鼻内镜术后抽取油纱条使用复方薄荷油滴鼻时机的选择

鼻内镜手术是利用高分辨、可变换视角的hopkins内镜开展鼻窦手术,使鼻腔、鼻窦,尤其是深部的手术能在直视下进行。术后通常会以油纱条填塞鼻腔,以压迫术腔止血。然而在抽取油纱条时,我们发现复方薄荷油滴鼻时机的选择对患者抽取纱条时术腔疼痛、出血量都有不同的影响，现报告如下。     

慢性鼻窦炎术后中鼻道填塞材料粘连发生的对比——凡士林纱条与生物止血棉的对比

目的 回顾性分析比较2种鼻腔填塞材料的疗效,寻找术中中鼻道填塞材料,指导临床鼻腔手术中填塞材料的选择.方法 选择我科2008年--2010年鼻窦手术中应用凡士林纱条、生物止血棉填塞材料的病例120例,所以病例来自同一手术治疗组,采用相同的手术设备及相同的术后随访方式,手术器械,鼻内镜监视系统,所有手术均在鼻内镜监视系统下实施.选取同型病例比较术后中鼻道填塞材料,在达到术后止血的前提下,比较术后三天、一周、一月的术腔情况.结果 三天:纱条组术腔血痂及分泌物填塞,生物止血棉组血性液体渗透;一周:纱条组:术腔纤维粘性渗出物,生物止血棉组:呈果胶状,暗红色,部分填充于术腔;一月:纱条组:术腔基本上皮化,中道粘连较高＜10%,生物止血棉组:术腔基本上皮化,中道粘连率＜2%.结论 止血棉在应用于慢性鼻窦炎(Ⅰ、Ⅱ型患者)中道填塞中,术后一月中鼻甲与鼻腔外侧壁粘连发生率明显下降.     

鼻内窥镜手术治疗慢性鼻窦炎和鼻息肉的疗效分析

目的探讨鼻内窥镜手术治疗慢性鼻窦炎、鼻息肉的疗效及影响因素。方法通过回顾分析我科自2000年2月-2004年l0月采用鼻内窥镜手术治疗314例慢性鼻窦炎、鼻息肉患者的情况。结果I型近期治愈者84例(98.6%),II型近期治愈者107例(86.1%),Ⅲ型近期治愈者100例(81%),I型与Ⅱ型、Ⅲ型近期治愈率比较,差异有显著性(P相似文献   

功能性鼻窦内窥镜手术50例观察与护理

目的 观察功能性鼻窦内窥镜手术治疗慢性鼻窦炎的疗效,总结护理体会.方法 内窥镜组采用局麻,用鼻窦内窥镜手术治疗.术后以凡士林纱条填塞24～48h,取出纱条后鼻腔换药4～7d.术后3个月内,1～2W复壹1次.精心术前心理护理、认真准备、术后一般护理、出血观察、鼻腔护理、并发症的观察.结果 内窥镜组治愈率为84%,总有效率为96%,均明显优于传统组(P＜0.05).结论 功能性鼻窦内窥镜手术治疗慢性鼻窦炎疗效显著.手术前一定要做好心理护理,认真准备,术后要密切观察病情,做好一般护理,别让病人感冒打喷嚏,做好专科护理,防止并发症.     

内窥镜下鼻窦手术疗效观察及护理

目的 探讨内窥镜下鼻窦手术患者的护理措施。方法 采用经鼻内窥镜手术治疗慢性鼻窦炎和鼻息肉患者142例，充分做好术前准备，重视鼻腔填塞期护理、术腔处理、局部用药及鼻腔冲洗，加强患者复诊指导。结果 随访8-12个月，治愈112例（78％）、好转20例（14％）、无效14例（7％）。结论 重视术后护理和定期复诊局部清理、鼻腔冲洗是提高内窥镜下鼻窦手术远期疗效，避免术腔粘连和闭塞的有效手段。     

内窥镜鼻窦手术60例疗效观察

目的 探讨提高鼻窦内窥镜手术疗效的方法。方法 对60例慢性鼻窦炎鼻息肉患者行经鼻内窥镜手术。结果 60例中随访半年以上者48例，治愈36例（75．4％），好转10例（20．3％），无效2例（4．3％），总有效率95．7％。无严重术后并发症，术后出血1例，中鼻甲与鼻中隔粘连2例（2侧），下鼻甲与鼻中隔粘连1例（1铡）。结论 鼻内窥镜手术治疗慢性鼻窦炎鼻息肉具有良好的疗效。手术操作熟练准确，彻底清除病变是手术成功的重要保证。     

