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.
Laryngoscope. 2011 Feb;121(2):417-21. doi: 10.1002/lary.21382.
OBJECTIVES/HYPOTHESIS: To measure the change in quality-of-life (QoL) after endoscopic sinus surgery (ESS) in patients with medically recalcitrant chronic rhinosinusitis (CRS) and minimally affected computed tomography (CT) scans of the paranasal sinuses.
Prospective, multicenter cohort study at three academic, tertiary care centers.
A total of 778 patients with CRS were enrolled between January 2001 and April 2009 after electing ESS. For the purposes of this analysis, patients with nasal polyposis, history of prior sinus surgery, or follow-up <6 months were excluded. Final study patients were categorized as low-stage CT CRS (Lund-Mackay ≤3; n = 17) and high-stage CT CRS (Lund-Mackay >3; n = 207). Primary outcome measures included two disease-specific QoL instruments: the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey.
In patients with low-stage CT CRS, a statistically significant improvement was found across all disease-specific QoL scores (all P ≤ .012), with the exception of the CSS medication usage subscale (P = .073). These QoL improvements were comparable to those in patients with high-stage CT CRS.
Some patients will present with CRS that is refractory to medical therapy even though their CT demonstrates relatively minimal disease. Based on the results of this study, ESS is associated with improved QoL in patients with low-stage CT CRS and can provide significant benefit to carefully selected patients with minimally affected CT scans.
目的/假设：测量内镜鼻窦手术（ESS）后药物难治性慢性鼻-鼻窦炎（CRS）患者生活质量（QoL）的变化，以及鼻窦计算机断层扫描（CT）受影响最小的患者。
在三个学术性三级护理中心进行的前瞻性、多中心队列研究。
2001 年 1 月至 2009 年 4 月期间，共有 778 例 CRS 患者在选择 ESS 后入选。出于本分析的目的，排除了鼻息肉、鼻窦手术史或随访<6 个月的患者。最终研究患者分为低期 CT CRS（Lund-Mackay ≤3；n=17）和高期 CT CRS（Lund-Mackay>3；n=207）。主要结局指标包括两种疾病特异性 QoL 工具：鼻-鼻窦炎生活质量指数和慢性鼻窦炎调查。
在低期 CT CRS 患者中，所有疾病特异性 QoL 评分均有统计学显著改善（所有 P ≤.012），除了 CSS 药物使用亚量表（P =.073）。这些 QoL 改善与高期 CT CRS 患者相当。
尽管 CT 显示疾病相对较轻，但有些患者仍会出现药物难治性 CRS。基于本研究的结果，ESS 与低期 CT CRS 患者的 QoL 改善相关，并可为 CT 扫描受影响最小的精心选择的患者提供显著益处。
