鼻内镜下等离子刀治疗难治性鼻出血的临床应用

Clinical application of plasma knife under nasal endoscope in the treatment of refractory epistaxis

目的对比等离子刀与双极电凝在难治性鼻出血治疗中的效果。方法将2013年5月至2018年5月住院接受治疗的难治性鼻出血并行手术治疗患者共430例,根据手术方式分组,等离子组224例,采用等离子刀治疗,对照组206例,采用双极电凝治疗,统计两组患者出血部位、手术时间、治疗效果及术后并发症等情况。结果出血部位以鼻中隔出血分布最多(29.53%),其次是嗅裂(25.81%)和下鼻道后穹隆(22.33%)。等离子组平均手术时间为(23.54±7.18)分钟,对照组平均手术时间为(33.72±9.61)分钟,比较差异有统计学意义(t=12.507,P<0.001),等离子组手术时间更短。等离子组治愈218例,复发6例,治愈率97.32%,对照组治愈195例,复发11例,治愈率94.66%,两组比较差异无统计学意义(χ^2=2.002,P=0.157)。等离子组鼻腔粘连9例,鼻中隔穿孔4例,并发症发生率为5.80%(13/224),对照组鼻腔粘连7例,并发症发生率为3.40%(7/206),两组比较差异无统计学意义(χ^2=1.400,P=0.237)。结论等离子刀能有效治疗难治性鼻出血,手术时间短,值得推广。

Objective To compare the effect of plasma knife and bipolar coagulation in the treatment of intractable epistaxis. Methods A total of 430 patients with refractory epistaxis who hospitalized and underwent surgery from May 2013 to May 2018 were divided into two groups according to surgical methods.224 cases in plasma group were treated with plasma knife,and 206 cases in control group were treated with bipolar coagulation.And then,the bleeding sites,operation time,treatment effect and postoperative complications of the two groups were counted. Results The bleeding sites were mainly distributed in nasal septum(29.53%),followed by olfactory cleft(25.81%) and inferior meatus posterior vault(22.33%).The average operation time of the plasma group was(23.54±7.18)min,shorter than that of the control group(33.72±9.61)min,difference was statistically significant( t =12.507,P <0.001).218 cases were cured in the plasma group,6 cases recurred,and the cure rate was 97.32%,while 195 cases were cured in the control group,11 cases recurred,and the cure rate was 94.66%,difference was not statistically significant(χ^2=2.002,P =0.157).There were 9 cases of nasal adhesion and 4 cases of nasal septum perforation in the plasma group,and the incidence of complications was 5.80%(13/224),while there were 7 cases of nasal adhesion in the control group,and the incidence of complications was 3.40%(7/206),difference was not statistically significant between the two groups(χ^2=1.400,P =0.237). Conclusion Plasma knife can effectively treat intractable epistaxis with short operation time,which is worthy of popularization.