山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (5): 16-25.doi: 10.6040/j.issn.1673-3770.0.2022.351

• 论著 • 上一篇    下一篇

浸润毕罗芬明胶海绵在功能性鼻内镜鼻窦手术后应用效果的临床观察

王丽雪1,曾毅2,王丽欣2,彭先兵2   

  1. 十堰市人民医院)耳鼻咽喉科, 湖北 十堰 442000;
    2. 十堰市人民医院 耳鼻咽喉科, 湖北 十堰 442000
  • 发布日期:2023-10-13
  • 通讯作者: 彭先兵. E-mail:971727307@qq.com

Clinical observation of the effect of infiltrating Biprofen Gelatin Sponge after functional endoscopic sinus surgery

WANG Lixue1, ZENG Yi2, WANG Lixin2, PENG Xianbing2   

  1. 1. Department of Otorhinolaryngology, Postgraduate Training Base of Jinzhou Medical University (Shiyan Renmin Hospital), Shiyan 442000, Hubei, China2. Department of Otorhinolaryngology, Shiyan Renmin Hospital, Shiyan 442000, Hubei, China
  • Published:2023-10-13

PDF (PC)

64

摘要： 目的 探讨慢性鼻窦炎伴鼻息肉患者鼻内镜术后行浸润毕罗芬喷剂明胶海绵填塞应用的有效性及安全性。 方法 112例筛窦病变为主行鼻内镜手术的慢性鼻窦炎伴鼻息肉患者随机分3个组,浸润糠酸莫米松明胶海绵术中填塞+生理海水术后术腔冲洗(A组);浸润糠酸莫米松明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(B组);浸润毕罗芬喷剂明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(C组)。手术前及术后第2、4、8、12周随访时分别采集症状的SNOT-22评分、Lund-Kennedy内镜评分及囊泡组织中血管内皮生长因子(vascular endothelial growth factor, VEGF)表达情况,比较3个组之间在手术前后主、客观评分的差异,评估其安全性。 结果 共有93例患者完成实验规定的3个月的术后随访。主观评分术后较术前明显下降,但术后各随访节点3组评分比较差异无统计学意义;客观内镜评估于术后第2、4、8、12周比较差异均有统计学意义,且呈A>B=C的趋势;客观免疫组化结果VEGF表达含量逐渐减少,在随访12周时比较差异有统计学意义,显示A>B=C的趋势。 结论 浸润糠酸莫米松明胶海绵术中填塞与浸润毕罗芬喷剂明胶海绵术腔填塞效能相当,均可有效改善慢性鼻窦炎伴鼻息肉患者鼻内镜术后的主观症状,加快术腔黏膜恢复和上皮化进程,黏膜组织VEGF表达明显减少,临床应用安全良好。

关键词: 鼻窦炎, 鼻息肉, 黏液促排剂, 糖皮质激素, 血管内皮生长因子

Abstract: Objective To investigate the efficacy and safety of gelatin sponge packing with infiltrating Biprofen spray in patients with CRSwNP after nasal endoscopic surgery. Methods 112 patients with CRSwNP undergoing nasal endoscopic surgery were randomly divided into three groups: those receiving intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with physiological sea water(group A), intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with Biprofen spray(group B), and intraoperative packing of gelatin sponge of infiltrating Biprofen spray and postoperative irrigation of the postoperative cavity of Biprofen spray(group C). SNOT-22 score, Lund-Kennedy endoscopic score and vascular endothelial growth factor(VEGF)expression in vesicles were determined before the operation and at 2, 4, 8 and 12 weeks postoperatively. The differences in subjective and objective scores before and after the operation were compared among the three groups to evaluate their safety. Results a total of 93 patients completed the required 3-month follow-up. The subjective score after operation was significantly lower than before, but there was no significant difference among the follow up nodes of the three groups postoperatively. Objective endoscopic evaluation showed a statistically significant difference in 2, 4, 8 and 12 weeks after operation, and a trend of A>B=C was observed. The differences in objective immunohistochemical score was statistically significant at 12 weeks of follow-up and showed a A>B=C trend. Conclusion The intraoperative packing effect of infiltrating momethasone furoate gelatin sponge is the same as that of infiltrating Biprofen gelatin sponge, which can effectively improve the subjective symptoms of chronic sinusitis with nasal polyps after nasal endoscopic surgery, accelerate mucosal recovery and epithelialization, and VEGF expression in mucosal tissue is significantly decreased. Thus, the clinical application of infiltrating Biprofen gelatin sponge is safe.

