儿童慢性鼻窦炎药物与手术治疗疗效对比

目的 比较药物和功能性鼻内镜鼻窦手术治疗儿童慢性鼻窦炎的疗效.方法 我科收治的慢性鼻窦炎患者90例,均经3个月以上规范保守治疗症状无减轻.分为3组:单纯慢性鼻窦炎34例(A组)、慢性鼻窦炎合并腺样体肥大34例(B组)和慢性鼻窦炎合并鼻息肉22例(C组).A组18例、B组18例、C组4例继续进行药物治疗;A组16例、B组16例、C组18例行功能性鼻内镜鼻窦手术.随访6个月,评估疗效.结果 继续行药物治疗的39例中,有效13例、无效26例,有效率33.33%;手术治疗的51例中,有效44例、无效7例,有效率86.27%.药物与手术治疗的有效率在A组差异无统计学意义(P=0.065),在B组和C组差异均有统计学意义(P均<0.05).所有手术病例在术后均未出现眶和颅等并发症.结论 对于合并腺样体肥大和鼻息肉的儿童慢性鼻窦炎,功能性鼻内镜鼻窦手术治疗效果较好;但对于单纯性慢性鼻窦炎,宜采用药物保守治疗.

Comparison of therapeutic effect of medicine and surgery on pediatric chronic sinusitis

Objective To compare the therapeutic effect of medicine and functional endoscopic sinus surgery （FESS） on pediatric chronic sinusitis. Methods Ninety cases with chronic sinusitis who had failed to respond to medical therapy were divided into 3 groups： group A with chronic sinusitis alone, group B with chronic sinusitis combined with adenoid hypertrophy and group C with chronic sinusitis combined with nasal polyps. Eighteen cases in group A, 18 in group B and 4 in group C were treated with medicine; while 16 cases in group A, 16 in group B and 18 in group C were treated with FESS. Outcomes were assessed at least 6 months postoperatively. Results Patients under FESS got improved in 44 cases and invalid in 7 cases, with the general effective rate being 86.27%. Patients under medical therapy got improved in 13 cases and invalid in 26 cases, with the general effective rate being 33.33%. The therapeutic effect between medicine and surgery was not significantly different in group A （ P = 0. 065 ）, and was obviously different in group B and group C （P 〈 0. 05 ）. There was no complication in all groups. Conclusions Pediatric chronic sinusitis with adenoid hypertrophy or nasal polyps should be treated by FESS, which bad a higher success rate. While chronic sinusitis alone should be treated with medicine.