鼻内镜术后不同填塞材料对术后黏膜转归的影响

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。

Packing material on outcomes of sinus mucosa with chronic rhinosinusitis after endoscopic sinus surgery

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 frag-mentable nasal dressing group A(n =93)and the swell sponge group B(n =74).Using Lund-Mackay CT scoring sys-tem,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 be-fore 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.