Key words: Sinusitis, Nasal polyps, Mucous excretion enhancers, Glucocorticoids, Vascular endothelial growth factor

中图分类号: 

  • R762
[1] 付清玲, 史剑波. 我国慢性鼻-鼻窦炎的流行病学特征及其伴随疾病和危险因素解析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(5): 321-324. doi:10.13201/j.issn.1001-1781.2018.05.001 FU Qingling, SHI Jianbo. Epidemiology, occupational and environmental risk factors of chronic rhinosinusitis in China[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(5): 321-324. doi:10.13201/j.issn.1001-1781.2018.05.001
[2] Massey CJ, Singh A. Advances in absorbable biomaterials and nasal packing[J]. Otolaryngol Clin North Am, 2017, 50(3): 545-563. doi:10.1016/j.otc.2017.01.006
[3] Hwang CS, Al Sharhan SS, Kim BR, et al. Randomized controlled trial of steroid-soaked absorbable calcium alginate nasal packing following endoscopic sinus surgery[J]. Laryngoscope, 2018, 128(2): 311-316. doi:10.1002/lary.26871
[4] Sabarinath V, Harish MR, Divakaran S. Triamcinolone impregnated nasal pack in endoscopic sinus surgery: our experience[J]. Indian J Otolaryngol Head Neck Surg, 2017, 69(1): 88-92. doi:10.1007/s12070-016-1041-x
[5] Lee SH. Mechanisms of glucocorticoid action in chronic rhinosinusitis[J]. Allergy Asthma Immunol Res, 2015, 7(6): 534-537. doi:10.4168/aair.2015.7.6.534
[6] 娄鸿飞, 王成硕, 张罗. 经鼻雾化吸入布地奈德混悬液和口服激素治疗慢性鼻-鼻窦炎鼻息肉的疗效及安全性的对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(9): 792-796. doi:10.13201/j.issn.1001-1781.2015.09.006 LOU Hongfei, WANG Chengshuo, ZHANG Luo. The efficacy and safety of budesonide inhalation suspension via transnasal nebulization compared with oral corticosteroids in chronic rhinosinusitis with nasal polyps[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(9): 792-796. doi:10.13201/j.issn.1001-1781.2015.09.006
[7] Chong LY, Head K, Hopkins C, et al. Different types of intranasal steroids for chronic rhinosinusitis[J]. Cochrane Database Syst Rev, 2016, 4(4): CD011993. doi:10.1002/14651858.CD011993.pub2
[8] Kern RC, Stolovitzky JP, Silvers SL, et al. A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps[J]. Int Forum Allergy Rhinol, 2018, 8(4): 471-481. doi:10.1002/alr.22084
[9] Sheth K. Evaluating the safety of intranasal steroids in the treatment of allergic rhinitis[J]. Allergy Asthma Clin Immunol, 2008, 4(3): 125-129. doi:10.1186/1710-1492-4-3-125
[10] Lee HS, Myers A, Kim J. Vascular endothelial growth factor drives autocrine epithelial cell proliferation and survival in chronic rhinosinusitis with nasal polyposis[J]. Am J Respir Crit Care Med, 2009, 180(11): 1056-1067. doi:10.1164/rccm.200905-0740OC
[11] 王军旗, 张超, 马明瑛. 鼻息肉术后囊泡组织中微血管密度及血管内皮生长因子在上皮化进程中的表达及意义[J]. 中国美容医学, 2016, 25(2): 37-39. doi:10.15909/j.cnki.cn61-1347/r.001006 WANG Junqi, ZHANG Chao, MA Mingying. Expression and significance of MVD and VEGF on vesicles in the process of epithelialization after endoscopic polypectomy[J]. Chinese Journal of Aesthetic Medicine, 2016, 25(2): 37-39. doi:10.15909/j.cnki.cn61-1347/r.001006
