【摘要】：目的:探討慢性鼻-鼻竇炎鼻內(nèi)鏡術(shù)后定期隨訪的臨床意義及評(píng)估鼻內(nèi)鏡手術(shù)治療對(duì)慢性鼻-鼻竇炎患者術(shù)后生活質(zhì)量及癥狀改善情況的影響。方法以2008年南昌慢性鼻-鼻竇炎的診斷和治療指南為診斷指標(biāo),將接受鼻內(nèi)鏡手術(shù)治療的120例慢性鼻-鼻竇炎患者分組，在臨床上分為不伴有鼻息肉組和伴有鼻息肉組。對(duì)兩組患者術(shù)后進(jìn)行定期隨訪1年，，分析術(shù)后隨訪對(duì)手術(shù)療效的影響。其次，評(píng)估所有患者術(shù)前、術(shù)后1、3、6和12個(gè)月生活質(zhì)量狀況及主要癥狀的改善情況,對(duì)術(shù)前和術(shù)后的主要癥狀和生活質(zhì)量的評(píng)分進(jìn)行比較。采用視覺模擬量表評(píng)估患者的主要癥狀，對(duì)所有患者的4個(gè)主要癥狀評(píng)分,分別為鼻塞、鼻分泌物、頭痛和嗅覺障礙。采用SNOT-20量表對(duì)生活質(zhì)量狀況進(jìn)行評(píng)估。結(jié)果不伴鼻息肉組：術(shù)后6個(gè)月，痊愈36例、好轉(zhuǎn)20例、無(wú)效4例；12個(gè)月痊愈50例、好轉(zhuǎn)7例、無(wú)效3例。伴鼻息肉組：術(shù)后6個(gè)月，痊愈30例、好轉(zhuǎn)27例、無(wú)效3例；12個(gè)月痊愈37例、好轉(zhuǎn)20例、無(wú)效3例。兩組病情轉(zhuǎn)歸差異具有統(tǒng)計(jì)學(xué)意義。對(duì)120例慢性鼻竇炎患者經(jīng)鼻內(nèi)鏡手術(shù)治療后，分別在術(shù)后第1、3、6、12個(gè)月對(duì)主要癥狀評(píng)分進(jìn)行評(píng)估，得分明顯下降,較術(shù)前均明顯下降(P均0.01)。術(shù)后第1、3、6、12個(gè)月主要癥狀評(píng)分與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義。20個(gè)條目和5大條目評(píng)分與術(shù)前比較均明顯下降(P均0.01)。術(shù)后第1、3、6、12個(gè)月的20個(gè)條目和5大條目的評(píng)分與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論鼻內(nèi)窺鏡術(shù)后進(jìn)行定期隨訪換藥及綜合治療是必不可少的重要環(huán)節(jié)，術(shù)后進(jìn)行定期規(guī)律的隨訪換藥及綜合治療可以顯著提高手術(shù)療效，術(shù)后進(jìn)行定期規(guī)律的鼻內(nèi)鏡隨訪是提高手術(shù)療效、減少CRS復(fù)發(fā)的關(guān)鍵。為提高治愈率，手術(shù)后加強(qiáng)隨訪換藥及后期綜合治療，與手術(shù)具有同等重要的作用。其次，鼻內(nèi)鏡手術(shù)可以使慢性鼻竇炎患者的癥狀和生活質(zhì)量得到明顯改善。鼻內(nèi)鏡手術(shù)是治療慢性鼻-鼻竇炎的有效方法。
[Abstract]:Objective: to investigate the clinical significance of chronic rhinosinusitis and to evaluate the effect of endoscopic sinus surgery on the quality of life and the improvement of symptoms in patients with chronic rhinosinusitis. Methods 120 patients with chronic rhinosinusitis who received endoscopic sinus surgery were divided into two groups according to the diagnosis and treatment guidelines of Nanchang chronic rhinosinusitis in 2008. The patients were divided into two groups: the group without nasal polyps and the group with nasal polyps. Two groups of patients were regularly followed up for 1 year, and the effect of postoperative follow-up on the outcome of the operation was analyzed. Secondly, the quality of life (QOL) and the improvement of major symptoms were evaluated in all patients before and after operation, and the scores of major symptoms and quality of life were compared before and after operation. The main symptoms of the patients were evaluated by visual analogue scale. The four main symptoms of all patients were nasal obstruction, nasal secretion, headache and olfactory disorder. The quality of life (QOL) was evaluated with SNOT-20 scale. Results in the group without nasal polyps, 36 cases were cured, 20 cases were improved, 4 cases were ineffective, 50 cases were cured at 12 months, 7 cases were improved, and 3 cases were ineffective. In the nasal polyp group, 30 cases were cured, 27 cases were improved, 3 cases were ineffective, 37 cases were cured at 12 months, 20 cases were improved, and 3 cases were ineffective. The difference between the two groups was statistically significant. The main symptom scores of 120 patients with chronic sinusitis were evaluated at the 1st and 12th month after endoscopic sinus surgery. The scores were significantly lower than those before operation (all P 0.01). There were significant differences in the scores of major symptoms between 6 and 12 months after operation, and the scores of 20 items and 5 items were significantly decreased compared with those before operation (P 0.01). The scores of 20 items and 5 items in 12 months after operation were significantly different from those before operation. Conclusion it is necessary and important to carry out regular follow up and comprehensive treatment after nasal endoscopy. The regular follow-up and comprehensive treatment can significantly improve the curative effect of the operation. Regular endoscopic follow-up is the key to improve the curative effect and reduce the recurrence of CRS. In order to improve the cure rate, it is of the same importance as the operation to strengthen the follow-up and dressing change and the later comprehensive treatment. Second, endoscopic sinus surgery can significantly improve the symptoms and quality of life in patients with chronic sinusitis. Endoscopic sinus surgery is an effective method for the treatment of chronic rhinosinusitis.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R765.9

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