CAJ | 학술논문

目的评估内镜鼻窦手术治疗慢性鼻-鼻窦炎的主客观临床结局并构建临床实用性的主客观结局评估体系.方法通过前瞻性队列研究,对120例慢性鼻-鼻窦炎患者术前和术后12个月的临床结局进行视觉模拟量表(visual analog scale,VAS)、医学结局研究简表36项(medical outcome study short-form 36-items,SF-36)和鼻腔鼻窦结局测试20条(sino-nasal outcome test-20,SNOT-20)等症状与生存质量的主观评估,以及内镜下黏膜形态、纤毛功能与组织病理学等客观评估.数据统计采用t检验、x2检验和Spearman相关分析处理手术前后主客观结局的变化及其相互关系.结果 ①术后12个月,VAS、SF-36和SNOT-20整体评分较术前明显改善(P＜0.01),其中85.96%、77.19%和83.33%的个体三项主观指标评分分别较术前改善,同时改善的比例为72.28%;手术前后各个时期,三种主观指标评分均具相关性(P值均＜0.01),其中SNOT-20兼性作用最大.②术后12个月,内镜下黏膜形态、纤毛功能和组织病理学整体评分较术前明显改善(P值均＜0.05),其中86.84%、86.81%和75.57%的个体三种客观指标评分分别较术前改善,同时改善的比例为71.85%;手术前后各个时期,三种客观指标评分均具相关性(P值均＜0.05),其中内镜下黏膜形态兼性作用最大.③SNOT-20与内镜下黏膜形态同时评估显示:术后12个月74.56%的患者主客观评分升降结局一致,而25.44%的患者主客观结局不一致,其中伴发鼻息肉患者更容易出现这种差异性(P＜0.05).④手术前后不同时期,SNOT-20与内镜下黏膜形态评分均无相关性(P＞0.05),但前10位条目总分与内镜下黏膜形态评分具有相关性(0.18≤r≤0.42,P＜0.05),而后10位条目总分与之不相关(P＞0.05).结论 ①内镜鼻窦手术可有效改善慢性鼻-鼻窦炎患者术后的症状、生存质量、内镜下黏膜形态、纤毛功能及组织状态等临床结局;②构建以SNOT-20和内镜下黏膜形态评估为主体的主客观结局评估体系,简约可靠,合理有效,具有临床实用性. 目的評估內鏡鼻竇手術治療慢性鼻-鼻竇炎的主客觀臨床結跼併構建臨床實用性的主客觀結跼評估體繫.方法通過前瞻性隊列研究,對120例慢性鼻-鼻竇炎患者術前和術後12箇月的臨床結跼進行視覺模擬量錶(visual analog scale,VAS)、醫學結跼研究簡錶36項(medical outcome study short-form 36-items,SF-36)和鼻腔鼻竇結跼測試20條(sino-nasal outcome test-20,SNOT-20)等癥狀與生存質量的主觀評估,以及內鏡下黏膜形態、纖毛功能與組織病理學等客觀評估.數據統計採用t檢驗、x2檢驗和Spearman相關分析處理手術前後主客觀結跼的變化及其相互關繫.結果 ①術後12箇月,VAS、SF-36和SNOT-20整體評分較術前明顯改善(P＜0.01),其中85.96%、77.19%和83.33%的箇體三項主觀指標評分分彆較術前改善,同時改善的比例為72.28%;手術前後各箇時期,三種主觀指標評分均具相關性(P值均＜0.01),其中SNOT-20兼性作用最大.②術後12箇月,內鏡下黏膜形態、纖毛功能和組織病理學整體評分較術前明顯改善(P值均＜0.05),其中86.84%、86.81%和75.57%的箇體三種客觀指標評分分彆較術前改善,同時改善的比例為71.85%;手術前後各箇時期,三種客觀指標評分均具相關性(P值均＜0.05),其中內鏡下黏膜形態兼性作用最大.③SNOT-20與內鏡下黏膜形態同時評估顯示:術後12箇月74.56%的患者主客觀評分升降結跼一緻,而25.44%的患者主客觀結跼不一緻,其中伴髮鼻息肉患者更容易齣現這種差異性(P＜0.05).④手術前後不同時期,SNOT-20與內鏡下黏膜形態評分均無相關性(P＞0.05),但前10位條目總分與內鏡下黏膜形態評分具有相關性(0.18≤r≤0.42,P＜0.05),而後10位條目總分與之不相關(P＞0.05).結論 ①內鏡鼻竇手術可有效改善慢性鼻-鼻竇炎患者術後的癥狀、生存質量、內鏡下黏膜形態、纖毛功能及組織狀態等臨床結跼;②構建以SNOT-20和內鏡下黏膜形態評估為主體的主客觀結跼評估體繫,簡約可靠,閤理有效,具有臨床實用性.
