Sahlstrand-Johnson P, Hopkins C, Ohlsson B, Ahlner-Elmqvist M
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Lund University, Skane University Hospital, Malmo, Sweden.
Department of Otolaryngology, Guys and St Thomas Hospital, London, United Kingdom.
Rhinology. 2017 Sep 1;55(3):251-261. doi: 10.4193/Rhino16.126.
Chronic rhinosinusitis with and without nasal polyps (CRSw/sNP) are common conditions decreasing health-related quality of life (HRQOL). Individual symptoms capable of predicting outcome after endoscopic sinus surgery (ESS) are poorly defined, and the indirect costs of CRS is rarely reported in Europe.
Patients with CRSw/sNP admitted for ESS were prospectively enrolled. Patients completed the 22 Sinonasal Outcome Test (SNOT-22), the short-form 36-item questionnaire (SF-36), a Visual Analogue Scale (VAS) and reported CRS-related absenteeism pre- and post-operatively.
181 patients were included. The SNOT-22 score diminished from 51.8 (48.7-55.0) pre-operatively to 33.0 (29.2-36.8) at 6 months. 64% achieved a clinically important improvement in the SNOT-22. SF-36 scores improved statistically significantly in all domains except Role Emotional. The VAS score halved from 68 (65-71) to 34 (29-39) at 6 months post-operatively. A pre-operative SNOT-22 score over 20 implied a greater chance of score improvement after 6 months. A multivariate model identified individual items associated with SNOT-22. Further, patients that had lees than 12 months of sinus disease derived greatest benefit. CRS-related absenteeism dropped from 8-14 days to 1-7 days 12 months after ESS.
This prospective study showed that ESS significantly improved the HRQOL and decreased absenteeism of patients with CRSw/sNP. Shorter duration of disease and Need to blow nose and Blockage/congestion of nose of SNOT-22 were identified as predictive factors for good surgical outcome.
伴或不伴鼻息肉的慢性鼻-鼻窦炎（CRSw/sNP）是常见疾病，会降低健康相关生活质量（HRQOL）。对于能够预测鼻内镜鼻窦手术（ESS）术后结果的个体症状，目前尚无明确界定，而且在欧洲，CRS的间接成本鲜有报道。
前瞻性纳入因ESS入院的CRSw/sNP患者。患者术前和术后均完成了22项鼻鼻窦结局测试（SNOT-22）、36项简短问卷（SF-36）、视觉模拟量表（VAS），并报告了与CRS相关的缺勤情况。
纳入181例患者。SNOT-22评分从术前的51.8（48.7-55.0）降至术后6个月时的33.0（29.2-36.8）。64%的患者在SNOT-22方面取得了具有临床意义的改善。除角色情感领域外，SF-36评分在所有领域均有统计学显著改善。术后6个月时，VAS评分从68（65-71）降至34（29-39）。术前SNOT-22评分超过20分意味着术后6个月评分改善的可能性更大。多变量模型确定了与SNOT-22相关的个体项目。此外，鼻窦疾病病程少于12个月的患者获益最大。ESS术后12个月，与CRS相关的缺勤天数从8-14天降至1-7天。
这项前瞻性研究表明，ESS显著改善了CRSw/sNP患者的HRQOL并减少了缺勤情况。疾病病程较短以及SNOT-22中的擤鼻需求和鼻塞/鼻充血被确定为手术效果良好的预测因素。
