两种止血材料用于鼻内镜下泪囊鼻腔吻合术效果比较

CLINICAL EFFECT OF TWO TYPES OF HEMOSTATIC MATERIALS IN ENDONASAL ENDOSCOPIC DACRYOCYSTORHINOSTOMY:A COMPARATIVE ANALYSIS

目的比较高分子止血膨胀材料膨胀海绵和主要成分为透明质酸的生物材料用于鼻内镜下泪囊鼻腔吻合术的效果。方法将69例(73眼)慢性泪囊炎病人随机分为两组,均在气管内插管全麻下或神经阻滞麻醉下进行鼻内镜下鼻腔泪囊吻合术,A组(35例)术后采用高分子止血膨胀材料膨胀海绵止血;B组(34例)采用主要成分为透明质酸的生物材料止血。观察两组止血效果、填塞期舒适度和治愈率及吻合口黏膜上皮化情况。结果两组止血效果比较差异无统计学意义(P>0.05);B组填塞期舒适度、治愈率及吻合口黏膜上皮化情况均优于A组,差异有显著性(χ2=5.533、7.490,t=8.270,P<0.05)。结论鼻内镜下泪囊鼻腔吻合术中应用透明质酸生物材料止血,可显著促进吻合口周围创面愈合及黏膜上皮化,从而提高吻合口开放率。

Objective To investigate the hemostatic effect of expansive sponge,a type of high-molecular expansive hemostatic material,versus a type of biomaterial with hyaluronic acid as the main constituent in endonasal endoscopic dacryocystorhinostomy. Methods A total of 69 patients（73 eyes）with chronic dacryocystitis were randomly divided into groups A and B,and endonasal endoscopic dacryocystorhinostomy was performed under general anesthesia with endotracheal intubation or nerve block anesthesia.The 35 patients in group A were given expansive sponge for hemostasis,and the 34 patients in group B were given the biological material with hyaluronic acid as the main constituent.The two groups were observed in terms of the outcome of hemostasis,degree of comfort during the filling period,cure rate,and epithelization of the anastomotic mucosa. Results There was no significant difference in the outcome of hemostasis between the two groups（P〈0.05）.Compared with group A,group B had significantly higher degree of comfort during the filling period and cure rate and significantly better epithelization of the anastomotic mucosa（χ~2=5.533 and 7.490,t=8.270,P〈0.05）. Conclusion When used in endonasal endoscopic dacryocystorhinostomy,the biomaterial containing hyaluronic acid can significantly promote the healing of perianastomotic wound and the epithelization of the anastomotic mucosa and thus increase the opening rate of the anastomosis.