목적 평고내경비두수술치료만성비-비두염적주객관림상결국병구건림상실용성적주객관결국평고체계.방법 통과전첨성대렬연구,대120례만성비-비두염환자술전화술후12개월적림상결국진행시각모의량표(visual analog scale,VAS)、의학결국연구간표36항(medical outcome study short-form 36-items,SF-36)화비강비두결국측시20조(sino-nasal outcome test-20,SNOT-20)등증상여생존질량적주관평고,이급내경하점막형태、섬모공능여조직병이학등객관평고.수거통계채용t검험、x2검험화Spearman상관분석처리수술전후주객관결국적변화급기상호관계.결과 ①술후12개월,VAS、SF-36화SNOT-20정체평분교술전명현개선(P＜0.01),기중85.96%、77.19%화83.33%적개체삼항주관지표평분분별교술전개선,동시개선적비례위72.28%;수술전후각개시기,삼충주관지표평분균구상관성(P치균＜0.01),기중SNOT-20겸성작용최대.②술후12개월,내경하점막형태、섬모공능화조직병이학정체평분교술전명현개선(P치균＜0.05),기중86.84%、86.81%화75.57%적개체삼충객관지표평분분별교술전개선,동시개선적비례위71.85%;수술전후각개시기,삼충객관지표평분균구상관성(P치균＜0.05),기중내경하점막형태겸성작용최대.③SNOT-20여내경하점막형태동시평고현시:술후12개월74.56%적환자주객관평분승강결국일치,이25.44%적환자주객관결국불일치,기중반발비식육환자경용역출현저충차이성(P＜0.05).④수술전후불동시기,SNOT-20여내경하점막형태평분균무상관성(P＞0.05),단전10위조목총분여내경하점막형태평분구유상관성(0.18≤r≤0.42,P＜0.05),이후10위조목총분여지불상관(P＞0.05).결론 ①내경비두수술가유효개선만성비-비두염환자술후적증상、생존질량、내경하점막형태、섬모공능급조직상태등림상결국;②구건이SNOT-20화내경하점막형태평고위주체적주객관결국평고체계,간약가고,합리유효,구유림상실용성.
Objective To assess the subjective and objective outcomes of chronic rhinosinusitis(CRS)following endoscopic sinus surgery(ESS) and establish an assessment system of outcome with ease of application clinically. Methods A prospective cohort study was conducted to survey and assess the outcomes of 120 consecutive CRS patients undergoing endoscopic sinus surgery at 12 months after operation.The subjective and objective measures comprised symptom by visual analog scale(VAS),health-related quality of life by medical outcome study short-form 36-items(SF-36)and sino-nasal outcome test-20 (SNOT-20)scales,endoscopic appearance,mucociliary function,and histological findings. The differences of subiective and oblective assessments before and after operation were compared by t-test and Chi-Square test and the correlations between the parameters above were analyzed by Spearman correlation analysis.Resuits At 12 months after operatiion, the patients'total scores by VAS,SF-36 and SNOT-20 scales improved significantly beyond the preoperative survey(P＜0.01);there were 85.96%,77.19% and 83.33% patients with the scores respectively superior to that of preoperation, of which 72.28% subjects benefited simultaneously from these parameters;and a significant correlation was observed among them before and after operation(P＜0.01) where SNOT-20 showed a more compatibility than the other two. At 12 months after operatiion,the patients' total scores of endoscopic appearance,mucociliary function,and histological findings significantly improved beyond the preoperative evaluation(P＜0.05);there were 86.84%,86.81%and 75.57% patients with the scores respectively superior to that of preoperation,of which 71.85% subjects benefited simultaneously from these parameters;and a significant correlation was observed among them before and after operation(P＜0.05) where endoscopic appearance showed a more compatibility than the other two. At 12 months after operatiion,74.56% patients showed an accordant improving or worsening outcome evaluated by SNOT-20 and endoscopic appearance,while 25.44% ones represented inverse endings,of which patients with comorbidity of nasal polyps more easily demonstrated this tendency significantly(P＜0.05). No significant correlation existed between the scores of SNOT-20 and endoscopic appearances both in preoperation and in postoperation(P＞0.05),but the total scores of the anterior 10-item,excluding the posterior 10-item,of SNOT-20 inventory was found significantly correlated with the quantitative appearances on nasal endoscopy throughout(0.18≤r≤0.42,P＜0.05). Conclusions Administration of ESS can effectively improve the outcomes of CRS patients including symptom,healthrelated quality of life,endoscopic appearance,mucociliary function,and histological findings. A subjectively and objectively measured assessment system with terseness,trustiness,reasonableness,and effectiveness and with ease of application clinically is established on the basis of SNOT-20 and endoscopic appearance evaluation for outcome research.