不同年龄慢性鼻窦炎经鼻内镜手术的主客观评估的结果

目的探讨不同年龄段的慢性鼻窦炎伴鼻息肉（chronic rhinosinusitis with polyps,CRSwNP）手术后的主客观病情评估与年龄段、随诊时间的关系。方法对192例CRSwNP行鼻内镜手术：鼻窦开放，息肉切除，下鼻甲射频消融下鼻甲骨骨折外移术，窦口鼻道复合体功能性切除术。将病例分为青少年组、成年组、老年组3个阶段，术后（0.5、1、3、6、12个月）随诊，对不同年龄段不同随诊时间进行主观病情评估（VAS评分）及客观检查及评分（Lund Kennedy内镜评分）。采用统计学分析不同年龄段同一随诊时间和同一年龄段不同随诊时间在术后的主客观病情评估的差异。结果不同年龄段的鼻塞、鼻漏的VAS评分在不同时间（术后3、6、12个月）对比，差异具有统计学意义（P<0.001）。面部胀痛感（术后1、3个月）各组无统计学意义（P>0.05)、而术后6、12个月比较差异具有统计学意义（P<0.05）。Lund Kennedy内镜评分在术后0.5、1个月青少年组与其他组比较无统计学意义（P>0.05）、而术后3、6、12个月比较差异具有统计学意义（P<0.001)。术后复查鼻内镜下水肿、囊泡、分泌物等比年长组要明显。结论术前应着重对不同年龄阶段患者的主观症状、术前检查进行评价，为患者制定个性化手术方案，提高临床疗效。

Analyses of subjective and objective evaluations after nasal endoscopic surgery in chronic rhinosinusitis patients of different age groups

Abstract:ObjectiveTo investigate the relationships among subjective and objective evaluations, patients’ age, follow up time after nasal endoscopic surgery in patients suffering from chronic rhinosinusitis with nasal polyps (CRSwNP) of different age groups.Methods192 patients with CRSwNP were included. According to the age, they were divided into adolescent, adult and elderly group. All the patients received nasal endoscopic surgeries including sinus opening, polypectomy, radiofrequency ablation and lateral shift of inferior turbinate, and functional resection of ostimeatal complex. After surgery, they were required to have clinical follow up at time points of half a month, one month, 3, 6 and 12 months. Subjective evaluation (visual analogy score, VAS) and objective examination (Lund Kennedy endoscopic score) were performed. The differences of evaluations among different age groups at the same follow up time and those of the same group at different follow up times were analyzed.ResultsThe differences of VAS scores of nasal obstruction and rhinorrhea were statistically significant (P<0.001) among different groups and at different follow up time (3, 6 and 12 months after surgery). The differences of VAS scores of facial fullness sensation among different groups at one month and 3 months after surgery were statistically insignificant (P>0.05), while those at 6 and 12 months were statistically. As for the Lund Kennedy scores, the differences between the adolescent group and other two groups at half a month, one month were insignificant (P>0.05), while those at 3, 6 and 12 months were all statistically significant (P<0.001).ConclusionThe preoperative evaluation should focus on subjective symptoms and special examinations according to the patient’s age. Surgical procedures for chronic rhinosinusitis with nasal polyps must be individualized for improving the therapeutic effect.