摘要
目的:探讨药物和手术治疗儿童慢性鼻-鼻窦炎(CRS)的临床疗效。方法:72例诊断为CRS的儿童随机分为药物治疗组(35例)和手术治疗组(37例),药物治疗采用糠酸莫米松喷鼻、碱性盐水鼻腔冲洗加用低剂量克拉霉素,疗程为12周。手术治疗分别采用:①腺样体切除(19例);②扁桃体加腺样体切除(10例);③内镜鼻窦手术(8例)。采用:①VAS评估其症状;②鼻内镜观察评估鼻腔,时间窗分别安排在治疗前和治疗后1、3、6、12个月;③CT评估,时间窗分别安排在治疗前和治疗后12个月。结果:2组患儿经过1个月治疗后,其症状VAS总分和鼻内镜评分均较治疗前明显下降(P<0.05),但2组间差异无统计学意义(P>0.05);经过治疗3、6个月,2组症状VAS总分和鼻内镜评分均较治疗前和治疗1个月明显下降(P<0.01),2组间差异有统计学意义(P<0.01);治疗后12个月,2组症状VAS总分、鼻内镜评分均较治疗前和治疗1、3、6个月明显下降(P<0.01),CT评分也较治疗前明显下降(P<0.01),2组间疗效差异有统计学意义(P<0.01);将手术治疗组中不同术式比较,结果显示术后1个月VAS总分和鼻内镜评分差异有统计学意义(P<0.01),其他各期均差异无统计学意义(均P>0.05)。结论:2种治疗方式对于儿童CRS均有较好的疗效。但首先应行药物治疗,小剂量长期应用克拉霉素是治疗儿童CRS一种安全有效的药物治疗方式,经过最大药物治疗疗效不满意的CRS患儿,可选择腺样体切除术、扁桃体切除术和内镜鼻窦手术等术式,腺样体和扁桃体切除术可作为腺样体和扁桃体肥大CRS患儿的推荐术式。
Objective：To compare the effect of the medical and surgical treatment of pediatric chronic rhinosinusitis（CRS）.Method：Seventy-two cases of pediatric CRS were randomly divided into medical group（35 cases） and surgical group（37 cases）.The patients in medical group received a 12-week course of clarithromycin,alkaline nasal douche and intranasal momestasone furoate.The patients in surgical group underwent adenoidectomy or（and） tonsillectomy or ESS.All patients underwent pre-and post-treatment assessments of visual analogue score（VAS） and nasal endoscopy.The assessments of CT were arranged before starting the treatment and post-treatment in 12-month.Result：Both groups of pediatric CRS significantly improved in VAS and endoscopic parameters of CRS in all stages.There were no significant difference between two groups in 1-month（P〉0.05）.The surgical group demonstrated greater change than medical group in 3-month,6-month and 12-month（P〈0.01）.In surgical group,37 cases underwent three different styles of operation： adenoidectomy（n=19）,adenoidectomy and tonsillectomy（n=10） and ESS（n=8）.VAS and endoscopic parameters were not significantly different among three groups in all stages except in 1-month.Conclusion：The results of this study warrant further that both medical and surgical treatment of pediatric CRS significantly improve in VAS and endoscopic parameters of CRS.The mainstay of management is medical treatment.Long-term,low-dose macrolide is an effective therapy and a valid alternative in pediatric CRS.Surgical intervention is necessary for cases that do not respond to prolonged course medical treatment.Adenoidectomy or（and） tonsillectomy seems to be a recommended surgical procedure for children with adenoid or（and） tonsil hypertrophy.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2011年第5期213-216,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
鼻-鼻窦炎
慢性
儿童
药物治疗
手术治疗
rhinosinusitis
chronic
child
medical treatment
surgical treatment