[12] 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.中国慢性鼻窦炎诊断和治疗指南(2018)[J].中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001
[13] 许庚, 陈合新, 文卫平, 等. 内镜鼻窦手术后局部应用Merogel对促进术腔黏膜上皮化的临床效果观察[J]. 中华耳鼻咽喉科杂志, 2003, 38(2): 95-97. doi:10.3760/j.issn: 1673-0860.2003.02.006 XU Geng, CHEN Hexin, WEN Weiping, et al. Clinical evaluation of local application of Merogel after endoscopic sinus surgery[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2003, 38(2): 95-97. doi:10.3760/j.issn: 1673-0860.2003.02.006
[14] Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012[J]. Rhinology, 2012, 50(Suppl.23): 1-298. doi:10.3760/cma.j.issn.1673-0860.2013.02.012
[15] Cao PP, Li HB, Wang BF, et al. Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese[J]. J Allergy Clin Immunol, 2009, 124(3): 478-484, 484. doi:10.1016/j.jaci.2009.05.017
[16] 高雅丽, 王威清, 吕威. 外周血嗜酸性粒细胞相关复合指标对嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的预测价值[J]. 中国耳鼻咽喉头颈外科, 2021, 28(10): 603-607. doi:10.16066/j.1672-7002.2021.10.003 GAO Yali, WANG Weiqing, LYU Wei. The predictive value of peripheral blood eosinophil related composite index for eosinophilic chronic rhinosinusitis with nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(10): 603-607. doi:10.16066/j.1672-7002.2021.10.003
[17] 谢朝峰, 林宏浩. 慢性鼻-鼻窦炎手术预后的临床影响因素分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 90-93. doi:10.6040/j.issn.1673-3770.0.2015.527 XIE Zhaofeng, LIN Honghao. Analysis of clinical risk factors on the postoperative prognosis of chronic rhinosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(4): 90-93. doi:10.6040/j.issn.1673-3770.0.2015.527
[18] Xu J, Park SJ, Park HS, et al. Effects of triamcinolone-impregnated nasal dressing on subjective and objective outcomes following endoscopic sinus surgery[J]. Eur Arch Otorhinolaryngol, 2016, 273(12): 4351-4357. doi:10.1007/s00405-016-4185-0
[19] Zhao KQ, Yu YQ, Yu HM. Effects of mometasone furoate-impregnated biodegradable nasal dressing on endoscopic appearance in healing process following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study[J]. Int Forum Allergy Rhinol, 2018, 8(11): 1233-1241. doi:10.1002/alr.22213
[20] Federspil P,Wulkow R,Zimmermann T. Effects of standardized Myrtol in therapy of acute sinusitis-results of a double-blind,randomized multicenter study compared with placebo[J].Laeyngoehinootologie, 1997, 76(1): 23-27. doi:10.1055/s-2007-997381
[21] Matheny KE, Tseng EY, Carter KB Jr, et al. Self-cross-linked hyaluronic acid hydrogel in ethmoidectomy: a randomized, controlled trial[J]. Am J Rhinol Allergy, 2014, 28(6): 508-513. doi:10.2500/ajra.2014.28.4106
[22] 顾其胜, 王文斌, 吴萍. 医用透明质酸钠在临床中的应用综述[J]. 中国修复重建外科杂志, 1998, 12(2): 124-126 GU Qisheng, WANG Wenbin, WU Ping. Review of clinical application of medical sodium hyaluronate[J]. Chinese Journal of Reparative and Reconstructive Surgery, 1998, 12(2): 124-126
[23] Shi RJ, Zhou JQ, Wang BS, et al. The clinical outcomes of new hyaluronan nasal dressing: a prospective, randomized, controlled study[J]. Am J Rhinol Allergy, 2013, 27(1): 71-76. doi:10.2500/ajra.2013.27.3833
