不同的评估指标在鼻咽癌放疗后慢性鼻-鼻窦炎治疗方案选择和疗效评估中的价值

目的探讨不同病情评估方法在鼻咽癌放疗后慢性鼻窦炎（CRS）选择个性化治疗方案及疗效评估中的价值。方法将98例鼻咽癌放疗后CRS分成3组：经保守治疗（组1）、经上颌窦自然口扩大（组2）及联合下鼻道开窗（组3）为特征的鼻内镜手术治疗，分析治疗前后视觉模拟量表（VAS）评分、鼻窦CTLund—Mackay评分、鼻内镜检查Lund—Kennedy评分等完整的主观、客观评价指标的特点。结果在症状的VAS评估中，保守治疗仅黏脓性鼻涕评分有统计学意义，手术治疗另有面部胀痛评分治疗前后差异有统计学意义，联合下鼻道开窗组优于单纯上颌窦自然口扩大组。保守治疗对上颌窦炎及蝶窦炎控制较差，手术对各鼻窦炎控制率较好，联合下鼻道开窗对上颌窦炎的控制优于单纯上颌窦自然口扩大。Lund—Mackay与Lund—Kennedy评分在保守治疗前后差异无统计学意义（P〉0．05）；Lund—Mackay评分在每组手术治疗前后、治疗后两组间及保守组与手术组治疗后的差异均有统计学意义（P〈0．05），而Lund—Kennedy评分差异无统计学意义（P〉0．05）。结论①黏脓性鼻涕、面部胀痛这两项VAS评分较高的患者宜选择以上颌窦自然口扩大联合下鼻道开窗术为主的综合治疗方案；②在对治疗前病变范围的评估和手术疗效的判断上，Lund—Mackay评分更能真实反映放疗后CRS的控制情况。

Evaluation indexes for treatment plan and curative effect evaluation in nasopharyngeal carcinoma patients withpostradiotherapy chronic rhinosinusitis.

Objective To investigate the value on different evaluation indexes for nasopharyngeal carcinoma patients with post-radiotherapy chronic rhinosinusitis （post RT-CRS）. Methods Ninty-eight post RT-CRS patients were divid- ed into 3 groups ： the expectant treatment （ group 1 ）, the maxillary natural ostium enlargement （ group 2 ） and the com- bined fenestration operation （ group 3 ） under nasal endoscopy. Visual analogue score （ VAS ）, sinus CT lund-mackay scores, and endoscopic lund-kennedy scores before and after treatment were analyzed. Results Only the VAS of puru- lent secretion was statistically different in group 1, but the VAS of purulent secretion and facial gas pains were statisti- cally different in groups 2 and 3, and the curative effect of group 3 was better than that of group 2. The curative effect of maxillary sinusitis and sphenoid sinusitis were unsatisfied in group 1. The good curative effect to all sinusitis was found in the groups 2 and 3, and the curative effect of group 3 was better than group 2. The sinus CT lund-mackay scores and the endoscopic lund-kennedy scores before and after treatment had no statistical difference in group 1. The statistical difference of the lund-mackay scores could been found between groups 2 and 3 before and after treatment, post-treatment in groups 2 and 3, between the expectant group and the operation groups. The endoscopic lund-kennedy scores had no statistical difference in all groups. Conclusion①Maxillary natural ostium enlargement in combination with fenestration operation under nasal endoscopy is better for post RT-CRS patients with high VAS of purulent secretion and facial gas pains. ② As to evaluation of the extent of disease before treatment and the operation effect, sinus CT lund-mackay scores is better than other evaluation indexes.