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1.
目的探讨改良中鼻甲部分切除术在功能性鼻内镜手术中的应用及其对慢性鼻窦炎症状改善和疗效的影响。方法选择中鼻甲垂直部长度≥25mm的慢性鼻窦炎患者60例,随机分为试验组和对照组,各30例。两组患者术前各项观察指标(鼻塞、流涕、头痛、嗅觉VAS评分,鼻内镜检查Lund Kennedy评分、CT Lund Mackey评分)差异无统计学意义(P>0.05)。试验组实施经鼻内镜鼻窦、鼻息肉手术并清除中鼻甲本身病变(泡甲、肥厚、息肉样变等)后,根据CT测量结果,以保留中鼻甲垂直部长度约21mm为参考值,切除多余的中鼻甲垂直部游离缘(即切除长度=CT测量长度-21 mm);对照组完成鼻窦、鼻息肉手术,按传统理念处理中鼻甲病变和变异,需要时切除中鼻甲前下部1/2~2/3。术后随访10~12个月,观察主观症状(鼻塞、流涕、头面痛及嗅觉障碍)、内镜检查Lund Kennedy评分、病情控制及疗效。结果两组术后各种症状VAS评分和内镜Lund Kennedy评分均明显优于术前(P均<0.05);术后试验组的各项观察指标及总疗效均优于对照组,两组鼻塞及头痛的改善、鼻内镜Lund Kennedy评分及疗效差异具有统计学意义(P均<0.05);而流涕、嗅觉改善方面,两组差异无统计学意义(P>0.05);鼻窦炎伴鼻息肉、鼻窦炎伴中鼻甲病变者,试验组的疗效优于对照组(P<0.05)。结论“改良部分切除”主要针对过长的中鼻甲垂直部,必须是在处理中鼻甲病变(泡甲、肥厚、息肉样变等)、保证中鼻道一定宽度后才予切除,有助于术后鼻部症状的改善和减少术腔粘连,提高鼻内镜手术疗效。  相似文献   

2.
目的“减张法”是保持鼻背软骨-鼻中隔软骨复合体完整性、通过解除张力而使其居中对称的方法。本文研究鼻内镜辅助下减张法功能性鼻整形手术的主观和客观疗效。方法对67 例行鼻内镜辅助下减张法功能性鼻整形手术的鼻畸形患者临床资料进行回顾性总结分析。美学效果用电子测量尺测量和患者视觉模拟评分法。鼻阻塞改善程度用鼻阻力计测量和鼻阻塞症状评分法评估。结果34 例I型鼻畸形患者鼻畸形角度电子测量值术后(2.24±1.68)度与术前(11.94±3.17)度比较,差异具有统计学意义(P<0.001)。33 例C型鼻畸形患者鼻畸形角度电子测量值术后(177.20±5.80)度与术前(158.34±9.96)度比较,差异具有统计学意义(P<0.001)。患者主观满意度很好53 例(79.1%),好13 例(19.4%),一般1 例(1.5%)。术后鼻阻塞较术前明显改善,差异具有统计学意义(α=0.95,P<0.001)。术后随访期间所有患者未见并发症。结论鼻内镜下减张法功能性鼻整形手术有效、微创,适用于各种鼻畸形的治疗。  相似文献   