不同止血材料在功能性鼻内镜手术中填塞的效果:组织相容性比较

背景:目前临床最常见且止血效果较好的材料为可吸收性止血棉和凡士林纱条。目的:对比可吸收性止血棉和凡士林纱条在功能性鼻内镜手术中的填塞效果。方法:纳入100例鼻窦炎患者,其中男57例,女43例,年龄16-61岁,病程5个月-23年,采用随机数表法均分为2组,观察组在功能性内镜手术治疗中采用可吸收性止血棉填塞术腔,对照组在功能性内镜手术治疗中采用凡士林纱条填塞术腔。对比两组填塞期的不适感、术后48 h抽出填塞物时的出血情况及术后24 h内的鼻腔渗血情况。结果与结论:观察组未发生与可吸收性止血棉相关的不良反应,说明可吸收性止血棉具有较高的组织相容性。观察组患者的不适反应率、术后48 h抽出填塞物时的出血率及术后24 h的鼻腔渗血量均显著低于对照组(P0.05)。表明可吸收性止血棉具有较好的止血功能,能有效减少鼻窦炎患者术后鼻腔出血量,缓解术后不适感。     

内镜下改良切口个性化三线减张鼻中隔成形的疗效分析

目的 探讨鼻内窥镜下鼻中隔成形术术式的改良及手术疗效。方法 采用随机抽样法将2014年1月~2017年7月100例鼻中隔偏曲手术患者,随机分为改良组与对照组,每组50例,改良组采用鼻内镜下改良切口鼻中隔成形术新方法,对照组采用传统鼻中隔黏膜下矫正术手术方法,针对两组患者术后的鼻中隔病变、症状消失率、伤口出血、肿胀,疼痛、愈合情况及术后并发症进行回顾对比分析。结果 观察组手术时间、术中出血量、并发症、治疗效果优于对照组,比较差异均有统计学意义(P＜0.05);随访6个月,观察组无鼻中隔穿孔、鼻腔粘连等并发症发生,鼻塞、头痛等症状改善,改良组患者有效率（96.00%）高于对照组（84.00%）,差异有统计学意义（P<0.05）,整体治疗满意度高。结论 采用鼻内窥镜下改良切口个性化鼻中隔成形术改变了以往传统的手术方式,具有出血少、粘膜张力小、视野广、愈合好、微创、并发症少、疗效确切,更符合鼻腔生理功能,值得临床推广应用。     

经鼻内窥镜脑脊液鼻漏修补术的护理体会

脑脊液经颅前窝底、颅中窝底、或其他部位的先天性或外伤性骨质缺损、破裂处或变薄处，流入鼻腔，称之为脑脊液鼻漏。鼻内窥镜下行脑脊液鼻漏修补具有视野清楚、安全、准确、微创、手术时间短、花费低、术后恢复快、并发症少等优点。现将我科2005年1月至2008年1月应用鼻腔内窥镜治疗脑脊液鼻漏患者18例护理体会报告如下。     

观察两种抽取鼻腔凡士林纱条方法疗效的比较

鼻腔鼻窦术后粘膜缺损，伤口无法缝合，需要进行鼻腔填塞止血，临床上通常用凡士林纱条进行填塞止血，常给患者带来不适，在抽取纱条时又会加重患者的痛苦，引起大量出血，有时还需重新填塞，更加加重患者的心理负担。为了减轻患者的经济负担和痛苦，我科改进了抽取纱条的方法，与传统的方法进行观察比较，发现改进后的抽取纱条的方法，患者痛苦小，出血量明显减少，对伤口愈合影响小，效果满意。现报告如下。     

经鼻内窥镜选择性鼻中隔粘膜下切除术

目的：探讨经鼻内窥镜选择性鼻中隔粘膜下切除术的意义及手术方法。方法：根据不同的手术目的对204例需要行鼻中隔手术的病人，经鼻内窥镜实施选择性鼻中隔粘膜下切除术。结果：采用该技术对单纯性鼻中隔偏曲患者手术临床治愈率100％，其手术有效治愈头痛、鼻阻及鼻出血等鼻中隔偏曲临床症状，达到临床治疗目的。未出现鼻腔粘连、鼻中隔穿孔等并发症。有2例形成鼻中隔血肿，经放置引流管处理后治愈。对于解除高位鼻中隔偏曲解剖异常引发的鼻窦炎，手术后效果良好。取鼻中隔软骨做为修补材料手术效果满意。结论：经鼻内镜选择性鼻中隔粘膜下切除术目的性强、方法灵活、创伤小、并发症少、手术效果确切。     

