鼻内镜术后不同填塞材料对术后黏膜转归的影响

doi:10.6040/j.issn.1673-3770.0.2016.182

摘要/Abstract

摘要： 目的探讨鼻内镜手术后,鼻腔不同填塞材料对慢性鼻窦炎患者鼻窦术腔黏膜转归的影响。方法对入选的167例鼻窦炎患者按填塞材料的不同分为纳吸棉组(A组,n=93)和膨胀海绵组(B组,n=74)。两组患者均执行同样的入院前治疗,由同一高年资医师手术,并给予相同的术后用药及复查换药周期安排,通过比较视觉模拟评分法(VAS)、术前Lund-Mackay鼻窦CT评分、术后鼻内镜Lund-Kennedy评分,比较两组术后鼻窦术腔黏膜恢复情况。结果 A、B组间术前Lund-Mackay、VAS和Lund-Kennedy分值差异均无统计学意义(P>0.05);两组Lund-Kennedy术后评分差异有统计学意义(P<0.01),且各时间点A组分值低于B组(P<0.01);两组VAS术后不同时间点评分组间差异均有统计学意义(P<0.01),术后4周及12周均显示A组评分低于B组,A组症状后期改善更佳。A组5例、B组7例12周时术腔局部水肿明显,囊泡增生,组织重塑不良,有息肉复发迹象,结合术后病理,给予个体化治疗方案等处理后,黏膜修复明显改善。结论鼻内镜术后纳吸棉填塞可促进术腔黏膜良性转归过程。

关键词: 鼻窦炎, 鼻内镜外科手术, 鼻腔填塞, 慢性, 黏膜

Abstract: Objective To explore the effect of different packing materials on sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery. Methods A total of 167 patients with chronic rhinosinusitis were divided into the fragmentable nasal dressing group A(n=93)and the swell sponge group B(n=74). Using Lund-Mackay CT scoring system, visual analogue scales(VAS)and Lund-Kennedy endoscopic scoring system, all patients were assessed in recover in pre-operation period, and the second week, the fourth week, and the twelfth week after the surgery. The data were analyzed by SPSS18.0 statistics software to compare the differences of outcomes of sinus mucosa. Results There was no difference about Lund-Mackay CT scores, the VAS scores and Lund-Kennedy endoscopic scores in two groups before surgery(P>0.05). About Lund-Kennedy endoscopic scoring, the scores of the two groups presented significant difference(P<0.01). Comparing with the scores of the second week, the scores of group A of the fourth week, and the twelfth week were lower than those of the group B(P<0.01). The VAS scores of group A were all significantly different from those of group B at same period(P<0.01), and the scores of group A at the post-operative 4 and 12 week were lower than those of group B. 5 cases of group A and 7 cases of group B had sinus region oedema seriously, ves hyperplasy and polypus recurrence. After individualized treatment, sinus mucosa presented recovery tendency. Conclusion Applying of fragmentable nasal dressing can promote preferable outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery.

Key words: Endoscopic sinus surgery, Nasal pacing, Sinus mucosa, Rhinosinusitis, chronic

中图分类号:

R765.4

许海波,洪燕丽,李兆生,许振跃. 鼻内镜术后不同填塞材料对术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(5): 85-87.

XU Haibo, HONG Yanli, LI Zhaosheng, XU Zhenyue. Packing material on outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 85-87.

参考文献

[1] Senior B A, Kennedy D W, Tanabodee J, et al. Long-term results of functional endoscopic sinus surgery[J]. Laryngoscope, 1998, 108(1):151-157.
[2] 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(20):92-94.
[3] Lund V J, Mackay I S. Staging in rhinosinusitis[J]. Rhinology, 1993, 107(1):183-184.
[4] Lund V J, Kennedy D W. Quantification for staging sinusitis. The staging and therapy group[J]. Ann Otol Rhinol Laryngol Supple, 1995, 167:17-21.
[5] 许庚,李源,谢民强,等.功能性内窥镜鼻窦手术后术腔黏膜转归阶段的划分及处理原则[J].中华耳鼻咽喉头颈外科杂志,1999,34(5):302-305.
[6] 左可军,李华斌,史剑波,等.功能性内镜鼻窦手术后不同鼻窦黏膜的转归规律[J].中华耳鼻咽喉头颈外科杂志,2012,47(5):368-372. ZUO Kejun, LI Huabin, SHI Jianbo, et al. Regularity of nasal mucous transitionary course of different sinuses after functional endoscopic sinus surgery[J]. Chin J Otorhinolaryngol Head Neck Surgery, 2012, 47(5):368-372.
[7] 熊观霞,詹杰民,江广理,等.功能性鼻窦内镜术后对鼻腔鼻窦气流的影响[J].中山大学学报(医学科学版),2009,30(2):205-210. XIONG Guanxia, ZHAN Jiemin, JIANG Guangli, et al. Influence of functional endoscopic sinus surgery on airflow of postoperative nasal cavity and sinuses[J]. J Sun Yatsen Univ(Med Sci), 2009, 30(2):205-210.

相关文章 15

[1]	宋晓宇, 张宇, 李成林, 宋西成. 加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 9-12.
[2]	张汝祥,田昊,马有祥. 鼻内镜鼻窦手术前筛窦颅底高度的CT评估价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 75-77.
[3]	王驰,刘星,孔磊,洪兴和,宁博. 鼻内镜下等离子射频消融术对合并鼻窦炎的小儿腺样体肥大患者疗效及鼻腔黏膜纤毛清除功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 78-81.
[4]	吴喜福, 孔维封, 王玮豪, 徐惠清, 戚敏, 杨钦泰. QoR-15在加速康复外科改善慢性鼻-鼻窦炎伴鼻息肉围手术期生活质量评估中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 5-8.
[5]	乔叔芬,杨飞轮,王臻妮,李学忠. YKL-40与慢性鼻-鼻窦炎组织重构的相关性探讨[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 95-99.
[6]	陈望兴,赵雪,刘岩,刘悦,金春顺. 鼻中隔偏曲及慢性鼻窦炎鼻息肉患者的精神心理状态调查[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 24-27.
[7]	黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31.
[8]	张炜,曾昱菡,余先崧. 慢性鼻窦炎手术前后ECP、EGF、IL-6的水平变化及临床意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 63-67.
[9]	李莹. 慢性鼻窦炎的辨证论治[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 27-30.
[10]	李宏梅,王兰,高照慧,王莹,薛金梅. p-ERK2及ERK2在鼻息肉组织的表达及其意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 42-46.
[11]	张劼,龚齐. 不同分型慢性鼻-鼻窦炎患者外周血嗜酸性粒细胞与中性粒细胞百分比及变态反应临床差异性分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 54-57.
[12]	覃纲,梁灼萍. 变应性真菌性鼻-鼻窦炎免疫治疗现状[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 23-26.
[13]	张俐悦,刘金兰,姚东方,李杰恩. IL-31、IL-33及其受体ST2在难治性鼻-鼻窦炎中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 37-41.
[14]	甘彬,张永举,许安廷. BRF2在慢性鼻-鼻窦炎伴鼻息肉发病过程中的作用研究[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 47-53.
[15]	郑雅霓, 刘鹤, 马亮, 张明生, 孙中武. 布地奈德联合生理盐水鼻腔冲洗对慢性鼻-鼻窦炎的疗效及对鼻腔分泌物IL-6、IL-8、TNF-α的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 58-62.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed