鼻内镜手术治疗真菌性鼻窦炎的疗效及术后复发的影响因素分析
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会理市人民医院 耳鼻咽喉科,四川 会理 615100

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Effect analysis of endoscopic sinus surgery on fungal sinusitis and the influencing factors of postoperative recurrence
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Department of Otorhinolaryngology, Huili People’s Hospital, Huili, Sichuan 615100, China

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    目的 探讨鼻内镜手术治疗真菌性鼻窦炎的疗效及术后复发的影响因素。方法 选择2019年4月-2022年4月于该院接受治疗的163例真菌性鼻窦炎患者作为研究对象,观察组(117例)采用鼻内镜手术进行治疗,对照组(46例)采用上颌窦根治术进行治疗。将观察组患者按照随机数表法以2∶1的比例,分为训练集(78例)和验证集(39例),根据患者术后是否复发,将训练集患者分为术后复发组(27例)和术后未复发组(51例)。比较观察组和对照组的治疗效果;对训练集患者的临床资料进行比较,并对患者术后复发的影响因素进行单因素和多因素分析。通过R软件构建贝叶斯网络模型,并进行模型的推理预测;通过受试者操作特征曲线(ROC curve)和校准曲线对模型的效能进行验证。结果 观察组治疗真菌性鼻窦炎的有效率为70.94%,明显高于对照组的52.17%,差异有统计学意义(χ2 = 5.16,P = 0.023);观察组的复发率为29.91%,明显低于对照组的47.83%,差异有统计学意义(χ2 = 4.66,P = 0.031)。Lund-Mackay评分 > 15分、吸烟、哮喘、多发性鼻息肉、嗜酸性粒细胞计数高和术后感染是鼻内镜术后复发的独立危险因素(P < 0.05)。训练集和验证集的曲线下面积(AUC)分别为0.767(95%CI:0.699~0.835)和0.741(95%CI:0.668~0.813),ROC curve特异度分别为90.42%和90.23%,灵敏度分别为90.18%和90.06%。结论 鼻内镜手术治疗真菌性鼻窦炎的疗效显著。Lund-Mackay评分 > 15分、吸烟、哮喘、多发性鼻息肉、嗜酸性粒细胞计数高和术后感染,是影响真菌性鼻窦炎患者鼻内镜术后复发的危险因素。

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    Objective To explore the curative effect of endoscopic sinus surgery for fungal sinusitis and the influencing factors of postoperative recurrence.Methods 163 patients with fungal sinusitis from April 2019 to April 2022 were selected as the study subjects. Among them, 117 patients in the observation group were treated with endoscopic sinus surgery. The control group (46 cases) was treated with radical maxillary sinusotomy. The patients in the observation group were divided into training set (78 cases) and verification set (39 cases) at a ratio of 2∶1 according to the random number method. The patients in the training set were divided into postoperative recurrence group (27 cases) and postoperative non recurrence group (51 cases) according to whether the patients recurred or not. To compare the therapeutic effect of fungal sinusitis between the observation group and the control group. The clinical data of patients in the training set were compared, and the influencing factors of postoperative recurrence were analyzed by univariate and multivariate analysis. Build Bayesian network model through R software, and make inference and prediction of the model. The effectiveness of the model was verified by receiver operator characteristic curve (ROC curve) and calibration curve.Results The effective rate of fungal sinusitis in the observation group was 70.94%, significantly higher than 52.17% in the control group, with a statistically significant difference (χ2 = 5.16, P = 0.023); The recurrence rate of the observation group was 29.91%, significantly lower than 47.83% of the control group, and the difference was statistically significant (χ2 = 4.66, P = 0.031). The Lund-Mackay score > 15 points, smoking, asthma, multiple nasal polyps, high eosinophil count and postoperative infection were independent risk factors for postoperative recurrence (P < 0.05). The AUC of the training set and validation set were 0.767 (95%CI: 0.699 ~ 0.835) and 0.741 (95%CI: 0.668 ~ 0.813), respectively, with ROC curve specificity of 90.42% and 90.23%, respectively, the sensitivity of 90.18% and 90.06% respectively.Conclusion Endoscopic sinus surgery has a significant effect on fungal sinusitis. Lund-Mackay score > 15 points, smoking, asthma, multiple nasal polyps, high eosinophil count and postoperative infection are risk factors for postoperative recurrence of patients undergoing endoscopic sinus surgery.

    表 2 影响真菌性鼻窦炎患者鼻内镜术后复发的单因素分析Table 2 Univariate analysis of recurrence after endoscopic sinus surgery in patients with fungal sinusitis
    表 3 多因素Logistic回归分析赋值表Table 3 Assignment table of multivariate Logistic regression analysis
    图1 真菌性鼻窦炎患者鼻内镜术后复发的贝叶斯网络结构分析图Fig.1 Bayesian network structure analysis of recurrence after endoscopic sinus surgery in patients with fungal sinusitis
    图2 真菌性鼻窦炎患者鼻内镜术后复发的贝叶斯网络推理图Fig.2 Bayesian network inference diagram of recurrence after endoscopic sinus surgery in patients with fungal sinusitis
    表 1 两组患者治疗效果比较 例(%)Table 1 Comparison of treatment effect between the two groups n (%)
    表 4 影响真菌性鼻窦炎患者鼻内镜术后复发的多因素Logistic回归分析Table 4 Multivariate Logistic regression analysis of recurrence after endoscopic sinus surgery in patients with fungal sinusitis
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付剑锋,王开府.鼻内镜手术治疗真菌性鼻窦炎的疗效及术后复发的影响因素分析[J].中国内镜杂志,2023,29(11):45-52

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  • 收稿日期:2022-11-23
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