功能性鼻内镜鼻窦手术后纳吸棉鼻腔填塞效果评估

Evaluation of the effect of Nasopore on nasal packing in functional endoscopic sinus surgery

目的:评估纳吸棉在功能性鼻内镜鼻窦手术(FESS)后鼻腔填塞的临床效果。方法:选取117例慢性鼻-鼻窦炎鼻息肉行双侧FESS且完成随访的患者,根据FESS术后使用鼻腔填塞材料不同分为纳吸棉组、藻酸钙组、高分子膨胀海绵组、藻酸钙加高分子膨胀海绵组,分别对4组患者填塞期鼻腔堵塞感、鼻痛、头胀痛程度和填塞物抽取时不适程度进行视觉模拟量表(VAS)评分,对鼻腔填塞期和填塞物抽取时不良反应发生率进行比较,在术后2、4、8、12周进行鼻内镜Lund-Kennedy评分。结果:1鼻腔填塞期鼻腔堵塞感、鼻痛、头胀痛VAS评分和填塞物抽取时不适VAS评分中,以纳吸棉组VAS评分最低,4组间差异有统计学意义(P<0.05);2纳吸棉组的溢泪、吞咽困难、填塞物取出后出血、周围黏膜擦伤、填塞物嵌顿不良反应发生率最低,优于其他组,差异有统计学意义(P<0.05);在发热、喷嚏、填塞24h内出血、抽取填塞物时晕厥不良反应发生率上,4组间差异无统计学意义(P>0.05);3术后同一时间点鼻内镜Lund-Kennedy评分4组间差异无统计学意义(P>0.05),各组鼻内镜Lund-Kennedy评分在术后2、4、8、12周呈下降趋势,差异有统计学意义(P<0.05)。结论:纳吸棉用于FESS后鼻腔填塞,具有止血作用肯定、填塞不适程度轻、填塞期与填塞物抽取时不良反应少的优点,并且能达到藻酸钙或高分子膨胀海绵填塞后术腔黏膜转归并愈合的疗效。

Objective：To investigate the effect of Nasopore on nasal packing in functional endoscopic sinus surgery.Method：A total of 117 chronic rhinosiunsitis with or without nasal polyps patients undergone bilateral functional endoscopic sinus surgery and finished follow up visit were recruited.In accordance with various nasal packing materials in operation,patients were divided into Nasopore group,Sorbalgon group,Merocel group and Sorbalgon combined Mercel group.The VAS score was measured and differences were observed in patients of four groups in terms of subjective symptoms,post-operation adverse reaction and recovery of mucosa of operative nasal cavity in 2,4,8 and 12 weeks.Result：1 The postoperative VAS symptoms score regarding nasal obstruction,nasal pain,head pressure feeling and discomfort in removal of the nasal packing in Nasopore group were significantly better than those in the other groups（P〈0.05）.2In Nasopore group,incidences of adverse reactions in epiphora,dysphagia,bleeding after removal nasal packing,surrounding mucosa scratches,nasal packing incarceration were significantly lower than that in the other groups（P〈0.05）.The incidences of fever,sneezing,bleeding in operation day and faint when removing nasal packing in four groups had no statistical differences（P〉0.05）.3 The postoperative Lund-Kennedy endoscopic mucosa morphology score in 2,4,8 and 12 weeks in four groups had no statistical differences（P〉0.05）,and in each group the score was significantly lower as time changes（P〈0.05）.Conclusion：The Nasopore packing has definite hemostatic efficacy,little postoperative discomfort and nice mucosal healing outcome as well in patients after functional endoscopic sinus surgery.It indicates that Nasopore is an effective and reliable packing material in FESS.