术前鼻窦CT Lund-Mackay评分对功能性内镜鼻窦手术后鼻腔填塞物选取的预测价值

doi:10.3760/cma.j.cn101202-20201229-00429

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摘要目的探讨功能性内镜鼻窦手术(FESS)术前鼻窦CT Lund-Mackay评分对术后鼻腔填塞物选取的预测作用。方法回顾性队列研究。纳入2015年5月—2020年1月蚌埠市第一人民医院耳鼻咽喉科鼻窦炎患者50例,其中男27例、女23例,年龄4~70(32.2±4.0)岁。50例患者均采用Messerklinger术式行FESS治疗,术后予以鼻腔填塞止血。根据鼻腔填塞材料的不同将患者分为凡士林填塞组和明胶海绵填塞组,每组25例。分别于手术前24 h和术后48 h行主观感受视觉模拟评分法(VAS)评分、鼻窦CT Lund-Mackay评分以及术后鼻腔填塞止血效果评价(以填塞期间出血＜5 mL为填塞止血满意)。对影响明胶海绵填塞效果的因素进行logistic回归分析。根据鼻窦CT Lund-Mackay评分绘制预测适合明胶海绵填塞效果的受试者操作特征(ROC)曲线,以最佳截断值预测明胶海绵填塞的效果。结果两组患者性别构成、病变侧别、术前各项VAS评分比较差异均无统计学意义(P值均＞0.05)。止血满意率凡士林组100%(25/25)、明胶海绵组92%(23/25),两组差异无统计学意义(χ²=3.615, P＞0.05)。两组患者术后填塞期总出血量及术后流涕VAS评分比较差异均无统计学意义(P值均＞0.05);明胶海绵组术后鼻塞、头面部胀痛及嗅觉障碍VAS评分均低于凡士林组,差异均有统计学意义(t=4.324、4.861、5.207, P值均＜0.05)。明胶海绵组患者术前鼻窦CT总评分以及筛窦CT总评分[(8.2±3.1)分、(3.1±1.9)分]均较凡士林组分值[(15.0±4.4)分、(6.5±1.4)分]更小,差异均有统计学意义(t=6.383、7.171, P值均＜0.05)。logistic回归分析结果提示,鼻窦CT总分[比值比(OR)=1.366(95% CI 1.004~1.860)]及筛窦CT总分[OR=2.155(95% CI 1.155~4.021)]是明胶海绵填塞止血满意的危险因素(P值均＜0.05),两者对于明胶海绵填塞止血满意均具有高度预测价值(AUC值分别为0.91、0.92,P值均＜0.05)。当鼻窦CT总分＜9.5分时,约登指数为0.80,预测适合明胶海绵填塞止血满意的敏感度为84.0%,特异度为96.0%;当筛窦总分＜4.5分时,约登指数为0.68,预测适合明胶海绵填塞止血满意的敏感度为76.0%、特异度为92.0%。结论术前鼻窦CT Lund-Mackay评分,对于FESS术后鼻腔填塞物种类的恰当选择具有一定意义;鼻窦CT Lund-Mackay总分及筛窦CT总分较低时,选择明胶海绵进行术腔填塞,既能有效止血,又能提高患者舒适度。

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	徐松波
	刘成珠
	尤国军
	祁冬
	吴目武
	娄帅
	张月婷
	郭燕燕

