可吸收止血材料用于鼻内镜术后填塞效果的观察
|
摘要
目的研究可吸收止血材料纳吸棉及明胶海绵在鼻内镜术后鼻腔填塞的临床效果。方法对56例因慢性鼻-鼻窦炎(CRS)于我科行功能性鼻内镜鼻窦手术(FESS)的患者进行随访。按术后填塞止血材料的不同分为纳吸棉组及明胶海绵组,比较2组在术前以及术后1 d的鼻部疼痛程度,术后2、4、12周的临床表现,包括鼻塞、流涕、头面部胀痛的视觉模拟评分(VAS)以及鼻内镜Lund-Kennedy评分。结果纳吸棉与明胶海绵都具有有效的止血作用。术后1 d 2组的填塞舒适度以及术后2周VAS、鼻内镜评分差异无统计学意义(P>0.05),术后1个月及3个月2组的VAS及鼻内镜评分差异有统计学意义(P<0.05)。纳吸棉组的鼻塞、流涕症状明显好于明胶海绵组,术腔愈合情况也比明胶海绵组更好,主要表现在息肉、水肿和鼻漏方面,而瘢痕、结痂评分差异无统计学意义。结论纳吸棉与明胶海绵都是有效的鼻腔止血材料,但是纳吸棉更理想。
Objective To investigate the effect of Gelfoam and Naso Pore on packing after functional endoscopic sinus surgery( FESS). Methods A total of 56 chronic rhinosinusitis( CRS) patients who had undergone FESS were followed up. In accordance with various nasal packing materials,patients were divided into Naso Pore group and Gelfoam group. Nasal pain was evaluated by visual analogue scale( VAS) before and 1 day after the operation.Clinical manifestations including VAS regarding nasal obstruction,nasal discharge and headache and Lund-Kennedy scores were evaluated 2,4,12 weeks after the operation. Results Both Naso Pore and Gelfoam had hemostatic effect.There was no significant difference in VAS and Lund-Kennedy scores between the two groups in 2 weeks( P > 0. 05).Difference of the two groups was significant in 4 and 12 weeks( P < 0. 05). In Naso Pore group,incidence of nasal obstruction and nasal discharge were lower and nasal cavity healing was better than Gelfoam group. Conclusions Both Naso Pore and Gelfoam are effective hemostatic packing materials and Naso Pore is better than Genlfoam.
Objective To investigate the effect of Gelfoam and Naso Pore on packing after functional endoscopic sinus surgery( FESS). Methods A total of 56 chronic rhinosinusitis( CRS) patients who had undergone FESS were followed up. In accordance with various nasal packing materials,patients were divided into Naso Pore group and Gelfoam group. Nasal pain was evaluated by visual analogue scale( VAS) before and 1 day after the operation.Clinical manifestations including VAS regarding nasal obstruction,nasal discharge and headache and Lund-Kennedy scores were evaluated 2,4,12 weeks after the operation. Results Both Naso Pore and Gelfoam had hemostatic effect.There was no significant difference in VAS and Lund-Kennedy scores between the two groups in 2 weeks( P > 0. 05).Difference of the two groups was significant in 4 and 12 weeks( P < 0. 05). In Naso Pore group,incidence of nasal obstruction and nasal discharge were lower and nasal cavity healing was better than Gelfoam group. Conclusions Both Naso Pore and Gelfoam are effective hemostatic packing materials and Naso Pore is better than Genlfoam.
引文
[1]Fokkens WJ,Lund VJ,Mullol J,et al.European Position Paper on Rhinosinusitis and Nasal Polyps 2012[J].Rhinol Suppl,2012,50(Suppl 23):1-298.
[2]Wang TC,Tai CJ,Tsou YA,et al.Absorbable and nonabsorbable packing after functional endoscopic sinus surgery:systematic review and meta-analysis of outcomes[J].Eur Arch Otorhinolaryngol,2015,272(8):1825-1831.
[3]Massey CJ,Suh JD,Tessema B,et al.Biomaterials in rhinology[J].Otolaryngol Head Neck Surg,2016,154(4):606-617.