3.
目的采用针对性的量表对慢性鼻-鼻窦炎鼻息肉手术患者的生存质量进行评估,评价初次与再次鼻-鼻窦炎鼻息肉手术患者术后各个测定时点的生存质量状况。方法通过视觉模拟量表(visual analog scale,VAS)、鼻腔鼻窦结局测量20条(sino nasal outcome test 20,SNOT 20)等症状及QOL量表,及鼻内镜检查量化评估评分法(Lund Kennedy 评分法)对30例慢性鼻-鼻窦炎鼻息肉再次手术(revision endoscopic sinus surgery,RESS)患者术前和术后1年进行随访,与40例慢性鼻-鼻窦炎鼻息肉初次手术(primary ESS,PESS)患者术后的评分结果进行比较。结果两组患者均进行鼻内镜手术治疗,1年后VAS总体症状评分,SNOT 20量表的20个条目总分与5大条目的总分等指标均明显好转(P<0.05),术后鼻内镜评分亦明显改善(P<0.05);两组术后的SNOT 20量表条目总分指标横向对比差异无统计学意义(P>0.05);术前影响患者最大的五个问题分别是:需要擤鼻涕、鼻涕倒流、流脓鼻涕、头昏、夜间睡眠质量不好。术后相应问题均有改善,但是相比较初发组鼻-鼻窦炎鼻息肉患者术后,再次手术组鼻-鼻窦炎鼻息肉患者组术后“忧虑”条目的情况有明显差异。结论不论对于初次还是再次手术患者来说,鼻内镜手术是一个可重复进行、能显著缓解症状、提高生存质量的有效治疗方式。经过手术后,需要擤鼻涕、鼻涕倒流、流脓鼻涕的症状有待进一步解决,对于复发再次手术组鼻-鼻窦炎鼻息肉患者出现的对于鼻内镜手术患者“忧虑”的情况,应该进行有针对性的病情解释和心理疏导工作。  相似文献   

4.
目的评估新型MLK鼻内镜评分在慢性鼻-鼻窦炎(CRS)患者手术前后的应用。方法使用前瞻性研究方法对51例CRS患者进行研究,术前进行视觉模拟量表(VAS)、鼻腔鼻窦结局测试22条(SNOT 22)和Lund Mackay CT评分,术中录制鼻腔检查过程。术后3个月召回患者进行鼻内镜随访并录像,同时完成上述评分。所得录像由两位双盲耳鼻咽喉医生分别使用MLK(Modified Lund Kennedy)、LK(Lund Kennedy)及DIP(discharge, inflammation, polyps)评分进行评估,分析3种内镜评分系统的重测信度和评分者信度,比较它们与其他主客观评价的相关性,分析手术效果。结果MLK评分手术前后的重测信度和评分者信度良好(ICC>0.75),均高于LK和DIP评分。同时与其他两种评分均有较高相关性(r>0.79,P<0.01)。术前MLK评分与CT评分有较高相关性(r=0.60,P<0.01)且高于DIP评分。术后MLK评分虽与VAS有较低相关性(r=0.30,P<0.05),但低于LK评分。患者术后各种主客观评分数值较术前显著下降,差异均具有统计学意义(P均<0.01)。结论MLK评分与CT、LK及DIP评分均显著相关,较之有更高的信度,可能更适合临床应用。  相似文献   

5.
慢性鼻-鼻窦炎患者主观症状与客观检查的相关性研究   总被引:1,自引:1,他引:0  
目的:探讨慢性鼻-鼻窦炎(CRS)患者主观症状与客观检查的相关性。方法:采用视觉类比法(VAS)对75例CRS患者的全身不适感以及鼻塞、头昏或头痛、面部疼痛或胀满感、嗅觉障碍、鼻分泌物或后鼻漏5个单个症状进行评分;对鼻窦CT和鼻内镜检查这两项客观检查结果分别采用Lund-Mackay法和Lanza—Kennedy法进行评分;分析上述指标间的相关性。结果:①Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分正相关(r=0.88,P〈0.01);②嗅觉障碍VAS评分与Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分正相关(r值分别为0.57和0.53,均P〈0.01);鼻塞、头昏或头痛、面部疼痛或胀满、鼻分泌物或后鼻漏以及患者全身不适感症状VAS评分与Lund—Mackay CT评分和Lanza—Kennedy鼻内镜检查评分无显著相关性(均P〉0.05);5个单个症状VAS评分之和与Lund-Mackay CT评分正相关(r=0.26,P〈0.05),但与Lanza—Kennedy鼻内镜检查评分不相关(P〉0.05)。结论:CRS患者的主观症状同客观检查间无显著相关性,对CRS患者进行病情评估和治疗方式选择时必须结合主观症状和客观检查。  相似文献   