鼻内镜下鼻中隔术中穿破的及时修复

目的探讨鼻内镜下及时修复鼻中隔术中对穿性破损的方法及临床效果。方法2001年6月～2005年6月在荆州市第一人民医院就诊的20例鼻中隔偏曲合并鼻窦炎、鼻息肉的病人，其中男性14例，女性6例，年龄22～58岁，平均年龄28岁。行鼻窦手术和鼻中隔手术，术中出现鼻中隔黏骨膜对穿性破损，17例立即采用鼻内镜下鼻中隔破损修补术，术中取自体鼻中隔或者鼻甲薄骨片封闭穿孔，复位破损黏骨膜进行修复，采用指套凡士林纱条填塞；2例在头灯照明下常规手术以鼻中隔软骨进行修复，1例未作处理。结果17例立即在鼻内镜下进行修复的病人，随访6个月，术后没有出现鼻中隔穿孔；2例在头灯照明下修复的病人于术后7、10d发现鼻中隔穿孔；1例未处理的病人于术后5周发现鼻中隔穿孔。结论鼻内镜下及时修复鼻中隔手术中出现的对穿性破损，视野清晰，修补可靠；术后局部应慎用激素或者开始使用激素的时间应当延迟。     

神经内镜引导下经鼻蝶窦入路切除垂体瘤的临床研究

目的：观察神经内镜下经单鼻孔蝶窦入路手术切除垂体瘤的临床疗效及安全性。方法：选取我院197例经单鼻孔蝶窦入路手术的垂体瘤患者,其中神经内镜下治疗的患者为105例(神经内镜组),显微镜下治疗的患者为92例(显微镜组)。比较两组手术时间、术中出血量、1年后随访复发率、术后住院时间与术后并发症、肿瘤全切率、内分泌激素下降情况。结果：神经内镜组术中出血量、手术时间、术后住院时间、1年后随访复发率、术后并发症(尿崩症、低钾血症、视力障碍、颅内血肿、鼻腔出血)发生率均低于显微镜组;肿瘤全切率、内分泌激素下降率均高于显微镜组,差异具有统计学意义(P<0.05)。结论：神经内镜辅助下行经鼻蝶窦入路垂体瘤切除术效果显著,具有手术时间短、术中出血量少、术后住院时间短,且并发症发生率低,安全性更强,值得在临床中推广。     

窦口鼻道复合体的解剖变异与鼻息肉

目的：为了探讨鼻息肉与窦口鼻道复合体的变异的相关性。方法：对１５４例鼻息肉患者采用鼻窦薄层（２ｍｍ）连续冠状扫描，显示鼻腔侧壁，尤其是窦口鼻道复合体的结构，并行鼻内窥镜检查及手术与３３例正常人对照。结果：窦口鼻道复合体畸形组鼻息肉发生率高。结论：鼻息肉的发生与窦口鼻道复合体变异有相关性。     

Cell and cytokine profiles in nasal secretions from patients with nasal polyposis: effects of topical steroids and surgical treatment

BACKGROUND: Nasal polyposis (NP), a chronic inflammatory disease of the paranasal sinus mucosa, is frequently associated with asthma. Previous reports showed that surgical treatment for nasal polyps may influence asthma evolution. We hypothesized that sinus surgery may alter the cytokine network in nasal secretions. METHODS: We evaluated the characteristics (cells and mediators) of nasal lavages in nine patients with untreated NP (group A), 17 patients treated with topical steroids (group B), 21 patients treated by nasal surgery endonasal ethmoidectomy associated with topical steroids (group C), and 12 healthy subjects (controls). RESULTS: Percentages of both eosinophils and neutrophils were higher in NP patients than in controls. Percentages of eosinophils and interleukin-5 (IL-5) level were higher in group A than in group C and controls. There was a positive correlation between IL-5 and eosinophils. In marked contrast, IL-8, IL-10, and IL-1beta levels were significantly higher in group C than in groups A and B and controls; TNF-alpha concentration was significantly lower in group C than in groups A and B and controls; and there was a negative correlation between IL-10 and TNF-alpha. The percentage of eosinophils was higher in asthmatic patients with NP than in nonasthmatic patients. In addition, in group C, asthmatic patients also had a significantly higher level of IL-10 than nonasthmatic patients. CONCLUSIONS: Our study demonstrates that percentages of eosinophils and neutrophils, and IL-5 level were increased in nasal secretions from untreated patients with NP. Topical steroid treatment is associated with a decrease of inflammatory cells and mediators. In marked contrast, nasal surgery is associated with marked changes, in cytokine profile in nasal secretions, that are clearly different from those of controls and topical steroid-treated NP patients.     

