卻對鼻腔前段構造影響較少。

關鍵字

聲反射鼻量計 ； 慢性鼻竇炎 ； 功能性內視鏡鼻竇手術 ； 最小橫截面 ； 鼻腔容積

並列摘要

BACKGROUND: Patients with chronic paranasal sinusitis (CPS) often complain of nasal stuffiness. To date, objective assessment of the effectiveness of functional endoscopic sinus surgery (FESS) on this complaint has not been standardized. This study employed acoustic rhinometry to analyze minimal cross-sectional area and nasal volume changes after FESS.
METHODS: Thirty-three CPS patients undergoing bilateral FESS were enrolled. Acoustic rhinometry was performed one day before and at least six months after surgery. Measurements included minimal cross sectional area in the nasal cavities (MCA2), nasal volume from the tip of the nozzle to 3 cm away from the nozzle (V03), nasal volume from 2 to 5 cm away from the nozzle (V25), and nasal volume from 4 to 7 cm away from the nozzle (V47). These measurements were performed before and after nasal decongestion. Questionnaires about subjective changes in nasal obstruction were also administered. Patients undergoing additional adjuvant procedures were
excluded.
RESULT: The patients were divided into two groups according to the presence or absence of nasal polyposis. For patients without nasal polyposis, significant increases in V25 and V47 after FESS were noted before and after nasal decongestion, but not in V03. For patients with nasal polyposis, V25 and V47 significantly increased after FESS, but V03 increased significantly only after nasal decongestion. Questionnaires about subjective changes in nasal stuffiness found that 22.7% experienced complete remission, 47.0% partial remiss ion, 13.6% only slight remission and 16.7% experienced no symptomatic improvement.
CONCLUSIONS: The study showed that most patient experienced subjective improvement in nasal stuffiness after FESS. The V25 and V47 nasal volumes increased significantly after FESS.

並列關鍵字

acoustic rhinometry ； chronic paranasal sinusitis ； functional endoscopic sinus surgery ； minimal cross sectional area ； nasal volume