少年儿童鼻内镜手术远期疗效及相关临床因素探讨

目的 探讨接受内镜鼻窦手术少年儿童鼻窦炎患者的疗效及影响疗效的相关因素。方法 接受内镜鼻窦手术的少年儿童鼻窦炎性疾病患者268例(432侧)，年龄3～17岁，平均14．3岁，男186例，女82例。全身麻醉176例，局部麻醉12例。188例(305侧)术后随访超过1年，占病例总数70．1％。随访在鼻内镜下进行，以黏膜表面麻醉为主。术后综合治疗包括：清理术腔、鼻腔冲洗、抗生素、激素、黏液促排剂及免疫调节剂等。结果 慢性鼻窦炎89例(147侧)，慢性鼻窦炎、鼻息肉86例(142侧)，鼻窦黏液囊肿13例(16侧)。治愈132例(70．2％)，好转43例(22．9％)，无效13例(6．9％)。术后头痛缓解率93．1％(175／188)，其次为鼻堵为85．1％(160／188)，脓涕60．1％(113／188)。11例手术前后无变化，2例症状较术前加重。术前56例失嗅者，术后34例(60．7％)改善或恢复。术后症状完全缓解123／188例(65．4％)，部分缓解52／188例(27．7％)，总有效率为93．1％。8例(4．3％)接受再手术。结论 少儿慢性鼻窦炎、鼻息肉内镜鼻窦手术远期疗效满意，应重视术中黏膜合理取舍和积极处理中鼻甲；随访质量为影响手术远期疗效重要因素。患者就医和手术前是否进行了规范药物治疗为手术适应证重要前提。

Long-term outcomes and analysis of its relative factors of nasal endoscopic sinus surgery in children]

OBJECTIVE: To evaluate the results of endoscopic sinus surgery (ESS) in children with chronic sinusitis. The long-term outcomes and the relative factors were analyzed retrospectively. MATERIALS AND METHODS: A total of 268 children (432 sides), 186 males and 82 females, aged 3 to 17 years (average, 14.3) were included in this study (underwent ESS). The postoperative follow-up time of 188 cases (305 sides, 70.1%) was over one year. The management during follow-up was adopted under nasal endoscope and local anesthesia. The postoperative treatment included cleaning operative cavity, nasal irrigation, antibiotics, steroid, immune regulator, etc. RESULTS: Overall cases included 89 cases (147 sides) of chronic sinusitis, 86 cases (142 sides) of nasal polyps and 13 cases (16 sides) of mucocele respectively. The cure rate was 70.2% (132 cases). 43 cases (22.9%) were improved, while other 13 cases were of no effect. Overall symptoms, 93.1% children with headache were improved, 85.1% children were free of nasal obstruction and 60.1% children gained a relief of purulent discharge. 11 cases had no change and 2 cases were worse compared with before surgery. 34 cases with anosmia were improved or recovered after ESS. The total effective rate of ESS was 93.1%. 8 cases received a revision ESS. CONCLUSIONS: ESS in children with chronic sinusitis and polyps has a good long-term outcomes. The reasonable reservation of mucosa during ESS must be emphasized. The quality of follow-up is an important factor affecting the results of ESS. Whether the disciplinary preoperative management was made or not is the hypothesis of ESS indications.