经鼻内镜鼻窦手术后鼻腔填塞或不填塞膨胀海绵的比较研究  

Comparative study on packing with or without Merocel after endoscopic sinus surgery

作　　者：陈晓栋[1] 石照辉[1] 李晓媛[1] 单伯仪[1] 薛涛[1] 乔莉[1] 陈福权[1] 

机构地区：[1]第四军医大学附属西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《中华耳鼻咽喉头颈外科杂志》2015年第10期854-857,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：陕西省卫生厅卫生科研基金项目（D64）

摘　　要：目的研究经鼻内镜鼻窦手术后鼻腔填塞与不填塞膨胀海绵的短期以及远期疗效差异。方法采用前瞻性研究方法将112例慢性鼻-鼻窦炎患者随机（数字表法）分为鼻腔填塞和鼻腔不填塞膨胀海绵组，其中填塞组37例，伴变应性鼻炎（allergicrhinitis，AR）10例（27．0％）；不填塞膨胀海绵组75例，伴AR15例（20．0％）。填塞组同时行鼻中隔矫正术11例（29．7％），不填组同时行鼻中隔矫正术26例（34．7％）。术后第1天对患者进行视觉模拟量表（visual analogue scale，VAS）评分，共19项内容。观察并统计两组患者术后48h内出血量。对患者术前及术后6个月分别进行鼻腔鼻窦结局测试22条（SNOT-22）评分并使用内镜观察术后6个月时患者鼻腔恢复情况。以SPSS17．0软件对数据进行统计学分析。结果术后第1天VAS评分提示鼻塞、鼻部疼痛、烦躁不安、溢泪、鼻痒、打喷嚏、头面部疼痛及压迫感等7项症状两组对比差异有统计学意义（P值均〈0．05），不填塞膨胀海绵组评分低于填塞组，余12项症状两组对比差异无统计学意义（P值均〉0．05）。术后48h内出血量观察，填塞组出血量0～45ml，中位数为3ml，不填塞膨胀海绵组出血量0～18ml，中位数为2ml，不填塞膨胀海绵组术后48h内平均出血量少于填塞组，差异有统计学意义（Z=-3．54，P=0．00）。术后6个月填塞组SNOT-22评分（38．47±20．25）分，不填塞膨胀海绵组（41．03±22．73）分；填塞组与不填塞膨胀海绵组各1例患者出现术腔粘连；填塞组1例，不填塞膨胀海绵组2例患者出现中鼻甲外移；填塞组无鼻中隔血肿，不填塞膨胀海绵组1例出现鼻中隔血肿；两组对比差异无统计学意义（χ2=0．75，P=0．86）。结论经鼻内镜鼻窦术后鼻腔不填塞膨胀海绵安全、可行，并且能减轻患者术后24h内部分不适症状。术后随访6个月，填塞与不�Objective To investigate the clinical effect of nasal packing with or without Merocel after endoscopic sinus surgery （ESS） in short and long term. Method A total of 112 patients with chronic rhinosinusitis who received endoscopic sinus surgery were randomly divided into two groups： packed group and non-packed group. In packed group, there were 37 cases, of which 10 cases were combined with allergic rhinitis and 1 1 cases received correction of nasal septum at the same time. In non-packed group, there were 75 cases, of which 15 cases were combined with allergic rhinitis and 26 cases received correction of nasal septum at the same time. Visual analogue score （VAS）, Nasal bleeding and sinonasal outcome Test-22 （ SNOT-22 ） were used to evaluate the clinical effect between two groups in short and long term respectively. Result The VAS of nasal obstruction, rhinodynia, dysphoria, epiphora, itching, sneeze, headache and facial pain in non-packed group were significantly lower than those in packed group （ P 〈 0. 05 ）. Within 48 hours after ESS, the amounts of nasal bleeding were 0 -45 ml （median 3 ml） in packing group and 0 - 18 ml （median 2 ml） in non-packing group. There were significant difference between two groups（ Z = -3.54, P =0.00）. The difference value of postoperative and preoperative SNOT-22 of the packed group was 38. 47 ± 20.25 and the non-packed is 41.03 ± 22.73 six months after ESS （ t = 0.58, P = 0.56）. Each group had one case of nasal adhesion. And as for middle turbinate dislodgement, there was one case in the packed group and two cases in the unpacked group. There was no case of nasal septum hematoma in the packed group, but two cases in the un-packed group. The results showed that there was no significant difference of clinical effect between the postoperative packing and unpacking groups. Conclusions It is safe and practicable to manage chronic rhinosinusitis without nasal packing after ESS, which in short term not only decrease discomfort, but also reduce nasal

关 键 词：鼻窦炎 内窥镜检查 鼻外科手术 生活质量 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]