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研究生:江榮山
研究生(外文):Rong-San
論文名稱:功能性內視鏡鼻竇手術對慢性鼻及鼻竇炎病患嗅覺功能之影響
論文名稱(外文):Effect of Functional Endoscopic Sinus Surgery on the Olfactory Function of Patients with Chronic Rhinosinusitis
指導教授:呂峰洲陳文貴陳文貴引用關係
學位類別:博士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:54
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研究目的:本研究旨在探討慢性鼻及鼻竇炎病患在接受功能性內視鏡鼻竇手術後,其嗅覺功能變化情形,並進一步探討可能的預後因子。
研究方法:收集接受功能性內視鏡鼻竇手術治療的慢性鼻及鼻竇炎病患。在手術前一日,這些病患的嗅覺功能用問卷、苯基乙醇氣味偵測閾值檢查、賓州大學嗅覺識別檢查及短時間氣味記憶分辨檢查來評估。手術六個月後,這些病患的嗅覺功能再用同樣方法來評估,同時分析可能的預後因子〈鼻塞、鼻腔截面積、鼻及鼻竇炎嚴重度、術前嗅覺喪失程度、鼻息肉、過敏性鼻炎、附帶鼻中膈鼻甲手術、術後類固醇治療〉對術後嗅覺功能改變的影響。
研究結果:本研究共收集70名慢性鼻及鼻竇炎病患。其中52名病患注意到他們的嗅覺功能在手術前就有受損,但是閾值檢查顯示66名病患的閾值高於-6,識別檢查顯示62名病患的分數低於30。手術後,27名病患說他們的嗅覺功能有進步,閾值檢查顯示30名病患的閾值有進步,識別檢查顯示36名病患的分數有進步。問卷、乙酚乙二醇氣味偵測閾值檢查和賓州大學嗅覺識別檢查的結果有好的一致性。在可能的預後因子中,鼻塞、鼻腔截面積、鼻及鼻竇炎嚴重度、術前嗅覺喪失程度、鼻息肉及過敏性鼻炎並無法有效預測術後嗅覺功能是否會進步,但是有嚴重鼻及鼻竇炎及嚴重術前嗅覺喪失的病患以及合併過敏性鼻炎或不合併鼻息肉的病患術後嗅覺功能較會進步。附帶鼻中膈鼻甲手術也無法幫忙改善術後嗅覺功能,但術後合併類固醇治療則可稍許幫忙改善嗅覺功能,雖然幫忙不是很顯著。
結論與建議:雖然許多方法被用來評估嗅覺功能,而且評估嗅覺功能的面向各個方法也不盡相同但是本研究顯示賓州大學嗅覺識別檢查是個較好的評估慢性鼻及鼻竇炎病患嗅覺功能的方法。對這些病患而言,疾病的嚴重度、是否合併鼻息肉及過敏性鼻炎、術後是否使用類固醇會影響術後嗅覺功能的改善,但影響不是很顯著。


Objectives: This study aims to investigate the change of olfactory function in patients with chronic rhinosinusitis after functional endoscopic sinus surgery and explore the potential prognostic factors.
Methods: Patients with chronic rhinosinusitis who had previously undergone functional endoscopic sinus surgery were enrolled in the study. On the day before FESS, olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test (STT), the University of Pennsylvannia Smell Identification Test (UPSIT) and a short-term odor memory/discrimination test, and re-evaluated by the same methods 6 months after FESS. The potential prognostic factors (nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps, allergic rhinitis, concurrent septoplasty and turbinal surgery, postoperative steroid treatment) for improvement in olfaction after FESS were also evaluated in these patients.
Results: A total of 70 patients with chronic rhinosinusitis were enrolled in the study. Fifty-two patients noticed their olfactory function was impaired before surgery, but the olfactory threshold was above –6 in 66 patients, and 62 patients’ UPSIT scores were below 30. After surgery, the olfactory function was improved in 27 patients using patients’ reports, in 30 patients by STT and in 36 patients by UPSIT. A good agreement existed between STT and UPSIT results and patients’ reports. Among potential prognostic factors, nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps and allergic rhinitis were not significantly reliable to predict improvement in olfaction after surgery, but patients with severe rhinosinusitis and severe preoperative olfactory loss and those with allergic rhinitis or without nasal polyps tended to show olfactory improvement. Concurrent septoplasty and turbinal surgery did not increase the rate of olfactory improvement after FESS, but postoperative use of nasal steroids did increase the rate of olfactory improvement, although the difference was not significant.
Conclusion: Although many methods have been used to evaluate olfactory function, and the domains of olfactory function evaluated were not the same among these methods, our study showed that UPSIT should be the test of choice for evaluating olfactory function in patients with chronic rhinosinusitis. For these patients, disease severity, coexistence of nasal polyps and allergic rhinitis, and postoperative use of nasal steroids were found to be more reliable prognostic factors for improvement in olfaction after FESS, but these factors were not significantly reliable.


封面內頁
授權書                          ii
口試委員簽名單                      iii
指導教授簽名單                      iv
中文摘要                         v
英文摘要                         vi
誌謝                         vii
目錄                        viii
表目錄                          x

第一章 前言
第一節 研究動機                      1
第二節 研究目的                     1
第二章 文獻探討
第一節 慢性鼻及鼻竇炎與嗅覺功能喪失           2
第二節 功能性內視鏡鼻竇手術與嗅覺功能喪失         2
第三節 影響功能性內視鏡鼻竇手術治療嗅覺異常因素     3
第三章 材料與方法
第一節 研究方法                     5
第二節 受試者                        5
第三節 一般檢查步驟                     5
第四節 嗅覺功能檢查步驟                  6
第五節 手術步驟                      7
第六節 統計分析                      7
第四章 結果
第一節 研究對象基本資料                10
第二節 術前一般檢查                    10
第三節 術前嗅覺功能檢查                  13
第四節 術中同時施行鼻中膈矯正術或下鼻甲黏膜下電燒術
以及術後併用類固醇                    16
第五節 術後嗅覺功能檢查                 19
第六節 術前術後嗅覺功能檢查之比較            22
第七節 嗅覺功能檢查之比較                25
第八節 術前鼻塞與術後嗅覺功能改善相關性         26
第九節 術前左右鼻腔第二最小截面積與術後嗅覺功能
改善相關性                         29
第十節 術前電腦斷層檢查分數與術後嗅覺功能改善相關性  30
第十一節 術前嗅覺喪失程度與術後嗅覺功能改善相關性    31
第十二節 過敏性鼻炎與術後嗅覺功能改善相關性      36
第十三節 鼻息肉與術後嗅覺功能改善相關性        38
第十四節 術中同時施行鼻中膈矯正術或下鼻甲黏膜下電燒術與術後嗅覺功能改善相關性                   40
第十五節 術後併用類固醇與術後嗅覺功能改善相關性    43
第五章 討論                  45
第六章 結論                  50
參考文獻      51



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