鼻腔止血器用于鼻腔填塞止血的疗效分析

目的分析比较高分子止血海绵和鼻腔止血器在鼻内镜术后的止血效果。方法选取100例需要进行鼻腔、鼻窦手术患者,其中男性76例,女性24例;年龄18~60岁,中位年龄36岁。随机分为2组,试验组50例,对照组50例。在术后分别放置高分子止血海绵和鼻腔止血器,观察患者的疼痛反应和止血效果,并对比取出填塞物时的难易程度及出血量,进行对比分析。结果两者止血效果相当,试验组少量渗血36例,对照组29例;两组无出血病例;止血效果两组差异无统计学意义(P0.05)。试验组无痛、轻度疼痛各26、24例,对照组各3、44例。试验组填塞物容易取出46例,对照组21例。两组在鼻腔胀痛、头痛、抽出时难易程度、抽出时出血量方面的差异均有统计学意义(P0.05),均显示试验组的效果优于对照组。结论鼻腔止血器不良反应少,临床效果优于高分子止血海绵填塞,值得广泛推广。     

鼻内镜下低温等离子刀切除术对鼻窦肿瘤患者术后黏膜恢复的效果

目的:分析鼻内镜下低温等离子刀切除术在鼻窦肿瘤术后患者黏膜恢复的效果.方法:选取2015年6月至2016年5月在本科室住院治疗的鼻窦肿瘤患者60例,按随机数表法分为观察组和对照组,观察并比较鼻内镜下低温等离子刀切除术在鼻窦肿瘤术后患者黏膜恢复的效果.结果:观察组的手术时间、术中出血量、住院时间以及并发症发生率均显著低于对照组,差异具有统计学意义(P＜0.05);观察组患者的黏膜形态Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级例数以及黏膜上皮化时间均显著低于对照组,差异具有统计学意义(P＜0.05).结论:鼻内镜下低温等离子刀切除术在鼻窦肿瘤术后患者黏膜恢复的效果好,鼻腔黏膜上皮化时间短,能有效避免术后并发症发生,具有显著的临床效果,值得推广应用.     

Clinical significance of the sphenoidal process of the cartilaginous nasal septum: A preliminary morphological evaluation

The bony septum ossifies from cranial to caudal and from ventral to dorsal, thereby forming the perpendicular plate of ethmoid bone and vomer. A small strip of cartilage from the cartilaginous septum remains between these parts, the so‐called sphenoidal process of the cartilaginous septum. This sphenoidal process is usually seen at the top of a deviated nasal septum during septoplasty. This study evaluated the clinical significance of the sphenoidal process of the cartilaginous septum as a cause of nasal septal deviation. We studied 37 patients with septal deviation who underwent septoplasty. The complex consisting of the sphenoidal process of the cartilaginous septum, perpendicular plate of the ethmoid bone (PPE), and vomer was removed at surgery. The sphenoidal process was measured and the surgical specimen were evaluated histologically and compared to controls. The mean length of the sphenoidal process in patients with a deviated nasal septum was 26.05 ± 5.32 mm versus 11.95 ± 2.38 mm in controls. The sphenoidal process was significantly longer in the patients with a deviated nasal septum (P < 0.05). The sphenoidal process of the cartilaginous septum was connected to the PPE and vomer in the patients with a deviated nasal septum and differed histologically from that of the controls. The sphenoidal process of the cartilaginous septum was long and prominent in the patients with septal deviation, implying that delayed nasal septal ossification may be one cause of nasal septal deviation. Clin. Anat. 23:265–269, 2010. © 2010 Wiley‐Liss, Inc.     

Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery

BACKGROUND: Local corticosteroids are widely used in the treatment of nasal polyps and chronic rhinosinusitis both before and after nasal surgery. Their efficacy after functional endoscopic sinus surgery (FESS) has not been fully established by placebo-controlled trials. OBJECTIVE: This double-blind placebo-controlled randomized study was performed in order to investigate whether fluticasone propionate aqueous nasal spray (FPANS) reduces the recurrence rate of nasal polyps and chronic rhinosinusitis during the first year after FESS. PATIENTS AND METHODS: The trial looked at 162 patients aged 18 years and older requiring FESS for chronic rhinosinusitis or nasal polyps. After FESS combined with peri-operative systemic corticosteroids, patients were randomized and given FPANS 400 microg b.i.d., FPANS 800 microg b.i.d. or placebo b.i.d. for the duration of 1 year. Patients were withdrawn from the trial (but still included in the study for statistical purposes) if there were recurrent or persistent diseases, defined as progressive regrowth of nasal polyps, recurrent signs and symptoms of chronic sinusitis combined with abnormalities on computed tomography scan and persistent complaints for at least 2 months after FESS. RESULTS: A significant reduction of symptoms was seen after FESS. After 1 year, 46 patients had been withdrawn from the trial because of recurrent diseases and 32 patients because of persistent symptoms. No differences in the number of patients withdrawn because of recurrent or persistent diseases were found between the patients treated with FPANS and patients treated with placebo. We were also unable to find a positive effect of FPANS compared with placebo in several subgroups such as patients with nasal polyps, high score at FESS or no previous sinus surgery. CONCLUSION: This placebo-controlled study does not show that treatment with FPANS up to 1 year after FESS had a positive effect compared with placebo.