Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea.
J Korean Med Sci. 2021 Oct 18;36(40):e264. doi: 10.3346/jkms.2021.36.e264.
Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes.
Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes.
In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis ( < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and (the value of prediction probability) = 1 / (1 + exp [-0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) - 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed.
Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.
内镜鼻窦手术（ESS）是治疗难治性慢性鼻-鼻窦炎（CRS）的主要方法。由于各种因素可能影响手术结果，因此医生很难预测手术结果。本研究旨在分析术后结果的预后因素，并建立预测模型，以确定影响术后结果的危险因素。
回顾性分析 2005 年、2010 年和 2016 年在 9 家机构接受 ESS 的 CRS 患者的病历。我们根据术后客观内镜结果将患者分为两组。收集患者的人口统计学资料、鼻部症状、嗅觉功能、血嗜酸粒细胞计数（EoB）和鼻组织嗜酸粒细胞计数（EoT）、Lund-Mackay CT 评分（LMS）。进行单因素和多因素分析，并建立术后内镜客观结局的预测方程。
共有 1249 例患者（27.0%）术后内镜检查不满意。在 10 个变量中，LMS（>5）、窦优势（上颌窦和筛窦）、EoB（>210）和 EoT（>100）在单因素分析中具有统计学意义（<0.05，均）。多因素分析显示，EoT（>100）和 LMS（>5）与术后不良结局显著相关。此外，我们选用 5 个显著变量建立了术后结局的风险模型，预测概率的公式为： （预测概率）=1/（1+exp[-0.392+1.088×EoT（>100）+0.123×平均 LMS（>5）-0.366×窦优势（上颌窦）+0.064×窦优势（相似）+0.200×EoB（4%）+0.344×EoB（>210）]。
组织嗜酸粒细胞计数和影像学严重程度与 ESS 术后结果较差相关，建立的风险模型可能有助于预测 ESS 的术后结果。
