Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
Int Forum Allergy Rhinol. 2012 Nov;2(6):444-52. doi: 10.1002/alr.21060. Epub 2012 Jun 13.
Although overall success rates of endoscopic sinus surgery (ESS) range from 76.0% to 97.5%, ongoing or recurrent symptoms may require revision surgery. Previous studies have shown that revision status is not a predictor of outcomes following ESS, but no distinction has been made between patients undergoing a single or multiple revision procedure. The purpose of this study was to compare quality-of-life (QOL) outcomes and associated risk factors of patients undergoing primary ESS, first-revision ESS, and multiple-revision ESS (second, third, fourth, and fifth or more).
Demographic and risk factor data were collected from a multi-institutional prospective cohort of 552 patients undergoing primary (n = 221) and revision (n = 331) ESS for chronic rhinosinusitis. Mean preoperative Lund-Mackay computed tomography (CT) scan scores, pre-/postoperative Lund-Kennedy endoscopy scores, Rhinosinusitis Disability Index (RSDI), and Chronic Sinusitis Survey (CSS) outcomes were analyzed using chi-square testing and 1-way analysis of variance (ANOVA).
Mean preoperative RSDI and CSS measurements were similar between primary ESS and all revision groups. Significantly more primary ESS patients met rigorous criteria for a minimally important difference in QOL improvement than revision ESS patients (73.8% vs 61.6%; p = 0.003). There was no significant difference in mean QOL improvement between revision groups (all p ≥ 0.174) even when comparing patients with and without nasal polyposis (all p ≥ 0.312).
Generally, patients undergoing primary, first-revision, and multiple-revision ESS showed postoperative improvement in QOL scores. More primary ESS patients had significant QOL improvement compared to revision ESS patients. There were no significant differences in mean QOL improvement between any of the individual revision groups. © 2012 ARS-AAOA, LLC.
尽管内镜鼻窦手术（ESS）的总体成功率在 76.0%至 97.5%之间，但持续或复发的症状可能需要进行修正手术。先前的研究表明，修正状态并不是 ESS 后结果的预测因素，但没有区分接受单一或多次修正手术的患者。本研究旨在比较行初次 ESS、初次修正 ESS 和多次修正 ESS（第二次、第三次、第四次和第五次或更多次）的患者的生活质量（QOL）结果和相关风险因素。
从多机构前瞻性队列中收集了 552 例慢性鼻-鼻窦炎患者行初次（n = 221）和修正（n = 331）ESS 的人口统计学和风险因素数据。使用卡方检验和单因素方差分析（ANOVA）分析术前 Lund-Mackay 计算机断层扫描（CT）评分、术前/术后 Lund-Kennedy 内镜评分、鼻-鼻窦炎生活质量问卷（RSDI）和慢性鼻窦炎调查（CSS）结果。
初次 ESS 和所有修正组的术前 RSDI 和 CSS 测量值相似。初次 ESS 患者达到 QOL 改善的最小有意义差异的严格标准的比例显著高于修正 ESS 患者（73.8% vs 61.6%；p = 0.003）。修正组之间的平均 QOL 改善没有显著差异（所有 p ≥ 0.174），即使比较伴有和不伴有鼻息肉的患者（所有 p ≥ 0.312）也是如此。
一般来说，行初次、初次修正和多次修正 ESS 的患者术后 QOL 评分均有改善。与修正 ESS 患者相比，更多的初次 ESS 患者有显著的 QOL 改善。任何单个修正组之间的平均 QOL 改善均无显著差异。© 2012 ARS-AAOA，LLC.
