儿童慢性鼻窦炎治疗方案与手术时机的选择

目的:探讨儿童慢性鼻窦炎(CRS)疗效及其相关因素,以选择最佳治疗方案与最佳手术时机.方法:根据是否伴有腺样体肥大与鼻腔结构异常,220例CRS患儿被分成4组,A组单纯鼻窦炎;B组伴腺样体肥大,其中B1组无鼻腔结构异常,B2组有鼻腔结构异常;C组仅伴鼻腔结构异常.参照文献,所有患儿均给予规范、系统的3阶段治疗.统计分析每个阶段各组鼻窦炎的疗效.结果:经第1阶段治疗后A组与B1、B2、C组比较,疗效均差异有统计学意义(均P＜0.01).而B1与B2组、B1与C组、B2与C组比较,疗效均差异无统计学意义(均P＞0.01).B组经第1阶段未治愈者94例进行第2阶段治疗后,B1与B2组比较,疗效差异有统计学意义(P＜0.01).经前述2阶段治疗后,无效者行鼻内镜手术,总有效率达89.65%.结论:①3阶段阶梯性治疗方案对儿童CRS的治疗具有一定的参考价值;②是否伴有腺样体肥大和(或)鼻腔结构异常是影响儿童CRS药物疗效的重要因素;③对伴有腺样体肥大和(或)鼻腔结构异常患儿宜在进行规范、系统的保守治疗的同时,切除腺样体和进行功能性鼻内镜手术,以缩短疗程,节约费用.

Choice of treatment plan and operation time on pediatric chronic sinusitis

Objective:To explore the curative effect of pediatric chronic sinusitis and analyze its relative factors, so that the best treatment plan and operation time can be choosed.Method:Two hundred and twenty cases of pediatric chronic sinusitis were divided into 4 groups: group A with only simple chronic sinusitis, group B accompanied adenoid hypertrophy. Among group B, group B1 with no nasal cavity structural abnomalities but group B2 on the contrary. Group C accompanied only nasal cavity structural abnomalities. According to the documents, all patients were admistered with standard and systematical three-stage treatment. The curative effect of each group was calculated and analyzed in each treated stage.Result:After the first stage treated in 220 pediatric chronic sinusitis, a statistical significance of curative effect could be observed between group A and B, A and B1, A and B2, A and C(P<0.01), but none between group B and C, B1 and B2, B1 and C, B2 and C (P>0.01). Ninety-four patients in group B were accepted the second stage treated: adenoidectomy after first treatment failed. There was a statistical significance of curative effect between group B1 and B2(P<0.01). Once the above management both failed, endoscopic sinus surgery (FESS) was carried out. The total effective rate of FESS was 89.65%.Conclusion:The systemic, disciplinary medical management has some referred value in the treatment for children with chronic sinusitis. Adenoid hypertrophy and nasal cavity structural abnomalities are two relative factors of the curative effect in pediatric chronic sinusitis. The time and cost of therapy can be saved if adenoidectomy and FESS are done for cases with adenoid hypertrophy or(and) nasal cavity structural abnomalities with the systemic, disciplinary medical managementsimultaneously.