鼻窦手术后前鼻镜联合鼻内镜与传统全鼻内镜换药模式的比较  

A Comparative Study of Debridement Under Nasal Speculum Combined With Nasal Endoscope or Traditional Nasal Endoscope After Endoscopic Sinusitis Surgery

作　　者：宋昱[1] 付嘉 于辉 邱梓瀚 刘俊秀[1] Song Yu;Fu Jia;Yu Hui(Department of Otolaryngology,Peking University Third Hospital,Beijing 100191, China)

机构地区：[1]北京大学第三医院耳鼻咽喉科,北京100191

出　　处：《中国微创外科杂志》2021年第3期248-252,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：首都卫生发展科研专项(2020-2Z-40918)。

摘　　要：目的探讨鼻窦内镜手术(endoscopic sinus surgery,ESS)后前鼻镜联合鼻内镜换药模式在临床中的应用价值。方法选择我科2019年8月~2020年10月40例ESS,分为2组:全鼻内镜下换药20例(传统模式组),即术后2周、术后1个月、2个月全鼻内镜下换药;前鼻镜联合鼻内镜换药20例(新模式组),即术后2周行前鼻镜下换药,术后1、2个月行全鼻内镜下换药。比较2组术后1、2个月内镜下Lund-Kennedy评分、主观症状视觉模拟评分(Visual Analogue Scale,VAS)。结果内镜下Lund-Kennedy评分:术后1个月传统模式组(6.0±1.5)分,与新模式组(6.4±1.4)分差异无统计学意义(t=-0.656,P=0.516);术后2个月传统模式组(4.9±0.9)分,与新模式组(4.7±0.6)分差异无统计学意义(t=0.831,P=0.411);2组内镜下Lund-Kennedy评分随时间的延长均呈下降趋势。术后1个月鼻堵症状VAS评分传统模式组(2.2±0.7)分,明显低于新模式组(2.9±1.2)分(t=-2.062,P=0.046),其余症状VAS评分2组间差异无统计学意义(P>0.05)。术前与术后1个月4个症状VAS评分均值的差值传统模式组(3.6±0.9)分,与新模式组(3.0±1.0)分差异无统计学意义(t=1.835,P=0.074);术前与术后2个月4个症状VAS评分均值的差值传统模式组(3.9±1.2)分,与新模式组(3.7±1.5)分差异无显著性(t=0.529,P=0.600)。结论前鼻镜联合鼻内镜换药模式与传统模式相比,内镜下Lund-Kennedy评分均无显著差异,主观症状VAS评分改善程度无显著差异,可实现症状完全控制,可作为传统全鼻内镜换药的一种替代模式。Objective To study the clinical value of new debridement scheme under nasal speculum combined with nasal endoscope.Methods A total of 40 patients receiving endoscopic sinusitis surgery(EES)between August 2019 and October 2020 were selected and grouped.The traditional group was given regular debridement under nasal endoscope in 2 weeks,1 month and 2 months after surgery;and the new method group was given debridement 2 weeks under nasal speculum,and 1 month and 2 months under nasal endoscope after surgery.The Visual Analogue Scale(VAS)of subjective symptoms and Lund-Kennedy score under endoscope were collected 1 and 2 months after surgery.Results The Lund-Kennedy score under endoscope showed no significant difference between the traditional group(6.0±1.5)points and the new method group(6.4±1.4)points at 1 month after surgery(t=-0.656,P=0.516)and no significant difference between the traditional group(4.9±0.9)points and new method group(4.7±0.6)points at 2 months after surgery(t=0.831,P=0.411),with declining tendency with time.The VAS score showed that nose blocking between the traditional group(2.2±0.7)points and the new group(2.9±1.2)points having significant difference(t=-2.062,P=0.046),but other symptoms having no significant difference at 1 month after surgery(P>0.05).Compared with 4 symptoms before surgery,the VAS gap of the mean values between the traditional group(3.6±0.9)points and the new method group(3.0±1.0)points showed no significant difference at 1 month after surgery(t=1.835,P=0.074),as well as no significant difference between the traditional group(3.9±1.2)points and the new method group(3.7±1.5)points at 2 months after surgery(t=0.529,P=0.600).Conclusion Debridement under nasal speculum combined with nasal endoscope is an alternative in clinical practice as it shows no significant difference in Lund-Kennedy score under endoscope and VAS score of subjective symptoms compared with the traditional method,and both methods control symptoms completely.

关 键 词：鼻窦内镜手术 换药 鼻内镜 

分 类 号：R47[医药卫生—护理学]