[24] 刘斌, 王长云, 张洪荣, 等. 海藻多糖褐藻胶生物活性及其应用研究新进展[J]. 中国海洋药物, 2004, 23(6): 36-41. doi:10.3969/j.issn.1002-3461.2004.06.010 LIU Bin, WANG Changyun, ZHANG Hongrong, et al. New progress in the research on bioactivities and applications of alginate, a kind of marine algal polysaccharide[J]. Chinese Journal of Marine Drugs, 2004, 23(6): 36-41. doi:10.3969/j.issn.1002-3461.2004.06.010
[25] 魏蕾, 吕佳飞, 李志洲. 花青素的提取纯化、抗氧化能力及功用方面的研究进展[J]. 氨基酸和生物资源, 2009, 31(4): 83-86. doi:10.3969/j.issn.1006-8376.2009.04.020 WEI Lei, LÜ Jiafei, LI Zhizhou. Recent studies on the extraction, purification, antioxidation and functions of anthocyanidins[J]. Amino Acids & Biotic Resources, 2009, 31(4): 83-86. doi:10.3969/j.issn.1006-8376.2009.04.020
[26] 华红利, 李芬, 习洋, 等. 探讨桃金娘油及花青素和透明质酸局部联合应用对暴露在PM2.5中AR大鼠的治疗作用[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 719-725. doi:10.13201/j.issn.2096-7993.2020.08.010 HUA Hongli, LI Fen, XI Yang, et al. To explore the therapeutic effect of myrtle oil, anthocyanin and hyaluronic acid in combination with topical application on allergic rhinitis in rats exposed to PM2.5[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(8): 719-725. doi:10.13201/j.issn.2096-7993.2020.08.010
[27] 曲静, 马晶影, 周兵, 等. 浸润激素纳吸棉鼻腔术后填塞效果的前瞻性单盲随机对照临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(6): 541-545. doi:10.13201/j.issn.2096-7993.2020.06.015 QU Jing, MA Jingying, ZHOU Bing, et al. Efficacy and safety of pulmicort repulas-impregnated nasal dressing following endoscopic sinus surgery: a randomized, single-blind, placebo-controlled study[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(6): 541-545. doi:10.13201/j.issn.2096-7993.2020.06.015
[28] 徐春英, 吴平, 郑明秀, 等. 血管内皮生长因子及其受体在多发鼻息肉中的表达[J]. 中国耳鼻咽喉头颈外科, 2008, 15(4): 238-239. doi:10.3969/j.issn.1672-7002.2008.04.023 XU Chunying, WU Ping, ZHENG Mingxiu, et al. Expression of vascular endothelial growth factor and its receptor in multiple nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2008, 15(4): 238-239. doi:10.3969/j.issn.1672-7002.2008.04.023
[29] 刘楠, 刘达, 刘领波, 等. 白细胞介素17与血管内皮生长因子在鼻息肉组织中的表达及相关性分析[J]. 中国耳鼻咽喉头颈外科, 2015, 22(10): 523-525. doi:10.16066/j.1672-7002.2015.10.010 LIU Nan, LIU Da, LIU Lingbo, et al. Interleukin 17 and vascular endothelial growth factor expression and correlation analysis in nasal polyp tissues[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2015, 22(10): 523-525. doi:10.16066/j.1672-7002.2015.10.010
[30] Nemati S, Keihanian F, Saeidinia A, et al. Effect of bevacizumab on growth of human nasal polyposis in vitro; an off-label use of anti-angiogenic agent for nasal polyposis treatment[J]. Drug Des Devel Ther, 2019, 13: 3383-3389. doi:10.2147/DDDT.S219724
[31] Shimizu S, Tojima I, Nakamura K, et al. Nasal polyp fibroblasts(NPFs)-derived exosomes are important for the release of vascular endothelial growth factor from cocultured eosinophils and NPFs[J]. Auris Nasus Larynx, 2022, 49(3): 407-414. doi:10.1016/j.anl.2021.10.002