6.
1007 1520.202003008·论著· 目的初步探讨瘦素(Leptin)在肥胖成人慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)发病中的作用及机制。方法按照体重指数(BMI)随机选取肥胖CRSwNP患者40例,体重正常CRSwNP患者30例,选取同期肥胖鼻中隔偏曲患者30例为对照组。通过酶联免疫吸附法(ELISA)测定3组患者血清中Leptin及其受体水平、EOS相关因子IL 4、IL 13的水平;RT PCR及免疫组织化学方法检测3组患者局部鼻黏膜中Leptin及其受体水平表达;苏木精-伊红染色法观察3组患者组织中EOS细胞浸润程度。另Pearson相关性分析Leptin水平与EOS相关指标及浸润程度的关系。结果与对照组比较,两组CRSwNP患者的血清与局部Leptin及其受体水平表达均升高,血清中EOS相关因子IL 4、IL 13的水平表达均显著升高,差异具有统计学意义(P<0.05);两组CRSwNP患者中肥胖患者的各项检测指标均显著高于体重正常患者(P<0.05),且Leptin及其受体水平与EOS相关指标、EOS浸润程度均呈正相关(P<0.05)。结论Leptin在CRSwNP患者中水平显著升高,且肥胖患者组更高,并与EOS浸润及其促进因子显著相关,提示Leptin可能通过促进EOS增殖浸润参与肥胖成人CRSwNP发病。  相似文献   

7.
目的探讨鼻内镜手术中的中鼻甲处理技巧和意义。方法回顾性分析收治的80例慢性鼻窦炎、鼻息肉患者随机分为观察组32例(39侧)和对照组48例(54侧),观察组强调中鼻甲的处理上尽可能保障中鼻甲空间结构和形态上的相对正常;对照组采用传统的Messerklinger术或wigand术式。术后6个月对比两组中鼻甲的稳定性,中鼻道狭窄或粘连的发生情况以及按lund—Kennedy内镜黏膜形态评分系统进行评价。结果两组患者的术前lund—Kennedy内镜黏膜形态评分差异无统计学意义(t=1.659,P〉0.05),观察组术后6个月Lund—Kennedy评分为(1.89±1.31)分,低于对照组(2.48±1.42)分,两组比较差异具有统计学意义(t=8.1,P〈0.01)。术后观察组中鼻甲结构良好稳定,中鼻甲轻度外移、中鼻道狭窄、中鼻甲与鼻腔外侧壁粘连3种情况的发生率分别为83.2%、4.1%、6.7%,对照组的发生率分别为44.9%、21.6%、10.3%,两组比较差异具有统计学意义(r=10.77,P〈0.01)。结论保障中鼻甲空间结构和形态上的相对正常有助于提高鼻内镜手术疗效,减少术后不良并发症。  相似文献   

8.
目的探讨部分颞肌瓣转位术对晚期不全面瘫患者的临床应用疗效。方法收集2015年1月—2017年1月接受部分颞肌瓣转位术的患者15例,其中男3例,女12例;年龄26~53岁,平均(32.3±8.6)岁。均为听神经瘤术后并发晚期不完全面瘫患者。依据Terzis量表对患者手术前后口角歪斜程度进行评定,并对患者并发症进行分析。结果所有患者术后随访12~24个月。15例患者术后的静态评分(1.00±0.00)分明显低于术前的静态评分(2.73±0.46)分,差异具有统计学意义(P<0.001);术后的动态评分(3.93±1.03)分明显高于术前的动态评分(2.00±0.00)分,差异具有统计学意义(P<0.001)。此外,在所有患者中均未观察到颞部凹陷,少部分患者颧弓处出现轻微臃肿。结论部分颞肌瓣转位术可以作为听神经瘤术后并发晚期不完全面瘫的一种有效治疗手段。  相似文献   

9.
目的分析鼻内镜不同下鼻甲成形术的疗效。方法将138例患者随机分为两组,所有患者均同时接受双侧下鼻甲的同一术式处理。A组72例,行双侧下鼻甲骨黏骨膜下骨质部分切除术;B组66例,行双侧下鼻甲骨折外移术。比较两组患者术后1、6及12个月的恢复以及疗效情况。结果两组患者术后12个月疗效具有统计学意义(P<0.01);两组鼻阻塞视觉模拟评分术后6、12个月比较,差异具有统计学意义(P<0.05),鼻阻力检测术后12个月比较差异具有统计学意义(P<0.05)。A组远期疗效优于B组。结论两种术式都保留了下鼻甲的黏膜以及舒缩功能的血窦组织,在进行有效减容的同时,保留下鼻甲正常的功能, 但从远期效果来看,下鼻甲前端黏骨膜下入路骨部分切除术的疗效明显好于下鼻甲骨折外移术,对于下鼻甲黏膜下组织增生或(和)下鼻甲骨质增生所引起的鼻阻塞均有良好的效果,值得适当放宽手术适应证。  相似文献   

