低温等离子射频消融技术在治疗慢性鼻-鼻窦炎中的应用

The Application of the Radiofrequency Treatment in Endoscopic Sinus Surgery

目的探讨低温等离子射频消融技术在治疗慢性鼻-鼻窦炎中的应用。方法将在鼻内镜手术中采用低温等离子射频消融治疗的慢性鼻-鼻窦炎患者77例(等离子组)与采用电动吸切器治疗的慢性鼻-鼻窦炎患者58例(对照组)比较术中出血情况、手术持续时间、鼻腔填塞物使用数量、术后行鼻内镜检查Lund-Kennedy评分以及VAS症状评分。结果术中出血量等离子组(32.6±4.6)mL,对照组(46.5±7.3)mL;手术持续时间等离子组(49.6±10.2)min,对照组(65.8±11.4)min;鼻腔填塞物数量[条,中位数(最小值,最大值)]等离子组2(1,4),对照组4(1,6),上述结果两组间比较均有统计学意义(均P<0.05或P<0.01);鼻内镜检查Lund-Kennedy评分在前4周内对照组鼻腔组织水肿、鼻漏及鼻腔内结痂较等离子组严重(P<0.05或P<0.01);而鼻息肉的形成在两组间相比差异无统计学意义;两组患者术后不同时间VAS症状评分比较,在术后1周内对照组患者觉疼痛和鼻腔渗血较等离子组患者严重,术后4周内对照组患者鼻塞症状较重,术后4周及3个月复诊时对照组患者觉鼻腔分泌物较多,在抽取鼻腔填塞物前,对照组患者流泪情况较等离子组严重,两组相比差异有统计学意义(P<0.05或P<0.01)。结论低温等离子治疗慢性鼻-鼻窦炎具有创伤小,术中术后出血少,术后组织反应轻恢复快,患者易耐受等优势。

Objective To investigate the application of the radiofrequency volumetric tissue reduction in functional endoscopic sinus surgery.Methods 135 patients with chronic rhinosinusitis were divided into two groups.In group A,77 cases of patients who performed RFVTR simultaneously were selected;in group B,58 cases who performed traditional surgical technique simultaneously were selected as the controls.The bleeding,the duration of performance and the quantity of wadding were recorded during the operation.Nasal endoscopy,visual analogue scale were used to assess treatment outcomes at the end of the 1st,2nd,4th week,the 1st,3rd months and the 1st year after surgery.Results The bleeding in group A and B were（32.6±4.6） mL and（46.5±7.3） mL respectively The duration of performance in group A and B were（49.6±10.2） min and 65.8±11 minutes respectively.The mean wadding in group A and B were 2（1,4）and 4（1,6） respectively.The edema,secretions,crusts and scarring in group B were more severe than those in group A according to Lund-Kennedy score after surgery;The pain,nasal obstruction,postoperative epistaxis,secretions and lacrimation in group B were more severe than those in group A according to VAS.Conclusion The chief advantages of the RFVTR are those they produce a less bleeding,precision of tissue removal and lead to less damage to surrounding tissues.The RFVTR offers an efficient alternative in FESS.