[4]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南(2012年,昆明)[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):92-94.
[5]Mo JH,Han DH,Shin HW,et al.No packing versus packing after endoscopic sinus surgery:pursuit of patients’comfort after surgery[J].Am J Rhinol,2008,22(5):525-528.
[6]Wang J,Cai C,Wang S.Merocel versus Nasopore for nasal packing:a meta-analysis of randomized controlled trials[J].PLo S One,2014,9(4):e93959.
[7]Verim A,Seneldir L,Naibogˇlu B,et al.Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis[J].Laryngoscope,2014,124(7):1529-1535.
[8]张学军,李志玉.多种鼻腔填塞生物材料的生物学及临床应用特点[J].中国组织工程研究与临床康复,2008,12(49):9747-9750.
[9]Yan M,Zheng D,Li Y,et al.Biodegradable nasal packings for endoscopic sinonasal surgery:a systematic review and meta-analysis[J].PLo S One,2014,9(12):e115458.
[10]李建兴,杨党卫,张伟强.纳吸棉和膨胀海绵填塞对慢性鼻-鼻窦炎鼻内镜术后鼻腔黏膜转归的影响[J].中国医学工程,2017,25(5):64-67.
[11]黄彩琴,陶跃进,周义兵.关于纳吸棉在鼻窦内镜术后填塞的疗效评价[J].中外医疗,2016,34:71-73.
[12]Lou H,Meng Y,Piao Y,et al.Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population[J].Am J Rhinol Allergy,2015,29(5):350-356.
[13]Kalish L,Snidvongs K,Sivasubramaniam R,et al.Topical steroids for nasal polyps[J].Cochrane Database Syst Rev,2012,12:CD006549.
[2]Wang TC,Tai CJ,Tsou YA,et al.Absorbable and nonabsorbable packing after functional endoscopic sinus surgery:systematic review and meta-analysis of outcomes[J].Eur Arch Otorhinolaryngol,2015,272(8):1825-1831.
[3]Massey CJ,Suh JD,Tessema B,et al.Biomaterials in rhinology[J].Otolaryngol Head Neck Surg,2016,154(4):606-617.
[4]中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.慢性鼻-鼻窦炎诊断和治疗指南(2012年,昆明)[J].中华耳鼻咽喉头颈外科杂志,2013,48(2):92-94.
[5]Mo JH,Han DH,Shin HW,et al.No packing versus packing after endoscopic sinus surgery:pursuit of patients’comfort after surgery[J].Am J Rhinol,2008,22(5):525-528.
[6]Wang J,Cai C,Wang S.Merocel versus Nasopore for nasal packing:a meta-analysis of randomized controlled trials[J].PLo S One,2014,9(4):e93959.
[7]Verim A,Seneldir L,Naibogˇlu B,et al.Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis[J].Laryngoscope,2014,124(7):1529-1535.
[8]张学军,李志玉.多种鼻腔填塞生物材料的生物学及临床应用特点[J].中国组织工程研究与临床康复,2008,12(49):9747-9750.
[9]Yan M,Zheng D,Li Y,et al.Biodegradable nasal packings for endoscopic sinonasal surgery:a systematic review and meta-analysis[J].PLo S One,2014,9(12):e115458.
[10]李建兴,杨党卫,张伟强.纳吸棉和膨胀海绵填塞对慢性鼻-鼻窦炎鼻内镜术后鼻腔黏膜转归的影响[J].中国医学工程,2017,25(5):64-67.
[11]黄彩琴,陶跃进,周义兵.关于纳吸棉在鼻窦内镜术后填塞的疗效评价[J].中外医疗,2016,34:71-73.
[12]Lou H,Meng Y,Piao Y,et al.Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population[J].Am J Rhinol Allergy,2015,29(5):350-356.
[13]Kalish L,Snidvongs K,Sivasubramaniam R,et al.Topical steroids for nasal polyps[J].Cochrane Database Syst Rev,2012,12:CD006549.