ACCOMPLISH评分：一种用于分级慢性鼻窦炎伴鼻息肉内镜手术范围的新型术中内镜评分系统

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中文摘要

背景： 当前用于分级内镜鼻窦手术（ESS）范围的评分系统存在局限性，这表明需要更简单的、也能由经验较少的耳鼻咽喉科医生使用的内镜评分。方法：我们前瞻性记录了30例慢性鼻窦炎伴鼻息肉受试者在ESS结束时的术野。五名经验不同的评分者根据对每个鼻窦客观、易于识别且按序分布的解剖标准的识别来对视频进行评分，这些标准如后壁、顶壁、颅底或纸样板。识别出的解剖标准数量越多，手术范围越广。该评分被命名为ACCOMPLISH，取值从1（范围较大）到0（ESS范围较小）。我们使用组内相关系数（ICC）和Gwet AC2系数测量评分者间一致性。结果：按手术经验从多到少排序，评分者的ACCOMPLISH评分中位数分别为0.95、0.97、0.70、0.82和0.88。所有评分者之间的一致性为中等（ICC=0.69；P<0.001），最有经验的评分者之间为极好（0.91；P<0.001），有经验与无经验评分者之间为好（0.81；P<0.001）。所有评分者对ACCOMPLISH标准的一致性在前组和后组筛窦几乎完全一致（Gwet AC2：0.86-0.91；均P<0.001），在额窦和蝶窦为高度一致（0.61-0.72；均P<0.001），在上颌窦为一般一致（0.21-0.22；均P<0.035）。结论：ACCOMPLISH评分作为一种简单、术中、内镜下的ESS范围分级评分，取得了较好的效果。其在有经验的鼻科医生中重复性极好，在经验较少的鼻科医生中仍保持良好。

英文摘要

Limitations of current scores grading the extent of endoscopic sinus surgery (ESS) indicate the need for simpler endoscopic scores utilized also by less experienced otorhinolaryngologists. We prospectively recorded in 30 subjects with chronic rhinosinusitis with nasal polyps the surgical field at the end of ESS. Five raters with different experience scored the videos based on the identification of objective, easily recognizable, and ordinally distributed anatomical criteria for each sinus, such as the posterior wall, roof, skull base, or lamina papyracea. The greater the number of identified anatomical criteria, the more extensive the surgery. The score was titled ACCOMPLISH, with values from 1 (greater extent) to 0 (lesser extent of ESS). We measured the inter-rater agreement with the intraclass correlation coefficient (ICC) and Gwet AC2 coefficient. The median ACCOMPLISH score of the raters, ordered from greatest to least surgical experience, was 0.95, 0.97, 0.70, 0.82, and 0.88. The inter-rater agreement was moderate between all raters (ICC=0.69; P<0.001), excellent between the most experienced raters (0.91; P<0.001), and good between experienced and inexperienced raters (0.81; P<0.001). The inter-rater agreement of all raters for the ACCOMPLISH criteria was almost perfect for the anterior and posterior ethmoidal sinus (Gwet AC2: 0.86-0.91; all P<0.001), substantial for the frontal and sphenoid sinus (0.61-0.72; all P<0.001), and fair for the maxillary sinus (0.21-0.22; both P<0.035). The ACCOMPLISH score fairly succeeded as a simple, intraoperative, endoscopic score grading the extent of ESS. Its repeatability was excellent among experienced rhinologists and remained good among less experienced rhinologists.