鼻腔及鼻窦良性病变鼻内镜术后的术腔处理及其局部用药  

Nasal cavity treatment and local medication after endoscopic sinus surgery of rhino-sinus benign lesions

作　　者：沈翠干 董伟达[2] 谭长强[2] 

机构地区：[1]金湖县中医院耳鼻咽喉科,江苏金湖211600 [2]江苏省人民医院耳鼻咽喉科,江苏南京210029

出　　处：《东南大学学报（医学版）》2011年第3期456-460,共5页Journal of Southeast University(Medical Science Edition)

基　　金：国家自然科学基金资助项目(81070789)

摘　　要：目的:回顾性分析鼻腔-鼻窦常见的部分良性病变鼻内镜术后不同处理及其局部用药方法对治疗效果的影响。方法:近5年在我科接受鼻内镜手术、并随访1年以上资料完整的患者236例,术后随访1～3年,平均1.5年。常规处理包括在鼻内镜下清理术腔分泌物、术腔囊泡及肉芽。皮质类固醇激素鼻腔喷雾每日2次,共计3周。发现有鼻腔粘连、上颌窦口瘢痕性粘连或缩小者均在内镜下分离,切除部分原粘连部位黏膜及其黏膜下组织,部分患者放置浸润5-氟尿嘧啶(5-FU)膨胀海绵填塞。3例内翻性乳头状瘤患者用干扰素a-2b(5 mIU.ml-1)作窦口局部黏膜下多点注射。部分并发术后上颌窦口瘢痕过度增生患者,在内镜下放置微型上颌窦引流支架。结果:治愈83.47%(197/236),好转11.44%(27/236),总有效率94.92%(224/236)。对于术后不同处理方法的效果分析显示:常规术后处理的195例患者中,4例无效的主要原因分别为1例伴发糖尿病患者术后鼻窦炎症发复、2例鼻息肉复发、1例窦口狭窄和鼻腔粘连。采用常规处理并对鼻腔粘连进行单纯粘连分离后,13例患者中7例失败,均为再发生粘连所致。对于1例鼻中隔矫正术后并发鼻中隔血肿患者,行术后常规处理和血肿清除后发生鼻腔粘连。其余患者(包括对于并发鼻腔粘连进行分离后局部放置浸润5-FU膨胀海绵或内镜下放置微型上颌窦引流支架的患者24例、内翻性乳头状瘤患者3例作局部黏膜下基底部干扰素注射)于随诊期间均未发生任何其他并发症。结论:鼻内镜术后术腔处理对疗效将产生致关重要的影响。应选择适当方法进行处理,可有效防止再粘连的发生。对于内翻性乳头状瘤患者,局部注射干扰素可有效防止肿瘤再复发,是一种简便易行的有效处理方法。Objective： To retrospectively analyse the effects of different treatment and local medication methods for rhino-sinus benign lesions.Methods： Totally 236 patients were operated endoscopic sinus surgery in our department in 5 years and were followed up for 1-3 years.Conventional treatment contained clearing the nasal cavity secretions,surgical cavity vesicles and granulation,including corticosteroid nasal spray 2 times a day,a total of 3 weeks.Some patients with 5-fluorouracil（5-FU） expansion sponge stuffed.Three cases of inverted papilloma were treated with interferon a-2b（5 mIU·ml-1） for the sinus mucosa of local multi-point injection.Micro maxillary sinus drainage stents were placed in patients with maxillary sinus overgrowth of scar tissue under endoscopic sinus surgery.Results： Cured 83.47%（197/236）,improved 11.44%（27/236）,the total effective rate 94.92%（224/236）.The analysis of different treatments showed： in 195 patients with routine postoperative treatment,one case of simple sinusitis with diabetes recurred,2 cases of nasal polyp patients recurred,one case of nasal sinus stenosis and adhesion.After conventional treatment and separation of nasal adhesion,7 cases of 13 patients in the recurrence of adhesions.1 case of postoperative septal hematoma in patients with nasal septum deviation,the nasal cavity adhesion occurred after conventional treatment and hematoma clearing.Conclusion： The efficacy of operative cavity treatment after endoscopic sinus surgery is crucial.The appropriate method of post-operation treatment can effectively prevent the occurrence of re-adhesion.For inverted papilloma patients,local injection of interferon may be effective in preventing tumor recurrence,and it is a simple and effective treatment.

关 键 词：鼻腔-鼻窦良性疾病 鼻内镜手术 术后处理 鼻腔粘连 

分 类 号：R765.2[医药卫生—耳鼻咽喉科] R765.4[医药卫生—临床医学]