Yuan X P, Guo Q R, Geng C L, Liu Y, Wang M, Xing Z M
Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Peking University, Beijing 100044, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Dec 7;51(12):902-908. doi: 10.3760/cma.j.issn.1673-0860.2016.12.005.
To analyze the subjective and objective results and the correlation of nasal obstruction because of nasal structural variation pre and post operation, and to provide clinical evidence for surgery and curative effect. Three groups were included in this study: group 1 were 78 patients with structural rhinitis, group 2 were 72 patients with chronic sinusitis (without nasal polyp) and group 3 were healthy controls of 75 cases. Assessment of nasal obstruction was achieved by visual analog scale (VAS), and objective measurement was achieved by rhinomanometry and acoustic rhinometry. The first two minimum cross-sectional area of nasal cavity (MCA1, MCA2), their distances from the nostrils (MD1, MD2) and the nasal volume of 5 cm depth from the nostril (NV5) were recorded. The ratio of the parameters of the two sides of the nasal cavity was calculated respectively. Nasal resistance total (RT) and calculated right-left nasal resistance ratio (Rlr) were recorded. Patients of group 1 and group 2 accepted endoscopic surgery and received the above evaluation again at three months after surgery. Three groups were compared with statistical test. The preoperative values of three groups (MCA1, MD1, MCA2, MD2, NV5, RT) showed no statistical significance ( value was 0.945, 0.245, 1.380, 0.036, 0.866, 1.651, respectively; all >0.05), while their ratio had statistical differences except MD1 ( value was 5.242, 1.726, 4.882, 4.005, 5.066, 5.316; =0.013, 0.199, 0.019, 0.024, 0.018, 0.011, respectively). Statistical results between the ratio of values (MCA1, MD1, MCA2, MD2, NV5, RT) and VAS of nasal obstruction of group 1 and group 2 showed significant positive correlations pre operation( of group 1 value was 0.471, 0.418, 0.260, 0.324, 0.305, 0.459, respectively; of group 2 value was 0.373, 0.403, 0.288, 0.366, 0.402, 0.249, respectively; all <0.05). VAS scores pre and post operation of group 1 had statistically difference (=35.122, <0.05). Postoperative value of MD1, MD2 and RT among three groups had no statistical difference ( value was 0.178, 0.582, 0.905, respectively; all >0.05). Postoperative value of MCA1, MCA2, NV5 among three groups had statistical difference ( value was 4.010, 5.126, 4.901, respectively; all <0.05). Postoperative ratio of MCA1, MD1, NV5 and Rlr among three groups had no statistical difference ( value was 1.023, 0.944, 0.524, 0.996, respectively; all >0.05). Postoperative ratio of MCA2 and MD2 among three groups had statistical difference ( value was 4.859, 4.357, respectively; all <0.05). Severity of nasal obstruction is related to structural variation of nasal cavity and the purpose of surgery is to restore structural symmetry of bilateral nasal cavity.
分析鼻腔结构变异所致鼻阻塞手术前后的主观和客观结果及其相关性,为手术及疗效提供临床依据。本研究纳入三组:第一组为78例结构型鼻炎患者,第二组为72例慢性鼻窦炎(无鼻息肉)患者,第三组为75例健康对照者。采用视觉模拟量表(VAS)评估鼻阻塞情况,通过鼻阻力计和鼻声反射仪进行客观测量。记录鼻腔前两个最小横截面积(MCA1、MCA2)、它们距鼻孔的距离(MD1、MD2)以及距鼻孔5 cm深度的鼻腔容积(NV5)。分别计算鼻腔两侧参数的比值。记录总鼻阻力(RT)和计算左右鼻阻力比值(Rlr)。第一组和第二组患者接受鼻内镜手术,并在术后三个月再次接受上述评估。对三组进行统计学检验比较。三组术前值(MCA1、MD1、MCA2、MD2、NV5、RT)差异无统计学意义(值分别为0.945、0.245、1.380、0.036、0.866、1.651;均>0.05),而其比值除MD1外有统计学差异(值分别为5.242、1.726、4.882、4.005、5.066、5.316;P = 0.013、0.199、0.019、0.024、0.018、0.011)。第一组和第二组数值(MCA1、MD1、MCA2、MD2、NV5、RT)比值与鼻阻塞VAS之间的统计结果显示术前呈显著正相关(第一组值分别为0.471、0.418、0.260、0.324、0.305、0.459;第二组值分别为0.373、0.403、0.288、0.366、0.402、0.249;均<0.05)。第一组手术前后VAS评分差异有统计学意义(=35.122,P<0.05)。三组术后MD1、MD2和RT值差异无统计学意义(值分别为0.178、0.582、0.905;均>0.05)。三组术后MCA1、MCA2、NV5值差异有统计学意义(值分别为4.010、5.126、4.901;均<0.05)。三组术后MCA1、MD1、NV5和Rlr比值差异无统计学意义(值分别为1.023、0.944、0.524、0.996;均>0.05)。三组术后MCA2和MD2比值差异有统计学意义(值分别为4.859、4.357;均<0.05)。鼻阻塞程度与鼻腔结构变异有关,手术目的是恢复双侧鼻腔结构对称性。