Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (4): 87-91.doi: 10.6040/j.issn.1673-3770.0.2019.373

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Potential risk factors and evaluation of a predictive risk score model for postoperative adhesion in functional endoscopic sinus surgeryCHEN Dong1, YU Hong2, LI Yang1, HUANG Qiang1, FANG Min1 1. Department of Otolaryngology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, China; 2. Department of Pathology, Jiangyou Peoples Hospital, Jiangyou 621700, Sichuan, ChinaAbstract:Objective〓

This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. MethodsA retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. ResultsPostoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. ConclusionThe incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.   

  1. Key words:Functional endoscopic sinus surgery;
    Synechiae;
    Risk factors;
    Risk assessment scoring功能性鼻内窥镜鼻窦手术(functional endoscopic sinus surgery, FESS)是用于药物治疗不能充分控制的慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)的金标准外科手术。中鼻道鼻腔粘连形成是FESS最常见的并发症, 会对疾病预后和患者生活质量产生不良影响［1］。即使对CRS患者采取了最佳的手术方式和仔细的术后清理, 仍有一部分患者会出现术后粘连［2］。识别术后粘连的高风险人群有利于及时采取积极防治措施。因此, 本研究旨在探究CRS患者某些固有的一般人口学特征、术前临床特征及术者因素是否会对FESS术后发生粘连的风险产生影响, 并探讨和建立术后粘连风险评分体系, 对预测效果进行评价。
  • Received:2019-07-26 Online:2020-07-20 Published:2020-08-28

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Abstract: Objective This study was conducted to explore the preoperative risk factors for postoperative adhesion in patients with chronic rhinosinusitis(CRS)undergoing functional endoscopic sinus surgery(FESS), and to construct a risk score model to evaluate their predictive effect. Methods A retrospective study was conducted on 323 patients with CRS who underwent FESS at our hospital between January 2015 and June 2018. The risk factors for postoperative adhesion were screened using a multivariate logistic regression analysis. The risk score was assigned according to the odds ratio(OR)value, and a receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effect. Results Postoperative adhesion occurred in 35 patients(10.8%). The logistic regression results showed that concha bullosa, primary FESS, operative experience less than 10 years, and a history of middle turbinate resection were independent risk factors for postoperative adhesion in FESS. The OR values were 1.12(95% CI: 1.06-1.18), 3.87(95% CI: 2.23-5.51), 3.19(95% CI: 2.07-4.31), and 2.24(95% CI:1.95-2.53), respectively. The risk score model assigned 1 point for vesicular middle turbinate, 4 points for first time FESS, 3 points for operative experience less than 10 years, and 2 points for middle turbinate resection. The ROC curve analysis showed that the area under the curve(AUC)was 0.784(95% CI: 0.672-0.896, P<0.05). When 4 points were selected as the cut-off point, the Jordan index was the largest, with a sensitivity of 75.1% and a specificity of 73.6%. Conclusion The incidence of postoperative adhesion in 323 patients with CRS who underwent FESS was 10.8%. The risk score model has certain reference value for predicting high-risk postoperative adhesion.

Key words: Functional endoscopic sinus surgery, Synechiae, Risk factors, Risk assessment scoring

CLC Number: 