[32] 王军旗, 文忠, 申聪香, 等. 囊泡分子免疫病理学改变对鼻内镜术后鼻腔黏膜上皮预后转归的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(9): 394-398. doi:10.13201/j.issn.1001-1781.2012.09.015 WANG Junqi, WEN Zhong, SHEN Congxiang, et al. Effect of nasal epithelial lining prognosis and turnover changed by vesicles molecular immuno-pathology after nasal endoscopic surgery[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2012, 26(9): 394-398. doi:10.13201/j.issn.1001-1781.2012.09.015
[33] 尉瑞, 李静波, 袁艳红, 等. 瑞纳CMC鼻腔止血气囊鼻腔填塞53例临床观察[J]. 中国中西医结合耳鼻咽喉科杂志, 2013, 21(3): 201, 211. doi:10.3969/j.issn.1007-4856.2013.03.013 YU Rui, LI Jingbo, YUAN Yanhong, et al. Clinical observation on 53 cases of reina CMC nasal hemostasis balloon nasal packing[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2013, 21(3): 201, 211. doi:10.3969/j.issn.1007-4856.2013.03.013
[34] 苗莉, 侯瑾, 王霞. 不同填塞止血材料在鼻内镜术后的应用[J]. 临床医学研究与实践, 2018, 3(12): 87-88. doi:10.19347/j.cnki.2096-1413.201812041 MIAO Li, HOU Jin, WANG Xia. Application of different stuffing hemostatic materials after endoscopic sinus surgery[J]. Clinical Research and Practice, 2018, 3(12): 87-88. doi:10.19347/j.cnki.2096-1413.201812041
[35] Kim JS, Kwon SH. Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis[J]. Laryngoscope, 2017, 127(5): 1026-1031. doi:10.1002/lary.26436
[36] Stern-Shavit S, Nachalon Y, Leshno M, et al. Middle meatal packing in endoscopic sinus surgery-to pack or not to pack? -a decision-analysis model[J]. Laryngoscope, 2017, 127(7): 1506-1512. doi:10.1002/lary.26506
[1] 王明明,罗洋,贺少娟,张现兴,李学忠. 慢性鼻窦炎鼻息肉基底干细胞转录组生物信息学分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 6-15.
[2] 崔宁,王云梦,杨景朴. 2型固有淋巴细胞在慢性鼻窦炎中的作用及调节机制研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 153-159.
[3] 袁玥,付圣尧,姜彦,陈敏. 细胞焦亡在慢性气道炎症性疾病中的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 166-171.
[4] 徐恩沛,孙先勇. 渗出性年龄相关性黄斑变性并发视网膜色素上皮脱离的诊治进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 125-142.
[5] 李聪,李玲,刘亭彦, 陈良. 氨基糖苷类抗生素耳毒性影响因素研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 128-134.
[6] 王露萍,寇芳柠,王皓,张灿伟,王艳玲,尤冉,吴伟珍. 视网膜下高反射物质在抗VEGF治疗nAMD患者中对视力预后的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 101-105.
[7] 王茜,刘娜,王少鹏. Leber特发性星芒状视神经视网膜炎1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 106-110.
[8] 李曼冯雪,王艳玲. 眼缺血综合征与缺血性脑卒中相关性研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 88-92.
[9] 敖天, 程雷. 慢性鼻窦炎伴鼻息肉的内型研究及其指导下的精准控制与治疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 7-14.
[10] 熊攀辉,沈暘,杨玉成. 基于表型和内在型的慢性鼻窦炎诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 15-19.
[11] 姚爽,娄鸿飞. 慢性鼻窦炎的内在型研究进展及精准医疗[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 20-29.
[12] 梁旭,史丽. 慢性鼻窦炎生物靶向药物治疗的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 30-35.
[13] 石帅,郑泉,程雷. 度普利尤单抗在慢性鼻窦炎伴鼻息肉治疗中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 36-42.
[14] 王欢,胡俐,余洪猛. 慢性鼻窦炎相关嗅觉功能障碍研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 43-49.
[15] 宜若男,陈福权. 嗜酸性粒细胞与嗅觉功能障碍[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 50-55.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发