慢性鼻窦炎鼻息内显微镜下手术中出血控制的观察

Bleeding control in sinonasal microsurgery]

OBJECTIVE: To explore the results of bleeding control in sinonasal surgery. METHODS: Between Jan 1998 and Jun 2000, 82 patients (144 sides) were observed and studied for the relationship between mental tension and bleeding. The effect of blood pressure control and operative time reduction was also observed. 58 sides were of type III, 71 sides of type II (among them, 56 sides belonged to stage II, 15 sides belonged to stage III), 15 sides were type I (among them, 4 sides belonged to stage I, 11 sides belonged to stage II). Of them, 60 patients had been operated for two times. All patients with sinusitis received micro-intranasal ethmoidectomy and 140 sides had had polyps removed. Sixteen patients received correction of deviated septum at the same time. 31 patients received resection of the inferior turbinate bone. Twenty-one patients were given Dridol' 5 mg and Dolantin 50 mg intravenously to control hypertension. Bleeding amount was compared between 21 hypertensive patients who used intravenous drugs and 57 hypertensive patients who did not use intravenous drugs during operation. To reduce operation time, the operation was simplified. RESULTS: The bleeding was limited to 10 ml in 99 sides(69%), the mean bleeding amount was controlled to (18.7 +/- 24.4) ml in 78(54%) sides of patients with hypertension. In 66 sides (46%) of patients with normal blood pressure, the mean bleeding amount was (13.2 +/- 16.8) ml (P < 0.05). In 21 patients in whom the hypertension was controlled, the mean bleeding amount was (13.0 +/- 6.7) ml. In 10 patients, the bleeding amount was (30.5 +/- 21.8) ml at the first operation with hypertension uncontrolled, the bleeding amount was only (11.0 +/- 8.2) ml at second operation when the blood pressure was controlled to normal (P < 0.05). After 6 months follow-up, 104 sides (72%) were cured, 32 sides (22%) improved, and 8 sides (6%) without improvement. CONCLUSION: Mental tension in operation can induce hypertension and increase bleeding, suitable sedation is necessary. With correct use of topical anesthesia and reduced operation time, the bleeding amount can be controlled to less than 10 ml in 69% of patients.