10.
目的:探讨变态反应性因素对慢性鼻-鼻窦炎(CRS)内镜鼻窦手术(ESS)疗效的影响。方法:术前对115例患者进行变态反应性因素血清相关指标测定:血清总IgE浓度、血清特异性变应原IgE半定量检测、血清ECP浓度;进行症状与生活质量调查:VAS、SNOT-20、SF-36问卷调查;并进行LundMackayCT系统评分及海口标准分型分期。实际随访ESS术后1年以上患者74例,进行鼻内镜检查,根据术后疗效评定海口标准、Lund—Kennedy内镜评分系统进行评估;并进行VAS、SNOT-20、SF-36问卷调查。结果:血清总IgE浓度增高者术后VAS评分改善低于不增高者(P〈0.05)。术前海口分型Ⅱ、Ⅲ型患者中血清总IgE浓度增高者手术有效率、术后LundKennedy内镜评分较不增高者差(P〈0.05)。3种及3种以上血清特异性变应原IgE阳性患者的手术有效率、术后Lund—Kennedy内镜评分较3种以下阳性患者差(P〈0.05)。血清特异性变应原IgE强阳性患者的手术有效率、术后Lund—Kennedy内镜评分、术后VAS评分、术后SNOT-20评分较无强阳性患者差(P〈0.05)。ESS术后有效患者的血清ECP浓度显著低于无效患者(P〈0.05)。血清ECP浓度与LundKennedy内镜评分成正相关(r=0.49,P〈0.05)。术前海口分型Ⅱ、Ⅲ型患者中,血清ECP浓度增高的患者手术有效率、术后Lund—Kennedy内镜评分、术后VAS评分、术后VAS评分改善较血清ECP浓度不增高者差(P〈0.05)。结论:变态反应性因素对CRS患者主客观疗效有-定的负面影响作用。血清总IgE浓度增高与血清ECP浓度增高在伴鼻息肉的患者中提示手术疗效不佳。本研究为CRS的免疫治疗提供了-定依据。  相似文献   

11.

Objectives

To explore the effect of intranasal administration of recombinant human basic fibroblast growth factor (rh-bFGF) on postoperative chronic rhinosinusitis with nasal polyps (CRSwNP) patients.

Design

A prospective, randomised, controlled, single-blinded trial.

Setting and Participants

Seventy-five hospitalised patients who met the criteria of primary bilateral CRSwNP were enrolled from March 2020 to January 2021.

Main outcome measures

Visual analogue scale, 22-item Sino-Nasal Outcome Test, Lund–Kennedy (L-K) system and scanning electron microscopy and quantitative real-time polymerase chain reaction.

Results

Seventy-five patients with CRSwNP were randomly assigned to three groups, and 72 patients completed the 1-month medication regimen and 1-year follow-up. Rh-bFGF nasal-spray and drop application reduced general nasal VAS scores within 2 weeks after endoscopic sinus surgery (ESS) compared to the control group. In contrast, only rh-bFGF nasal-drops reduced SNOT-22 scores at 2 weeks and 1 year compared with the control group. A significant reduction in the endoscopic L-K score was observed in the rh-bFGF nasal-spray and drop group compared with the control group. This is primarily because rh-bFGF promotes cilia growth in the nasal mucosal epithelium after the operation, as illustrated by scanning electron microscopy and expression of CP110, Tap73 and Foxj1 mRNA. For eosinophilic CRSwNP, the general VAS score of rh-bFGF nasal-drops was more obviously reduced compared to the control group after ESS. A similar trend was observed for L-K score.

Conclusions

Rh-bFGF nasal-drops and sprays can quickly and effectively relieve postoperative symptoms and improve long-term prognosis of patients with CRSwNP. Moreover, rh-bFGF nasal-drops is also an effective method for postoperative patients with eosinophilic CRSwNP.  相似文献   

12.
This study was carried out to compare the outcomes of endoscopic sinus surgery in patients with chronic sinusitis without nasal polyps (CRS) and those with nasal polyps (NP). We also sought to determine the correlation between preoperative computed tomography (CT) findings and postoperative endoscopy and symptom score improvement. Data were collected from two groups of patients diagnosed as CRS with and without nasal polyps that underwent functional endoscopic sinus surgery with a 1-year postoperative follow up. Preoperative symptoms, CT scores, and endoscopic scores were recorded. Postoperative symptom and endoscopic scores were recorded at 1, 6, and 12 months. Assessment of symptoms was performed subjectively using visual analogue scoring (VAS). CT scan findings were scored using the Lund–Mackay system. Endoscopic examination findings were scored according to the staging system proposed by Lanza and Kennedy. The correlations between the CT score, endoscopic scores and VAS scores were calculated. There was a statistically significant correlation between the preoperative CT, symptom, and endoscopic scores. Postoperative symptom and endoscopic scores also showed a significant correlation. Total CT scores of the CRS group were significantly lower than the scores of the NP group. Also preoperative endoscopy and symptom scores were statistically lower in CRS group compared to NP group. Endoscopy total scores and symptom total scores of both groups were significantly decreased at postoperative 12th month. Statistically significant difference was observed between the preoperative and postoperative symptom and endoscopy scores. The patients with polyps had higher symptom scores and worse objective findings compared to the patients with CRS. In all patients groups, objective and subjective scores seemed to correlate well preoperatively and postoperatively. These data suggest that endoscopic sinus surgery provides significant symptomatic relief and endoscopic healing in patients with CRS and NP.  相似文献   

13.
Conclusion The recurrence rates of chronic rhinosinusitis (CRS) were higher in the aspirin nasal provocation test (ANPT)-positive group, regardless of the presence of nasal polyps. Thus, a careful endoscopic examination is required during follow-up in ANPT-positive patients with CRS. Objectives The aim of this study was to evaluate the clinical features and prognosis after surgical treatment in patients with CRS and aspirin hypersensitivity. Methods In a prospective study, 100 patients were analyzed with CRS who underwent endoscopic sinus surgery at the hospital from October 2012 to March 2013. This study measured changes in nasal volume and symptoms before and after the ANPT and examined patient’s asthma history, allergy, Lund–Mackay score (LMS), total immunoglobulin E, percentage of peripheral eosinophils, and objectively measured relapse at 6 months. Results Patients wwith CRS and nasal polyps (CRSwNP) were more likely to have a positive ANPT test result compared to those without nasal polyps (CRSsNP) (21.4% vs 5.5%). The ANPT-positive group had a higher LMS and required more revision endoscopic sinus surgery than those in the ANPT-negative group. The results were that similar results were observed in CRSwNP and CRSsNP.  相似文献   

14.
目的 分析慢性鼻-鼻窦炎伴鼻息肉( chronic rhinosinusitis with nasal polyps,CRSwNP)患者的血清维生素D水平与鼻内镜临床疗效的相关性。方法 40例CRSwNP患者入院行鼻内镜手术,随机分为试验组和对照组。试验组每日口服维生素D(800 IU)+布地奈德喷鼻剂喷鼻,对照组只给予布地奈德喷鼻剂喷鼻,持续8周。实验前后分别测量血清25羟基维生素D水平,记录Lund-Kennedy评分、鼻腔鼻窦结局测试-20条、视觉模拟量表评分。结果  筛查60例试验对象血清维生素D水平,其中80%患者伴有维生素D不足(<50 nmol/L);试验后两组间VD水平的差异有统计学意义(P =0.001);治疗后,试验组与对照组间鼻塞、脓涕、头面部疼痛、视觉模拟量表评分总分等评分的差异均具有统计学意义;两组间嗅觉障碍症状评分的差异无统计学意义。治疗后试验组与对照组间鼻腔鼻窦结局测试-20条评分、Lund-Kennedy评分的差异均具有统计学意义。结论 在CRSwNP患者中血清维生素D水平普遍较低,临床上对患者予以补充维生素D后可显著提高患者血清中25羟基维生素D的水平,与改善CRSwNP患者的临床症状及提高临床综合治疗效果呈正相关。  相似文献   

