Friedman W H, Katsantonis G P, Bumpous J M
Park Central Institute, St. Louis, MO 63139.
Otolaryngol Head Neck Surg. 1995 Feb;112(2):210-4. doi: 10.1016/S0194-59989570238-5.
In 1990 we reported an initial prospective study of 100 patients using a four-stage system for classification of chronic rhinosinusitis. Between January 1988 and July 1992, we used this system in staging an additional 1814 patients, on whom 2980 intranasal sphenoethmoidectomies were performed. In this staging system a protocol trial of medication was given for 2 weeks, followed by axial and coronal computed tomography. Medication consisted of a second-generation cephalosporin antibiotic, usually cefuroxime; a 4-day burst of intraoral steroids, usually prednisone; and an antihistamine decongestant if not contraindicated. The stages of chronic hyperplastic rhinosinusitis included the stages described in the 1990 report (i.e., stage I, single-focus disease; stage II, discontiguous disease throughout the ethmoid labyrinth; stage III, diffuse disease responsive to medication; and stage IV, diffuse disease unresponsive to or poorly responsive to medication). The results of this study have shown that the computed tomography staging system based on computed tomography extent of disease after medical therapy is a simple, easily remembered, and very effective modality for the classification of chronic sinusitis. This system provides a rationale for discussing and planning surgery with patients and physicians and is a convenient reference for the reporting of end results. More importantly, a linear relationship between disease stage and outcomes is demonstrated. This statistically highly significant feature of the staging system provides a firm basis for the production of outcomes after various treatment strategies, particularly ethmoidectomy and the treatment of sinusitis.
1990年，我们报告了一项对100例患者进行的初步前瞻性研究，该研究采用了一种四阶段系统对慢性鼻窦炎进行分类。在1988年1月至1992年7月期间，我们使用该系统对另外1814例患者进行分期，这些患者共接受了2980次鼻内蝶筛窦切除术。在这个分期系统中，先给予2周的药物试验方案，然后进行轴位和冠状位计算机断层扫描。药物包括第二代头孢菌素抗生素，通常为头孢呋辛；4天的口服类固醇冲击治疗，通常为泼尼松；以及在无禁忌证时使用的抗组胺减充血剂。慢性增生性鼻窦炎的分期包括1990年报告中描述的分期（即，I期，单灶性疾病；II期，整个筛窦迷路的不连续疾病；III期，对药物有反应的弥漫性疾病；IV期，对药物无反应或反应不佳的弥漫性疾病）。这项研究的结果表明，基于药物治疗后疾病的计算机断层扫描范围的计算机断层扫描分期系统是一种简单、易于记忆且非常有效的慢性鼻窦炎分类方法。该系统为与患者和医生讨论及规划手术提供了理论依据，也是报告最终结果的方便参考。更重要的是，证明了疾病分期与预后之间存在线性关系。分期系统的这一具有高度统计学意义的特征为各种治疗策略（特别是筛窦切除术和鼻窦炎治疗）后的预后评估提供了坚实基础。