关键词 ：鼻窦炎, 鼻窦CT评分, 功能性内镜鼻窦手术, 鼻腔填塞

Abstract：Objective This study aimed to explore the predictive value of the preoperative sinus CT Lund-Mackay score in the selection of nasal packing after functional endoscopic sinus surgery (FESS).Methods A retrospective cohort study was conducted. A total of 50 patients with inflammatory lesions of paranasal sinuses were enrolled in the Department of Otorhinolaryngology of Bengbu First People's Hospital from May 2015 to January 2020. All patients performed CT and CT score (including the Lund-Mackay score and total CT score of ethmoid sinus) before operation. All the 50 patients received Messerklinger FESS treatment and postoperative nasal packing for hemostasis. On the basis of different nasal packing materials, the patients were divided into the Vaseline packing group and gelatin sponge packing group, with 25 cases in each group. The visual analog scale (VAS), total blood loss after packing, and CT score of paranasal sinuses were evaluated before surgery and 48 h after surgery. Hemorrhage ＜5 mL during tamponading was considered as satisfactory. Logistic regression analysis was used to predict the risk factors suitable for gelatin sponge stuffing based on the sinus CT score of paranasal sinuses. The optimal cut-off value was determined by the receiver operating characteristic (ROC) curve, and the area under curve (AUC) was used to predict the CT score of the paranasal sinuses suitable for gelatin sponge stuffing.Results No statistical significance in gender, pathological nature and side, and preoperative VAS scores (including nasal congestion, runny nose, dysosmia, and head and facial pain VAS) was found between the two groups (all P values＞0.05). Twenty-five cases (100%) in the Vaseline group and 23 cases (92%) in gelatin sponge group achieved hemostasis, no significant difference was found between the two groups(P＞0.05). No significant difference VAS of runny nose during postoperative filling, and total blood loss after filling (all P values＞0.05) was found between the gelatin sponge group and Vaseline group. Nasal congestion VAS, head and facial pain VAS, and dysosmia VAS were lower, and the differences were statistically significant (t=4.324、4.861、5.207, all P values＜0.05). The total score of paranasal sinus CT of sinuses and the ethmoid sinus CT score in the gelatin sponge group [(8.2±1.2) points, (3.1±1.9) points] were lower than those in the Vaseline group [(15.0±4.0) points, (6.5±1.4) points]. The differences were statistically significant (t=6.383, 7.171, all P values＜0.01). The total paranasal sinus CT score [odds ratio (OR)=1.366 (95% CI 1.004-1.860)] and ethmoid sinus CT score [the sum of anterior and posterior sieve scores, OR=2.155 (95% CI 1.155-4.021)] were significantly correlated with the hemostatic satisfaction of gelatin sponge packing (all P values＜0.05). The ROC curve showed that both groups had a high predictive value with hemostatic satisfaction of gelatin sponge packing (AUC values were 0.91 and 0.92 respectively, all P values＜0.05). When the total CT score of paranasal sinuses was less than 9.5, the Yoden index was 0.80, and the sensitivity and specificity of predicting gelatin sponge packing were 84.0% and 96.0%, respectively. When the total score of the ethmoid sinus was less than 4.5, the Yoden index was 0.68, and the sensitivity and specificity of gelatin sponge packing were 76.0% and 92.0%, respectively.Conclusions The evaluation of the CT score of the paranasal sinus before FESS is of certain significance in predicting the use of reasonable nasal packing after operation. When the total score of CT of the paranasal sinus and CT of the ethmoid sinus is low, gelatin sponge can be used for cavity packing, which can not only effectively stop bleeding, but also improve the comfort of patients.

Key words： Sinusitis CT score of paranasal sinuses Functional endoscopic sinus surgery Nasal packing

收稿日期: 2020-12-29

通讯作者: 刘成珠,Email:1648064560@qq.com

引用本文:

徐松波, 刘成珠, 尤国军, 祁冬, 吴目武, 娄帅, 张月婷, 郭燕燕. 术前鼻窦CT Lund-Mackay评分对功能性内镜鼻窦手术后鼻腔填塞物选取的预测价值[J]. 中华解剖与临床杂志, 2021, 26(6): 690-695.
Xu Songbo, Liu Chengzhu, You Guojun, Qi Dong, Wu Muwu, Lou Shuai, Zhang Yueting, Guo Yanyan. Predictive value of the preoperative CT Lund-Mackay score of paranasal sinuses in the selection of nasal packing after functional endoscopic sinus surgery. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 690-695.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20201229-00429 或 http://www.cjac.com.cn/CN/Y2021/V26/I6/690

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