保守与手术治疗鼻咽癌放疗后慢性鼻-鼻窦炎的疗效比较

目的:比较保守及两种不同手术方式治疗鼻咽癌放疗后慢性鼻-鼻窦炎(CRS)的疗效。方法:将99例放疗后CRS患者随机分为保守治疗组(A组)、上颌窦自然窦口扩大组(B组)、上颌窦自然窦口扩大联合下鼻道开窗组(C组),对比治疗前后3组的VAS、Lund-Mackay及Lund-Kennedy评分。结果:鼻塞VAS评分B、C组治疗后显著低于治疗前,且C组低于B组;脓涕VAS评分3组治疗后显著低于治疗前,且B、C组低于A组,C组低于B组;Lund-Mackay与Lund-Kennedy评分B、C组治疗后显著低于治疗前,且B、C组低于A组,C组低于B组(均P<0.05)。结论:保守治疗对脓涕为主要表现的放疗后CRS患者疗效较好,手术治疗对以鼻塞、脓涕为主要表现者疗效较好,上颌窦自然窦口扩大联合下鼻道开窗术式疗效最佳。

Comparison of curative effect between conservative treatment and surgical treatmentfor chronic rhinosinusitis following radiotherapy of nasopharyngeal carcinoma

Objective:To compare the curative effect of conservative treatment and two different surgical methods for chronic rhinosinusitis(CRS)following radiotherapy of nasopharyngeal carcinoma.Methods:99 patients with postradiotherapic CRS were randomly divided into 3 groups:conservative treatment group(group A),maxillary natural ostium enlargement group(group B),and maxillary natural ostium enlargement combined with inferior meatus fenestration group(group C).The VAS,Lund Mackay and Lund Kennedy scores of the three groups before and after treatment were compared.Results:The VAS score of nasal obstruction in group B and C was significantly lower than that before treatment,and that in group C was lower than group B;the VAS score of purulent discharge in the three groups was significantly lower than that before treatment,and that in group B and C was lower than group A,and that in group C was lower than group B;the Lund Mackay and Lund Kennedy scores in group B and C were significantly lower than those before treatment,and those in group B and C were lower than group A,and those in group C were lower than group B(all P<0.05).Conclusion:Conservative treatment is better for patients with purulent discharge as the main manifestation of postradiotherapic CRS,while surgical treatment is better for patients with nasal obstruction and purulent discharge as the main manifestation of postradiotherapic CRS.Maxillary natural ostium enlargement combined with inferior meatus fenestration has the best curative effect.