本文選題：鼻竇炎 + 鼻息肉�。� 參考：《浙江大學(xué)》2010年碩士論文

【摘要】： 目的：探討功能性鼻竇內(nèi)窺鏡手術(shù)治療慢性鼻-鼻竇炎、鼻息肉的療效和預(yù)后,分析其影響因素,并指導(dǎo)提高鼻竇內(nèi)窺鏡手術(shù)的治療效果。 方法：回顧性分析浙大大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院2007年1月至2008年12月兩年期間的行鼻竇內(nèi)窺鏡手術(shù)的245例資料完整的患者。分析包括是否有長(zhǎng)期應(yīng)用鼻減充血?jiǎng)┦�、慢性鼻竇炎手術(shù)史、變應(yīng)性鼻炎病史及哮喘病史等；是否伴有全身性的疾��；是否堅(jiān)持鼻竇內(nèi)窺鏡術(shù)后的綜合治療。療效評(píng)定按照�？跇�(biāo)準(zhǔn)執(zhí)行(以鼻內(nèi)窺鏡檢查為準(zhǔn))；黏膜評(píng)判標(biāo)準(zhǔn)參考Lund-Mackay評(píng)分系統(tǒng)。其結(jié)果經(jīng)SPSS15.0統(tǒng)計(jì)軟件統(tǒng)計(jì)分析。 結(jié)果：所有245例患者,達(dá)到治愈的患者有194例(79.18%),達(dá)到好轉(zhuǎn)的患者有42例(17.14%),總有效率96.32%。手術(shù)并發(fā)癥共發(fā)生42例。其中鼻腔粘連38例,眶紙板損傷2例,鼻中隔穿孔2例。Ⅰ、Ⅱ、Ⅲ型的療效呈遞減趨勢(shì),其中以Ⅰ型3期,Ⅱ型2、3期和Ⅲ型的療效較差,經(jīng)X2檢驗(yàn),差異有顯著性(Personx2=16.858,P=0.002,P0.05)。黏膜達(dá)到一級(jí)愈合的百分率在各型各期間呈遞減趨勢(shì)。而在四級(jí)水平的百分率則以Ⅱ型3期與Ⅲ型最高,經(jīng)過X2檢驗(yàn),與其他幾組的差異有顯著性(Personx2=11.371, P=0.001,P0.05)。本組合并長(zhǎng)期應(yīng)用鼻減充血?jiǎng)┑酿つど掀せ瘯r(shí)間差異無(wú)明顯顯著性(t=1.707,P=0.0510,P0.05)。合并慢性鼻竇炎手術(shù)史、合并變應(yīng)性鼻炎和(或)哮喘患者黏膜上皮化時(shí)間也明顯延長(zhǎng),差異具有顯著性(t1=-3.123,P1=0.019,P0.05；t2=-3.531,P2=0.003,P0.05).本組合并全身性疾病,如心血管疾病、自身免疫性疾病、內(nèi)分泌異常疾病、合并營(yíng)養(yǎng)障礙或(和)特殊感染患者的有效率與總有效率的差異無(wú)顯著性(t1=1.264,P1=0.381,P0.05,t2=0.412,P2=0.816,P0.05,t3=0.033,P3=0.955,P0.05,t4=0.113,P4=0.551,P0.05)。本組合并鼻中隔偏曲并同時(shí)行鼻中隔成形術(shù)患者的有黏膜上皮化時(shí)間比較無(wú)顯著性差異(t=0.084,P=0.399,P0.05)。能夠規(guī)范使用局部鼻噴劑和口服藥物患者的總有效率、術(shù)后能夠規(guī)范鼻腔沖洗及術(shù)腔隨診患者的黏膜上皮化時(shí)間與不能進(jìn)行規(guī)范使用藥物治療和鼻腔沖洗及術(shù)腔隨診患者的黏膜上皮化時(shí)間比較,差異亦有顯著性(t1=-3.160,P1=0.025,P0.05；t2=-2.065,P2=0.012,P0.05) 結(jié)論：本文資料顯示,疾病本身的臨床分型分期、鼻部前驅(qū)手術(shù)史、鼻腔長(zhǎng)期減充血?jiǎng)┦褂檬芬约靶g(shù)后門診隨訪和藥物治療與鼻竇內(nèi)窺鏡手術(shù)的預(yù)后療效密切相關(guān)。但是,某些全身性疾病史、鼻中隔成形術(shù)等因素對(duì)于手術(shù)的療效無(wú)明顯關(guān)聯(lián)性。因此,預(yù)提高鼻竇內(nèi)窺鏡手術(shù)療效,術(shù)前詳細(xì)的病史采集和準(zhǔn)確臨床判斷和術(shù)后規(guī)律系統(tǒng)的綜合治療是毋庸置疑的重要因素,這對(duì)于疾病的預(yù)后和療效具有非常重要的作用。
[Abstract]:Objective: to investigate the effect and prognosis of functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis and nasal polyps. Methods: 245 patients who underwent endoscopic sinus surgery from January 2007 to December 2008 were analyzed retrospectively. The analysis includes whether there is a long history of nasal hyperemia, chronic sinusitis, allergic rhinitis and asthma, whether there are systemic diseases, and whether to insist on comprehensive treatment after endoscopic sinus surgery. The curative effect was evaluated according to Haikou standard (nasal endoscopy) and mucosal evaluation was made by Lund-Mackay scoring system. The results were analyzed by SPSS 15.0 statistical software. Results: 194 cases (79.18%) were cured and 42 cases (17.14%) were improved. The total effective rate was 96.32%. Surgical complications occurred in 42 cases. There were 38 cases of nasal adhesion, 2 cases of orbital board injury and 2 cases of perforation of nasal septum. The curative effect of type 鈪，

本文編號(hào)：2054658