Poetker David M, Mendolia-Loffredo Sabrina, Smith Timothy L
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Am J Rhinol. 2007 Jan-Feb;21(1):84-8. doi: 10.2500/ajr.2007.21.2978.
The aim of this study was is to investigate the outcomes of endoscopic sinus surgery (ESS) when performed for chronic rhinosinusitis associated with sinonasal polyps.
Forty-three patients with polyps were compared with 76 patients without polyps before and after ESS. Mean follow-up was 1.5 years. Patients were analyzed prospectively based on computed tomography (CT), endoscopy, quality-of-life (QOL) assessment, and visual analog scales (VASs). Univariate analyses were performed to evaluate whether the presence of polyps was predictive of outcome.
Patients with polyps had worse CT and endoscopy scores both pre- and postoperatively when compared with patients without polyps (p < 0.0001 for each). All patients, regardless of polyps, improved on endoscopic exam; however, patients with polyps showed a greater degree of improvement (p = 0.002). Despite this, postoperative endoscopic scores in patients with polyps were worse than those without polyps (p < 0.0001). Patients with polyps had better QOL as measured by the Chronic Sinusitis Survey (CSS) both pre- and postoperatively (p = 0.001 and 0.044, respectively). The preoperative VAS indicated that patients with polyps had increased nasal obstruction compared with patients without polyps (p = 0.002) while having less facial pain and headache (p = 0.002 and 0.005, respectively). Patients with polyps showed a greater postoperative improvement in nasal congestion (p = 0.003) but no difference in level of improvement in postoperative headache or pressure.
Despite significantly worse objective testing scores, patients with polyps report significantly better QOL as measured by the CSS and less facial pain/headache as measured by VAS scores pre- and postoperatively. Polyps were not found to be predictive of QOL or endoscopic outcome.
本研究的目的是调查针对伴有鼻息肉的慢性鼻-鼻窦炎进行鼻内镜鼻窦手术（ESS）的疗效。
对43例有息肉的患者和76例无息肉的患者在ESS术前和术后进行比较。平均随访时间为1.5年。基于计算机断层扫描（CT）、鼻内镜检查、生活质量（QOL）评估和视觉模拟量表（VAS）对患者进行前瞻性分析。进行单因素分析以评估息肉的存在是否可预测疗效。
与无息肉的患者相比，有息肉的患者在术前和术后的CT及鼻内镜检查评分均更差（每项p<0.0001）。所有患者，无论有无息肉，在内镜检查中均有改善；然而，有息肉的患者改善程度更大（p = 0.002）。尽管如此，有息肉患者的术后鼻内镜检查评分仍比无息肉患者差（p<0.0001）。通过慢性鼻窦炎调查问卷（CSS）测量，有息肉的患者在术前和术后的生活质量均更好（分别为p = 0.001和0.044）。术前VAS表明，与无息肉的患者相比，有息肉的患者鼻塞更严重（p = 0.002），而面部疼痛和头痛较轻（分别为p = 0.002和0.005）。有息肉的患者术后鼻塞改善程度更大（p = 0.003），但术后头痛或压迫感的改善程度无差异。
尽管客观测试评分明显更差，但通过CSS测量，有息肉的患者报告的生活质量明显更好，并且通过VAS评分测量，术前和术后的面部疼痛/头痛更少。未发现息肉可预测生活质量或内镜检查结果。
