内窥镜鼻窦手术后应用重组人表皮生长因子效果观察

Analysis of Clinical Application of Recombinant Human Epidermal Growth Factor on ESS for Chronic Sinusitis

目的探讨慢性鼻-鼻窦炎内窥镜鼻窦手术(endoscopic sinus surgery,ESS)后应用重组人表皮生长因子的临床效果。方法选择在我院行双侧ESS的慢性鼻-鼻窦炎患者30例,采用双侧鼻腔自身对照的方法,将左侧鼻腔设为观察组,右侧鼻腔设为对照组。手术完成前对照组术腔予浸有丙酸氟替卡松的可吸收止血棉填充,观察组术腔予浸有丙酸氟替卡松及重组人表皮生长因子外用溶液的可吸收止血棉填充。术后第5天清除术腔填充物后对照组继续予丙酸氟替卡松喷鼻,观察组予重组人表皮生长因子外用溶液+丙酸氟替卡松喷鼻,均使用1个月,术后3个月比较两组完全上皮化时间、Lund-Kennedy、疗效及不良反应发生情况。结果术后两组术腔上皮化时间比较差异有统计学意义(P<0.05);两组Lund-Kennedy评分均下降,与术前比较差异均有统计学意义(P<0.05),观察组与对照组比较差异亦有统计学意义(P<0.05)。两组病情完全控制率比较差异有统计学意义(P<0.05),有效率比较差异无统计学意义(P>0.05)。两组共有2例出现轻度不良反应,对症处理后恢复。结论 ESS术后应用重组人表皮生长因子可加速术后创面上皮化,提高临床效果。

Objective To investigate the effect of recombinant human epidermal growth factor on ESS for chronic si-nusitis. Methods 30 cases with chronic sinusitis treated by ESS with complete follow-up medical records were randomly se-lected in Huangshi Central Hospital, all the cases were self-controlled by bilateral nasal cavity, with the left nasal cavity for the experimental group, the right nasal cavity for the control group. For the control group, stypic cotton soaked in Fluticasone propionate nasopore was packed into the nasal cavity before the end of the operation. For the experimental group, recombinant human epidermal growth factor was added into Fluticasone propionate nasopore which was packed into the nasal cavity after op-eration. All the cavity tamponades were excisioned on the fifth day after operation, the control group used fluticasone propio-nate nasal spray, the experimental group received recombinant human epidermal growth factor for external use solution com-bined with fluticasone propionate nasal spray. All the treatment course lasted for 1 month, and the epithelization time,Lund-Kennedy scores, treatment effect and adverse reaction were compared between the two groups in the third month after opera-tion. Results The difference of the mean epithelization time between the two groups was statistically significant （P 〈 0. 05）, the Lund-Kennedy scores of the two groups were reduced in the 3rd month postoperatively, and there was statistically signifi-cant difference between the scores before operation （P 〈 0. 05）,the score of experimental group was significantly reduced, compared with that of control group（P 〈0. 05）,the completely controlled rates of the two groups showed statistically significant differences （P〈 0. 05）, the total effective rate of the two groups did not show statistically significant differences （P 〉 0. 05）. Mild adverse reactions occurred in two cases of the two groups, which disappeared after symptomatic treatment. Conclusion Application of recombinant human epidermal growth factor after ESS can accelerate wound epithelization and improve the thera-peutic effect of ESS for chronic sinusitis.