摘要
目的观察功能性内镜鼻窦手术(FESS)治疗鼻-鼻窦炎的效果,并分析外周血嗜酸性粒细胞(EOS)数目对手术效果的影响。方法回顾性分析2017年1月至2019年1月阜阳市人民医院收治的90例鼻-鼻窦炎患者的病例资料,根据治疗方法的不同将其分为两组:对照组(n=34)和观察组(n=56)。对照组患者采用抗菌药物、生理性海盐水和鼻喷激素等常规综合治疗,观察组患者采用常规综合治疗联合FESS手术治疗。比较两组患者的治疗效果,采用鼻-鼻窦炎疾病特异性生活质量量表(SNOT-20)和视觉模拟疼痛量表(VAS)评价主观症状改善情况,采用CT Lund-Mackay评分和鼻内镜Lund-Kennedy评分来客观评价鼻窦炎严重程度。分析外周血EOS数目对手术效果的影响。分析EOS数目与主客观症状评分的相关性。结果①术后6个月,观察组总有效率(85.71%)明显高于对照组(64.71%),差异具有统计学意义(P<0.05);术后6个月,观察组患者的鼻-鼻窦炎疾病特异性生活质量量表评分(SNOT-20)、疼痛视觉模拟量表评分(VAS)、鼻窦炎患者CT评分(Lund-Mackay)、鼻窦炎患者鼻内镜评分(Lund-Kennedy)分别为(10.47±4.09)分、(9.84±3.21)分、(11.35±3.09)分、(7.32±2.01)分,均明显低于对照组[(18.11±5.43)分、(15.21±4.59)分、(14.33±2.13)分、(10.53±4.25)分],差异具有统计学意义(P<0.05)。②观察组患者术前EOS数目为(63.4±30.5)×10^6/L,其中EOS阳性23例(41.07%),阴性33例(58.93%);阴性患者手术总有效率(93.94%)明显高于阳性患者(73.91%),差异具有统计学意义(P<0.05)。EOS阴性患者术前术后SNOT-20评分、VAS评分、Lund-Mackay评分、Lund-Kennedy评分的差值分别为(27.63±5.83)分、(24.01±4.03)分、(9.43±2.04)分、(10.52±2.17)分,均明显大于EOS阳性患者术前术后各评分的差值[(24.34±5.11)分、(22.09±5.67)分、(7.55±1.81)分、(9.15±1.85)分],差异具有统计学意义(P<0.05)。③相关性分析显示,外周血EOS数目与SNOT-20评分、VAS评分、Lund-Mackay评分、Lund-Kennedy评分均呈正相关(r=0.5579,0.507,0.631,0.643,P<0.05)。结论常规综合治疗联合FESS手术治疗鼻-鼻窦炎效果明显优于单纯常规综合治疗,但手术效果受到外周血EOS影响,EOS阴性患者的手术效果更佳,主客观症状改善更加明显。
Objective To observe the effect of functional endoscopic sinus surgery(FESS)in the treatment of rhinosinusitis,and to analyze its relationship with the number of EOS in peripheral blood.Methods The clinical data of 90 patients with rhinosinusitis who were treated in Fuyang people's Hospital from January 2017 to January 2019 were analyzed retrospectively.According to different treatment methods,the patients were divided into two groups:control group(n=34)and observation group(n=56).The control group was treated with antibiotics,physiological sea salt water and nasal spray hormone,while the observation group was treated with FESS on the basis of the control group.The improvement of subjective symptoms was evaluated by Sino-Nasal Outcome Test-20(SNOT-20)and visual analogue scale(VAS),and the severity of nasosinusitis was evaluated by CT Lund-Mackay score and endoscopic Lund-Kennedy score.The influence of EOS number in peripheral blood on the operation effect was analyzed.The correlation between EOS number and subjective and objective symptom score was analyzed.Results Six months after operation,the total effective rate of the observation group was significantly higher than that of the control group(85.71%vs.64.71%),the difference was statistically significant(P<0.05).Six months after the operation,the SNOT-20,VAS,Lund-Mackay and Lund-Kennedy of patients in the observation group were(10.47±4.09),(9.84±3.21),(11.35±3.09)and(7.32±2.01)respectively,which were significantly lower than those in the control group[(18.11±5.43),(15.21±4.59),(14.33±2.13),(10.53±4.25)],the difference was statistically significant(P<0.05).The number of EOS in the observation group before operation was(63.4±30.5)×10^6/L,of which 23(41.07%)were EOS positive and 33(58.93%)were negative.The total effective rate of negative patients was significantly higher than that of positive patients(93.94%vs.73.91%),(P<0.05).The difference of preoperatively and postoperatively SNOT-20,VAS,Lund Mackay and Lund Kennedy in patients with negative EOS were(27.63±5.83),(24.01±4.03),(9.43±2.04),(10.52±2.17)respectively,which were significantly greater than those of patients with positive EOS[(24.34±5.11),(22.09±5.67),(7.55±1.81),(9.15±1.85)],the difference was statistically significant(P<0.05).Correlation analysis showed that the number of EOS in peripheral blood was positively correlated with the score of SNOT-20,VAS,Lund-Mackay and Lund-Kennedy(r=0.5579,0.507,0.631,0.643,P<0.05).Conclusion FESS is better than conventional comprehensive treatment in the treatment of nasosinusitis,but the effect of operation is affected by EOS in peripheral blood.The effect of negative patients is better,and the improvement of subjective and objective symptoms is better.
作者
胡璐璐
闫智强
张新海
HU Lu-lu;YAN Zhi-qiang;ZHANG Xin-hai(Department of Otolaryngology Head and Neck Surgery,Fuyang People's Hospital,Fuyang Anhui 236000,China)
出处
《临床和实验医学杂志》
2020年第18期2001-2004,共4页
Journal of Clinical and Experimental Medicine
基金
安徽省自然科学基金项目(编号:81071296)。