15.
To compare the long-term effects of different postoperative treatment regimes after functional endoscopic sinus surgery (FESS), we performed a randomized controlled trial. Inclusion criteria were chronic rhinosinusitis with (CRSwNP) or without (CRS-NP) bilateral nasal polyps and acute recurrent rhinosinusitis (ARR). All patients (male/female = 56/65; mean age = 42.8 years; age range 18–73 years) underwent sinus surgery for the first time. The patients included in 2004 were allocated to a packing in middle meatus for 5 days or saline irrigation only postoperatively. The patients included in 2005 were randomized to debridement 6 and 12 days postoperatively or saline irrigation. At baseline and 56 weeks (32–77) postoperatively, the patients reported symptoms such as nasal congestion, facial pain, headache, and change in sense of smell, nasal discharge, sneezing and reduced general condition on visual analogue scale (VAS). We used ANCOVA to compare symptom improvement. Among patients with CRSwNP, nasal congestion and sneezing improved, respectively, 20 mm (P value = 0.041) and 18 mm (P value = 0.011) more in the debridement group than in the saline irrigation group. Although a packing had positive effects on the symptom improvement they were not significant. Patients with CRSwNP, who had undergone debridement after FESS, had significantly larger symptom improvement 56 weeks after surgery than patients who had only done saline irrigation.  相似文献   

16.
OBJECTIVE: To determine whether preoperative computed tomography (CT) stage predicts degree of symptom improvement after endoscopic sinus surgery (ESS). METHODS: A series of adult patients undergoing ESS was prospectively evaluated with CT and the rhinosinusitis symptom inventory (RSI) preoperatively and at a minimum of 12 months postoperatively. Symptom domains (nasal, facial, oropharyngeal, systemic, and total) were computed and both absolute change and percentage change in symptom domain scores before and after ESS were correlated with the preoperative CT scan stage according to three staging systems: Lund-MacKay, Kennedy, and Harvard. RESULTS: One-hundred sixty-one patients (mean age, 40.2 years) completed the study with a mean follow-up of 19.4 months. Overall, statistically significant decreases in RSI symptom domains were noted for the nasal (net change -30.1 [range -100 to +100]), facial (-26.1), oropharyngeal (-13.4), systemic (-17.0), and total (-20.8) symptom scores (all P < .001). For the absolute change in total symptom score, no statistically significant correlation with CT stage was demonstrated for any of the staging systems (Lund: Spearman rho = -0.004, P = .962; Kennedy: rho = -0.008, P = .918; Harvard: rho = -0.011, P= .891). Similarly, no significant correlation with CT stage was demonstrated with the other symptom domains. Additionally, no significant correlation was identified between preoperative CT stage and percentage change in symptom domain scores. CONCLUSIONS: Although CT scan is widely accepted as an accurate diagnostic tool for chronic rhinosinusitis, CT scan stage alone does not significantly predict symptom outcomes after chronic rhinosinusitis, regardless of staging system utilized.  相似文献   

17.
目的 探讨老年慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with or without nasal polyps,CRSwNP)患者鼻内镜术后复发的影响因素.方法 行鼻内镜治疗的老年CRSwNP患者126例,根据是否复发分为复发组(52例)和未复发组(74例),对可能影响其术后复发的相关因素...  相似文献   

18.
目的:通过对比观察慢性鼻-鼻窦炎鼻内镜术后两种随访结果,探讨鼻内镜随访对慢性鼻-鼻窦炎总体疗效的影响。方法:同期接受鼻内镜手术的各类慢性鼻-鼻窦炎123例,依据随访完成情况的不同,分为A、B两组,对比分析其转归情况。结果:A组56例,6个月痊愈31例、好转24例、无效1例;12个月痊愈44例、好转12例、无效0例。B组67例,6个月痊愈14例、好转43例、无效10例;12个月痊愈24例、好转42例、无效1例。两组病情转归情况差异有统计学意义(χ2=18.387 P<0.01)。结论:鼻内镜术后随访情况的不同可以直接影响到综合治疗的合理实施及慢性鼻-鼻窦炎的总体疗效。  相似文献   

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