Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Str Republicii nr 18, 3400 Cluj-Napoca, Romania.
Otolaryngol Head Neck Surg. 2010 Feb;142(2):196-201. doi: 10.1016/j.otohns.2009.10.038.
To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps.
Prospective.
Tertiary referral center.
A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model.
Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence (P = 0.034, 95% confidence interval for odds ratio 0.92-7.21).
Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.
评估内镜鼻窦手术治疗无上颌窦息肉的慢性上颌窦炎复发的预后因素。
前瞻性研究。
三级转诊中心。
2002 年至 2007 年间，在一家机构为 411 例无上颌窦息肉的慢性上颌窦炎（307 例鼻源性鼻窦炎、74 例牙源性鼻窦炎和 30 例口-上颌窦瘘）患者进行了手术。分析了 10 个参数，以研究它们与复发的关系：鼻窦炎的病因、中鼻甲部分切除术、吸烟史、过敏、哮喘、胃食管反流、术前内镜评分、CT 分期、上颌窦黏膜评分和出血评分。通过方差检验比较术前特征和复发率。采用 Kaplan-Meier 法分析失败作为时间相关变量。对单因素分析确定的变量进行多因素 Cox 比例风险模型分析。
28 例（6.8%）出现复发性鼻窦炎。在单因素分析中，术前内镜评分、CT 分期和出血评分与复发有关。然而，多因素分析表明，只有出血是复发的独立预测因素（P=0.034，优势比 95%置信区间为 0.92-7.21）。
术中出血可能是上颌窦内窥镜手术失败的危险因素，但存在很大的不确定性，需要进一步研究。
