既往鼻中隔成形术是否影响鼻成形术结局？功能、心理及自我评估指标的比较分析

文献信息

中文摘要

背景： 鼻中隔鼻成形术后的患者满意度取决于功能结局和主观因素，包括自我感知、自尊和心理健康。
方法： 在一项前瞻性研究中纳入75例符合鼻中隔鼻成形术条件的患者：47例女性（62.7%）和28例男性（37.3%），年龄18-63岁，M=34.24，SD=10.53。27例患者（36%）既往接受过鼻中隔成形术，其中7例（9.3%）需要耳廓软骨移植；48例患者（64%）无既往鼻中隔手术史。患者在术前以及术后1个月和6个月完成经验证的鼻成形术结局评价（ROE）、标准化美容与健康鼻部结局调查（SCHNOS）和鼻塞症状评价（NOSE）问卷。生活质量和自尊分别在术前和术后采用世界卫生组织生活质量-BREF（WHOQOL-BREF）和自尊量表进行评估。数据使用IBM SPSS 29.0分析，α=0.05。
结果： 两组均显示美学结局改善。与初次病例相比，既往鼻中隔成形术与术后1个月总体鼻成形术满意度较低以及术后1个月和6个月美容满意度较低相关（即SCHNOS-美容（SCHNOS-C）评分较高，该评分值越高表示越不满意）。两组NOSE评分均显著改善，而无论手术史如何，术后生活质量和自尊均显著提高。
结论： 鼻中隔鼻成形术后鼻功能、生活质量和自尊均有显著改善；在缺乏未手术对照组的情况下，这些变化代表观察到的术前至术后变化，而非手术因果关系的证据。既往鼻中隔成形术可能与较差的早期功能和美学恢复相关，但并不妨碍有意义的术后改善。这些患者可能需要更详细的术前规划和咨询。

英文摘要

Background: Patient satisfaction after rhinoseptoplasty depends on both functional outcomes and subjective factors, including self-perception, self-esteem and psychological well-being. Methods: A prospective study was conducted in 75 patients qualified for rhinoseptoplasty as follows: 47 women, 62.7%, and 28 men, 37.3%, aged 18-63 years, M = 34.24, and SD = 10.53. Twenty-seven patients (36%) had undergone previous septoplasty, including seven (9.3%) who required auricular cartilage grafting, while 48 patients (64%) had no prior septal surgery. Validated the Rhinoplasty Outcome Evaluation (ROE), the Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and the Nasal Obstruction Symp-tom Evaluation (NOSE) questionnaires were completed preoperatively and at 1 and 6 months postoperatively. Quality of life was assessed with the World Health Organisation Quality of Life-BREF (WHOQOL-BREF) and self-esteem with Self-Esteem Scale, both before and after surgery. Data were analysed using IBM SPSS 29.0, with α = 0.05. Results: The groups showed improvement in aesthetic outcomes. Previous septoplasty was associated with lower overall rhinoplasty satisfaction at one month and lower cosmetic satisfaction at one and six months compared with primary cases (i.e., higher SCHNOS- Cosmesis (SCHNOS-C) scores, on which higher values denote greater dissatisfaction). NOSE scores improved markedly in both groups, while quality of life and self-esteem increased significantly after surgery, regardless of surgical history. Conclusions: Rhinoseptoplasty was followed by significant improvement in nasal function, quality of life and self-esteem; in the absence of a non-operated control group, these changes represent observed pre- to postoperative change rather than proof of surgical causation. Previous septoplasty may be associated with less favourable early functional and aesthetic recovery, but it does not prevent meaningful postoperative improvement. These patients may require more detailed preoperative planning and counselling.