内镜鼻窦手术后吸收性明胶海绵附云南白药粉填塞效果的临床观察

Clinical efficacy of absorbabie gelatin spongeasp attaches the White pharmaceuticals of YunNan following endoscopic sinus surgery

目的前瞻性比较吸收性明胶海绵附云南白药粉与传统的藻酸钙联合油纱条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23例慢性鼻窦炎患者行内镜鼻窦手术，术后右侧鼻腔以吸收性明胶海绵填塞（观察组），左侧鼻腔以藻酸钙＋油纱条填塞（对照组）。术后1d抽取对照侧填充物，观察侧吸收性明胶海绵附云南白药粉保留至术后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（visualanalogscale，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。结果除外地患者失访2例外，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，观察组〈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，观察组〈对照组（Z=3．075，P〈0．05）；术后1周术腔干痂评分，观察组〈对照组（Z=-2．103，P〈0．05）；其余各项评分差异无统计学意义；观察侧术腔平均上皮化时间为（8．69±1．9）周，对照侧为（11．75±1．8）周，两组差异有统计学意义（n=14t=5．63P〈0．05）。结论吸收性明胶海绵附云南白药粉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较传统方式较快。

Objective To compare the clinical benefits of absorbabile gelatin spongeasp attaches the White pharmaceuticals of YunNan with traditional packing material sorbalgan plus vaseline gauze prospectively. Methods Twenty-three patients with chronic sinusitis of similar grade were enrolled in the study. Aater endoscopic sinus surgery,the nasal cavities of each patient were packed with absorbabile gelatin spongeasp in the right side as observing group and sorbalgon plus Vaseline gauze in the left side as control group, sorbalgon plus Vaseline in the left nasal cavity was removed in the first day after operation and absorbabie gelatin spongeasp attaches the White pharmaceuticals of YunNan remained in the right nasal cavity until the first endoscopic followup 1 week postoperatively. The same perioperative treatments sneh as irrigation and local steroid were given in both sides of nasal cavities. The grade of rhinalgia, nasal obstruction, discharge, bleeding and epipliora 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 mueosa, 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 the complete mueosal healing. Results The Other two were lost in the follow-up. Twenty-one patients completed the follow-up ranging between 2-20 months. The scores of rhinalalgia, epiphora at the operation day and the rhinalgia at the amount of crust at the first week after operation in absorbabile gelatin spongeasp attaches the White pharma- ceuticals of YunNan side were lower than sorbalgan plus vaseline gauze side （ P 〈 0. 05 ）. The scores of the amount of crust at the first week after operation in absorbabile gelatin spongeasp attaches the White pharmaceuticals of YunNan side were lower than sorbalgan plus vaseline gauze side （ P 〈 0. 05 ）. The averge epitheliun of abserving group were lower than control group. Statistically, significant deference was found between the two group. Conclusion Patients felt more comfortable with the package of absorbabile gelatin spongeasp attaches the White pharmaceuticals of YunNan than traditional material. No pain and secondary bleeding happened. The efficacy of absorbabie gelatin spongeasp attaches the Yannan white on mucosal healing was faster than traditional packing materials.