内镜鼻窦手术后Rhino凝胶填塞效果的观察

Clinical efficacy of rapid Rhino Stammberger sinus dressing following endoscopic sinus surgery

目的前瞻性比较新型鼻腔填塞材料Rhino凝胶与传统填塞物用于内镜鼻窦手术后填塞的效果。方法对双侧病变基本对称，手术范围基本相同的24例慢性鼻窦炎患者行内镜鼻窦手术，术后右侧鼻腔以Rhino凝胶填塞（观察组），左侧鼻腔以藻酸钙＋油纱条填塞（对照组）。术后1日抽取对照侧填充物，观察侧凝胶保留至术后1周第1次内镜复查时清理，鼻腔冲洗、鼻喷糖皮质激素等其他局部处理双侧鼻腔相同。采用视觉模拟量表（visual analog scale，VAS）记录两侧鼻腔术后当天（填塞期）、术后第1天（抽取左侧填充物时）、术后第2天（抽取左侧填充物后）患者鼻痛、鼻堵程度，分泌物、渗血、流泪量，以及术后内镜复查术腔恢复情况（干痂、分泌物、反应膜、黏膜水肿、囊泡、窦口阻塞），并对两组上述11项观察项目评分和上皮化时间进行比较。结果苏醒时因血压过高，凝胶侧鼻腔出血改用纱条填塞1例；外地患者失访2例。余21例完成2—20个月的随访。术后当天、术后第1天鼻痛，术后当天流泪评分，Rhino组〈对照组（Z值分别为-3．575、-3．546、-2．736，P值均〈0．05）；术后第1天渗血评分，Rhino组〈对照组（Z=-3．075，P〈0．05）；术后1周术腔干痴评分，Rhino组〈对照组（Z=-2．103，P〈0．05）；其余各项评分差异无统计学意义；凝胶侧术腔平均上皮化时间为（10．7±2．6）周，对照侧为（10．6±2．9）周，两组差异无统计学意义（t=-0．146，P=0．886）。结论Rhino凝胶可减轻患者鼻腔填塞期的不适，并可避免专门撤除填充物造成的痛苦和出血，较传统方法有明显的优越性。在促进术腔恢复方面与传统方式相当。

Objective To compare the clinical benefits of rapid Rhino Stammberger sinus dressing （RR） , a new nasal packing material for functional endoscopic sinus surgery （ESS） , with traditional packing materials sorbalgon plus Vaseline gauze （SV） prospectively. Methods Twenty-four patients with chronic sinusitis of the similar grade were enrolled in the study. After ESS, the nasal cavities of each patient were packed with RR in the right side as observing group and SV in the left side as control group. SV in the left nasal cavity was removed in the first day after operation and RR remained in the right nasal cavity until the first endoscopic follow-up 1 week postoperatively. The same perioperative treatments such as irrigation and local steroid were given in both sides of nasal cavities. The grade of rhinalgia, nasal obstruction, discharge, bleeding and epiphora in each side of nasal cavities were assessed on a visual analogue scale （VAS） by the patients at the operation day （packing period） , the first day and the second day after operation respectively. Postoperative endoscopic assessment of nasal cavities including crust, discharge, pseudomembrane, edema of mucosa, bubble and ostium obstruction were carried out by a rhinologist on VAS at 1, 2, 3, 4, 6, 8 weeks postoperatively. The follow-up continued until the complete mucosal healing. Results Three patients were dropped from statistical analysis. One of them with severe hypertension bleeding when he awoke from anesthesia, the RR was run out from the nasal cavity. The other two were lost in the follow-up. Twenty-one patients completed the follow -up ranging between 2 -20 months. The scores of rhinalgia, epiphora at the operation day and the rhinalgia at the first day after operation in RR side were lower than SV side （P 〈 0. 05 ）. The scores of the amount of crust at the first week after operation in RR side were lower than SV side （ P 〈 0. 05 ）. Statistically, no significant deference was found between RR and SV in the length of mucosal healing period. Conclusions Patients felt more comfortable with the package of RR than traditional material. No pain and secondary bleeding happened. The efficacy of RR on mucosal healing was similar with SV. RR showed some advantages and could be used as packing material following ESS.