三种填塞物对鼻内镜术后出血及粘连的影响

The effect of three genus packing materais on hemorrhage and adhesion after endoscopic sinus surgery

目的比较不同填塞物对鼻内镜鼻窦术后出血及粘连的影响,以寻求一种满意的填塞止血材料。方法分析76例鼻窦术后分别采用凡士林纱条33例(62侧),Merocel高膨胀止血材料17例(31侧),硅胶引流管(内径0.6cm,外径0.8cm)24例(46侧)3种材料填塞鼻腔,观察比较术后当天出血量、抽取填塞时出血量、术后粘连情况。结果①术后当天鼻腔渗血三组无统计学差别;②抽取填塞物时的出血量以凡士林纱条组占比例最高,其次为Merocel高膨胀止血材料,硅胶管组最少;③发生粘连情况,凡士林纱条组与Merocel高膨胀止血材料组分别为15%和17%,均高于硅胶管组。结论鼻窦手术尤其是引起中鼻甲漂移者用硅胶管加凡士林纱条固定填塞术腔能较长时间放置中鼻道,待中鼻甲固定成型后再取出,可有效防止中鼻甲外移粘连,由于放置时间较久抽取时一般不出血,不失为一种理想的鼻窦术后填塞材料。

Objective To compare the effects of different packing materais on hemorrage and adhesion after ansal endoscopic sinus surgery. Methods Patients were randomized to 3 groups; and Vaseline, Merocel and silica gel tube plus Vaseline were applied after ansal endoscopic sinus surgery respectively. Post-operation hemorrhage and adhesion were observed. Results ① Meroecl group had the highest rate of blood oozing on the day of operation,while there was no difference between Vaseline and silica gel tube plus Vaseline group. ② For withdrawing hemorrhage volume,Vaseline group was the most, Merocel group ranked second and silica gel tube plus Vaseline group was the least. ③ For adhesion situation, 15% and 17% occurred in Vaseline group and Merocel group respectively,both higher than silica gel tube plus Vaseline group. Conclusion Silica gel tube plus Vaseline could stay long in situ and is ideal for preventing hemorrhage and adhesion after sinus surgery.