鼻内镜手术术后处理方法与鼻-鼻窦良性病变转归关系的研究

Study on relationship between postoperative treatment method in nasal endoscopic surgery and outcome of nose and paranasal sinuses benign lesions

目的探讨鼻-鼻窦良性病变患者采用鼻内镜手术治疗后,不同术腔处理方法对患者治疗效果的影响差异。方法本研究采取回顾性研究方式,选取南京中医大学附属南京市中西医结合医院2012年1月至2015年1月采取鼻内镜手术治疗的鼻-鼻窦良性病变患者198例进行研究。其中常规组100例,患者术后仅采取了常规处理,即单纯术腔清理+皮质类固醇激素喷鼻;特殊组98例,根据患者情况除常规组方法外,还采用鼻腔粘连分离或局部放置浸润5-FU膨胀海绵或基底部干扰素注射。结果术前,特殊组和常规组患者的鼻堵视觉模拟评分法(VAS)、嗅觉VAS、鼻腔鼻窦结局测量20条(SNOT-20)、糖精试验时间、客观Lund-Kennedy评分比较差异无统计学意义(P>0.05);术后12个月复查时,特殊组患者的鼻堵VAS、嗅觉VAS、SNOT-20、糖精试验时间、客观Lund-Kennedy评分均低于常规组患者,差异有统计学意义(P<0.05);术后3、12个月特殊组的鼻黏膜嗜酸性粒细胞计数均显著低于常规组患者,差异有统计学意义(P<0.05);术后12个月特殊组痊愈75例、好转20例、无效3例,常规组痊愈62例、好转29例、无效9例,特殊组患者的临床效果优于常规组患者,差异有统计学意义(P<0.05)。结论鼻-鼻窦良性病变患者采用鼻内镜手术治疗后应根据患者的实际情况给予恰当的术后处理,将有助于提高鼻内镜手术治疗的临床效果。

Objective To study the influence of different operative methods after nasal endoscopic surgery on the effect in the patients with nose and paranasa[ sinuses benign lesions. Methods This research took the retrospective study mode,198 cases of nose and paranasal sinuses benign lesions treated by nasal endoscopic operation in the ENT department of our hospital from January 2012 to January 2015 were selected for conducting the research,in which the routine group（100 cases） adopted the conventional treatment, simple surgical cavity cleaning and corticosteroid hormone nasal spray, the special group（98 cases） adopted the nasal cav- ity adhesion separation or local placing infiltration 5-FU expanding sponge or basal interferon injection according to the conditions of patients in addition to the conventional method. Results Preoperative nasal blockage visual analogue scale（VAS） ,smell VAS,nasal cavity and paranasal sinuses outcome test-20（SNOT-20）, saccharin test time and objective Lund-Kennedy score had no statistical difference between the special group and conventional group（P〉0.05） sin the re-examination at postoperative 12 months, the nasal blockage VAS,smell VAS,SNOT-20,saccharin test time and objective Lund-Kennedy scores in the special group were lower than those in the conventional group,the difference was statistically significant（P〈0.05） ;the eosinophil counts at postoperative 3,12 months in the special group were significantly lower than those in the conventional group, the difference was statistically significant （P〈0.05） ;at postoperative 12 months,75 cases in the special group were cured,20 cases were improved and 3 cases were ineffec- tive,while 62 cases in the conventional group were cured,29 cases were improved and 9 cases were ineffective,the clinical effects of the special group were superior to the conventional group, the difference was statistically significant （P〈0.05）. Conclusion The patients with nose - paranasal sinuses benign lesions should give the appropriate postoperative treatment after nasal endoscopic surgery, which is conducive to improve the clinical effects of nasal endoscopic sinus surgery.