Symptom-Based Surgical Outcome for Chronic Rhinosinusitis

慢性鼻竇炎患者之症狀導向手術預後分析

巫清隆(Ching-Lung Wu) ； 傅嘉祥(Chia-Hsiang Fu) ； 黃啟哲(Chi-Che Huang) ； 陳益瑋(Yi-Wei Chen) ； 張伯宏(Po-Hong Chang) ； 李達人(Ta-Jen Lee)

《台灣耳鼻喉頭頸外科雜誌》 51卷1期 (2016/03) Pp. 47-56

https://doi.org/10.6286/2015.51.1.47

摘要

背景：影響慢性鼻竇炎患者之手術預後因子者眾，對患者而言，在術前評估手術於主觀症狀上能否帶來最大進步是相當重要的，本研究經由分析術前症狀與可能的相關因子，期能建立預測手術預後之模型。方法：此為一前瞻性世代研究，共收案107名無鼻息肉之慢性鼻竇炎患者，紀錄其基本資料及客觀臨床發現後安排鼻竇內視鏡手術治療，並於手術前1天及手術後第12個月各完成一份將症狀分為四大類別之「10公分視覺類量表」，患者根據電腦斷層之Lund-Mackay scores分成三組進行研究分析。結果：除眼部症狀外，術後不論組別於各類別之症狀分數上皆有顯著進步。電腦斷層之分數僅跟術前鼻部症狀有關，與術後各類症狀之進步並無明顯相關。鼻過敏僅發現於疾病較嚴重之組別明顯較多且術前眼部症狀較嚴重( p = 0.042)。結論：主觀症狀之手術預後跟手術前主要症狀之類別有相關，而與電腦斷層分級無關；除眼部症狀外，各類別不論組別於術後皆能有顯著進步。另鼻過敏於術前疾病嚴重度較具重要性而與手術預後較無明顯相關。

關鍵字

慢性鼻竇炎 ； 內視鏡鼻竇手術 ； 治療 ； 預後 ； 生活品質

並列摘要

BACKGROUND: Surgical outcome for chronic rhinosinusitis (CRS) is usually multifactorial, and assessment of the possibility of greatest postoperative subjective improvements before surgery is the issue of most concern to patients. We would like to establish a model to predict surgical outcome in advance through evaluation of preoperative symptoms and potential medical variants. METHODS: In a prospective cohort, one-hundred and seven patients with CRS without nasal polyps receiving endoscopic sinus surgery were enrolled. Baseline characteristics and objective clinical findings were recorded. Patients were categorized into three groups according to the Lund-Mackay scores of computed tomography (CT). By use of a 10-cm visual analog scale containing four domains, symptom scores were obtained the day before the surgery and 12 months postoperatively. RESULTS: Significant improvements of symptom scores after surgery were found in all groups for all symptoms but ophthalmic domain. The CT scoring was only correlated to preoperative rhinologic symptoms and had no striking connection with symptom improvement. The nasal allergy was found to be more prevalent in advanced-diseased group and responsible for worse visual status ( p = 0.042) preoperatively. CONCLUSIONS: Subjective surgical outcome was correlated with the type of preoperative main symptoms but not with radiographic stages. Symptoms improved significantly after surgery in all radiographic stages in almost all aspects except visual complaints. The nasal allergy may have more importance in disease severity rather than surgical outcomes.

並列關鍵字

chronic rhinosinusitis ； endoscopic sinus surgery ； therapy ； outcome ； quality of life