Khalid Ayesha N, Mace Jess, Smith Timothy L
Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Otolaryngol Head Neck Surg. 2009 Sep;141(3):358-63. doi: 10.1016/j.otohns.2009.05.034.
Adults with cystic fibrosis (CF) represent a challenging subset of patients with chronic rhinosinusitis (CRS). While data suggest that endoscopic sinus surgery (ESS) may benefit pediatric CF patients, there remains a paucity of data regarding the impact of endoscopic sinus surgery on adult CF patients with CRS. Our purpose was to evaluate objective and quality-of-life measures in adult CF patients with CRS following ESS.
Nested case-control study.
Tertiary care center.
Twenty patients with CF were evaluated and matched to 20 controls without concomitant CF. Preoperative CT and preoperative/postoperative endoscopic findings were recorded as objective measures. Changes in two disease-specific quality-of-life (QoL) instruments were also evaluated both preoperatively and postoperatively.
Mean postoperative follow-up was similar for cases and controls (13.1 +/- 7.9 months vs 14.0 +/- 6.0 months, respectively). Preoperative CT scores (16.9 +/- 4.5 vs 10.9 +/- 5.9, P = 0.001) and endoscopy scores (9.3 +/- 5.8 vs 5.7 +/- 4.6, P = 0.049) were significantly worse in CF patients. Postoperative endoscopy scores were significantly worse for CRS patients with CF (P = 0.001), although the degree of improvement on endoscopy within each group was no different (P = 0.071). Additionally, both groups experienced similar improvement in QoL after ESS (all P > or = 0.134).
While baseline measures of disease severity are worse in the CF population, our data support objective and QoL improvements for adult patients with comorbid CF comparable to patients without CF.
患有囊性纤维化（CF）的成年人是慢性鼻-鼻窦炎（CRS）患者中具有挑战性的一个亚组。虽然数据表明内镜鼻窦手术（ESS）可能使儿科CF患者受益，但关于内镜鼻窦手术对成年CRS-CF患者影响的数据仍然匮乏。我们的目的是评估成年CRS-CF患者接受ESS后的客观指标和生活质量指标。
巢式病例对照研究。
三级医疗中心。
对20例CF患者进行评估，并与20例无CF的对照者相匹配。记录术前CT和术前/术后内镜检查结果作为客观指标。还对两种疾病特异性生活质量（QoL）工具在术前和术后的变化进行了评估。
病例组和对照组的术后平均随访时间相似（分别为13.1±7.9个月和14.0±6.0个月）。CF患者的术前CT评分（16.9±4.5对10.9±5.9，P = 0.001）和内镜评分（9.3±5.8对5.7±4.6，P = 0.049）明显更差。CRS-CF患者的术后内镜评分明显更差（P = 0.001），尽管每组内镜检查的改善程度没有差异（P = 0.071）。此外，两组在ESS后生活质量均有相似改善（所有P≥0.134）。
虽然CF人群中疾病严重程度的基线指标更差，但我们的数据支持成年合并CF的患者在客观指标和生活质量方面的改善与无CF的患者相当。
