鼻竇內視鏡手術出血量相關因子的分析及探討

Evaluation of the Factors Associated with Bleeding During Functional Endoscopic Sinus Surgery

周同威(Tung-Wei Chou) ； 李國森(Kuo-Sheng Lee) ； 林鴻清(Hung-Ching Lin) ； 蔡循典(Hsun-Tien Tsai) ； 呂宜興(Yi-Shing Leu) ； 李振川(Jehn-Chuan Lee) ； 王瀛標(Ying-Piao Wang)

《台灣耳鼻喉頭頸外科雜誌》 50卷2期 (2015/06) Pp. 99-104

https://doi.org/10.6286/2015.50.2.99

摘要

背景：慢性鼻竇炎病人接受鼻竇內視鏡手術時，其手術出血量可能因鼻竇炎嚴重程度不同、麻醉方式、微創刀使用與否而有所差異，本研究即針對此問題，統計本院鼻竇內視鏡手術出血量，並對於其相關因子進行分析及探討。方法：回溯性研究，收集自2006年1月到2012年1月共1,285名在台北馬偕醫院接受鼻竇內視鏡手術的病患，針對性別、年齡、高血壓病史、影像上鼻竇炎混濁範圍、雙側鼻竇炎與否、鼻息肉嚴重程度、再次手術、全靜脈麻醉（TIVA）、微創刀使用及手術時間等因子進行統計分析。先以單變項分析各因子與手術出血量之相關性，再進一步採用多變項線性迴歸分析各因子與出血量多寡的統計意義。結果：多變項分析結果發現男性、鼻息肉嚴重程度、影像上鼻竇炎混濁範圍、雙側鼻竇炎、手術時間與手術出血量增加呈相關性（p ＜ 0.05）；再次手術與手術出血量減少呈相關性（p ＜ 0.05）；而高血壓、全靜脈麻醉（TIVA）、年齡及使用微創刀等因子和手術出血量並無統計上之意義。結論：手術出血量增加的因子，統計上有意義為男性、鼻息肉嚴重程度、影像上鼻竇炎混濁範圍、雙側鼻竇炎、手術時間；而再次手術是出血量減少的因子。其中最重要因子為影像上鼻竇炎混濁範圍。

關鍵字

鼻竇炎 ； 手術出血量 ； 全靜脈麻醉 ； 微創刀

並列摘要

BACKGROUND: For patients receiving endoscopic sinus surgery for chronic rhinosinusitis, the amount of bleeding during surgery varies with the severity of sinusitis, the method of anesthesia, and the use of a microdebrider. The present study aims at summarizing the amount of bleeding from functional endoscopic sinus surgery at this hospital over the past few years, as well as analyzing and gaining insight into factors associated with it. METHOD: This is a retrospective study. We analyzed a total of 1285 patients who received endoscopic sinus surgery at Taipei Mackay Memorial Hospital from January 2006 to January 2012. We evaluated various factors, including gender, age, history of hypertension, the extent of sinus opacification in imaging studies, bilaterality of sinusitis, the severity of nasal polyps, revised operation, total intravenous anesthesia (TIVA), the use of a microdebrider, duration of operation, etc. A univariate analysis of the correlation between the factors and the amount of bleeding was performed, followed by a multivariate linear regression analysis to determine the statistical significance of the correlation. RESULTS: The univariate analysis followed by the multivariate analysis demonstrated that the male gender, more severe nasal polyps, a greater extent of sinusitis in imaging studies, bilateral sinusitis and a longer duration of operation were associated with increased amount of bleeding (p ＜ 0.05); that revised operations were associated with decreased amount of bleeding (p ＜ 0.05); and that there was no statistically significant correlation between hypertension, total intravenous anesthesia (TIVA), age, use of a microdebrider, other factors and the amount of bleeding. CONCLUSIONS: The statistically significant factors associated with increased amount of bleeding include the male gender, nasal polyps, the extent of sinusitis in imaging studies, bilateral sinusitis, and the duration of operation, while revised operations are associated with decreased amount of bleeding. Among them, the extent of sinusitis in imaging studies is the most important factor.

並列關鍵字

chronic rhinosinusitis ； surgical bleeding ； total intravenous anesthesia ； microdebrider