  • R764
[1] Adriaensen GFJPM, Lim KH, Fokkens WJ. Safety and efficacy of a bioabsorbable fluticasone propionate-eluting sinus dressing in postoperative management of endoscopic sinus surgery: a randomized clinical trial[J]. Int Forum Allergy Rhinol, 2017, 7(8):813-820. doi:10.1002/alr.21963.
[2] Zheng XL, Zhao YX, Xu M. Efficacy and safety of 3 nasal packing materials used after functional endoscopic sinus surgery for chronic rhinosinusitis: a comparative study in China[J]. Med Sci Monit, 2017, 23:1992-1998. doi:10.12659/msm.899553.
[3] 程友, 李泽卿, 张勇, 等. 经鼻蝶垂体瘤切除术后脑脊液鼻漏的影响因素分析[J]. 中国耳鼻咽喉颅底外科杂志, 2014, 20(2):134-136. doi:10.11798/j.issn.1007-1520.201402011. CHENG You, LI Zeqing, ZHANG Yong, et al. Risk factors in cerebrospinal fluid rhinorrhea following transnasosphenoidal resection of pituitary adenoma[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2014, 20(2):134-136. doi:10.11798/j.issn.1007-1520.201402011.
[4] Maharaj DD, Virk RS, Bansal S, et al. Comparison of basal Lamella relaxing incision and combined conventional medialisation and controlled synechiae in functional endoscopic sinus surgery: a randomised prospective study[J]. J Laryngol Otol, 2018, 132(7):605-610. doi:10.1017/S0022215118000944.
[5] Manji J, Habib AR, Macias-Valle L, et al. Comparing the efficacy of Silastic and gloved-Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial[J]. Int Forum Allergy Rhinol, 2018. doi:10.1002/alr.22119.
[6] Mantovani M, Rinaldi V, Torretta S, et al. The dragonfly splint: a new disposable device designed to prevent both medial and lateral turbinate synechiae after sinonasal surgery[J]. J Craniofac Surg, 2014, 25(2):547-550. doi:10.1097/SCS.0000000000000388.
[7] Testa D, Marcuccio G, Panin G, et al. Nasal mucosa healing after endoscopic sinus surgery in chronic rhinosinusitis of elderly patients: role of topic alpha-tocopherol acetate[J]. Aging Clin Exp Res, 2017, 29(Suppl 1):191-195. doi:10.1007/s40520-016-0647-x.
[8] 马明忠, 周霞, 伊纪亮, 等. 慢性鼻-鼻窦炎鼻内镜术后鼻腔粘连的预防及处理探讨[J]. 中国中西医结合耳鼻咽喉科杂志, 2017, 25(4):276-277. doi:10.16542/j.cnki.issn.1007-4856.2017.04.011. MA Mingzhong, ZHOU Xia, YI Jiliang, et al. Prevention and treatment of nasal adhesion after endoscopic surgery for chronic rhinosinusitis[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2017, 25(4):276-277. doi:10.16542/j.cnki.issn.1007-4856.2017.04.011.
[9] 张敏, 王永良. 鼻内窥镜术后粘连发生情况及影响因素分析[J]. 中国医药导报, 2015, 12(4): 80-82. ZHANG Min, WANG Yongliang. Investigation on the occurrence status of adhesion after nasal endoscopic operation and its influence factors[J]. China Medical Herald, 2015, 12(4): 80-82.
[10] 林庆洪, 王龙海, 张玉琴. 鼻内镜手术治疗慢性鼻窦炎鼻息肉的临床观察[J]. 中国耳鼻咽喉颅底外科杂志, 2015, 21(3):252-254. doi:10.11798/j.issn.1007-1520.201503024.
[11] 岳伟. 鼻内镜鼻窦手术中鼻腔鼻窦解剖变异与慢性鼻窦炎的关系[J]. 山东大学耳鼻喉眼学报, 2016(1):64-66. doi:10.6040/j.issn.1673-3770.0.2015.500. YUE Wei. Relationship between sinonasal anatomic variation and chronic sinusitis in endoscopic sinus surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016(1):64-66. doi:10.6040/j.issn.1673-3770.0.2015.500.
[12] 张万红, 赵玉林, 李星丹. 泡状中鼻甲引流通道的三维CT影像学观察[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(10):753-756. doi:10.13201/j.issn.1001-1781.2017.10.004. ZHANG Wanhong, ZHAO Yulin, LI Xingdan. 3D computed tomographic study of concha bullosa drainage pathway[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2017, 31(10):753-756. doi:10.13201/j.issn.1001-1781.2017.10.004.
[13] 董吕华, 毛华杰, 赵波. 两种术式治疗泡状中鼻甲的临床研究[J]. 中国耳鼻咽喉头颈外科, 2014, 21(11):611-612. doi:10.16066/j.1672-7002.2014.11.017.
[14] 沈勤峰, 沈小燕, 朱荣强, 等. 鼻内镜下中鼻甲功能性部分切除治疗慢性鼻窦炎76例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5):82-85. doi:10.6040/j.issn.1673-3770.0.2018.176. SHEN Qinfeng, SHEN Xiaoyan, ZHU Rongqiang, et al. Role of functional middle turbinectomy in functional endoscopic sinus surgery for chronic sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5):82-85. doi:10.6040/j.issn.1673-3770.0.2018.176.
[15] Jiang RS, Liang KL. The influence of functional endoscopic sinus surgery on sleep related outcomes in patients with chronic rhinosinusitis[J]. Int J Otolaryngol, 2019, 2019:7951045. doi:10.1155/2019/7951045.
[16] Corbett M, OConnor P, Byrne D, et al. Identifying and reducing risks in functional endoscopic sinus surgery through a hierarchical task analysis[J]. Laryngoscope Investig Otolaryngol, 2019, 4(1):5-12. doi:10.1002/lio2.220.
[17] Dubny S, Peluso F, Masson I, et al. Application of a health risk assessment model for cattle exposed to pesticides in contaminated drinking waters: a study case from the Pampas region, Argentina[J]. Chemosphere, 2018, 196:585-592. doi:10.1016/j.chemosphere.2018.01.013.
[18] Zhou HX, Hu YH, Li XQ, et al. Assessment of the risk of venous thromboembolism in medical inpatients using the Padua prediction score and caprini risk assessment model[J]. J Atheroscler Thromb, 2018, 25(11):1091-1104. doi:10.5551/jat.43653.
[19] 万晓龙. ERCP术后胰腺炎危险因素分析及预测效果评价[J]. 中国中西医结合消化杂志, 2018, 26(8):677-680. doi:10.3969/j.issn.1671-038X.2018.08.11. WAN Xiaolong. Analysis of the risk factors for post-ERCP pancreatitis and assessment its predict effect in patients of gastroenterology department[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion, 2018, 26(8):677-680. doi:10.3969/j.issn.1671-038X.2018.08.11.
[20] 祝语. 慢性鼻窦炎病因及发病机制[J]. 科技风, 2016(23):167. doi:10.19392/j.cnki.1671-7341.201623159.
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