浸润毕罗芬明胶海绵在功能性鼻内镜鼻窦手术后应用效果的临床观察

Clinical observation of the effect of infiltrating Biprofen Gelatin Sponge after functional endoscopic sinus surgery

目的 探讨慢性鼻窦炎伴鼻息肉患者鼻内镜术后行浸润毕罗芬喷剂明胶海绵填塞应用的有效性及安全性。方法 112例筛窦病变为主行鼻内镜手术的慢性鼻窦炎伴鼻息肉患者随机分3个组,浸润糠酸莫米松明胶海绵术中填塞+生理海水术后术腔冲洗(A组);浸润糠酸莫米松明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(B组);浸润毕罗芬喷剂明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(C组)。手术前及术后第2、4、8、12周随访时分别采集症状的SNOT-22评分、Lund-Kennedy内镜评分及囊泡组织中血管内皮生长因子(vascular endothelial growth factor,VEGF)表达情况,比较3个组之间在手术前后主、客观评分的差异,评估其安全性。结果 共有93例患者完成实验规定的3个月的术后随访。主观评分术后较术前明显下降,但术后各随访节点3组评分比较差异无统计学意义;客观内镜评估于术后第2、4、8、12周比较差异均有统计学意义,且呈A>B=C的趋势;客观免疫组化结果VEGF表达含量逐渐减少,在随访12周时比较差异有统计学意义,显示A>B=C的趋势。结论 浸润糠酸莫米松明胶海绵术中填塞与浸润毕罗芬喷剂明胶海绵术腔填塞效能相当,均可有效改善慢性鼻窦炎伴鼻息肉患者鼻内镜术后的主观症状,加快术腔黏膜恢复和上皮化进程,黏膜组织VEGF表达明显减少,临床应用安全良好。

Objective To investigate the efficacy and safety of gelatin sponge packing with infiltrating Biprofen spray in patients with CRSwNP after nasal endoscopic surgery. Methods 112 patients with CRSwNP undergoing nasal endoscopic surgery were randomly divided into three groups: those receiving intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with physiological sea water(group A), intraoperative packing of momethasone furoate gelatin sponge and postoperative irrigation with Biprofen spray(group B), and intraoperative packing of gelatin sponge of infiltrating Biprofen spray and postoperative irrigation of the postoperative cavity of Biprofen spray(group C). SNOT-22 score, Lund-Kennedy endoscopic score and vascular endothelial growth factor(VEGF)expression in vesicles were determined before the operation and at 2, 4, 8 and 12 weeks postoperatively. The differences in subjective and objective scores before and after the operation were compared among the three groups to evaluate their safety. Results a total of 93 patients completed the required 3-month follow-up. The subjective score after operation was significantly lower than before, but there was no significant difference among the follow up nodes of the three groups postoperatively. Objective endoscopic evaluation showed a statistically significant difference in 2, 4, 8 and 12 weeks after operation, and a trend of A>B=C was observed. The differences in objective immunohistochemical score was statistically significant at 12 weeks of follow-up and showed a A>B=C trend. Conclusion The intraoperative packing effect of infiltrating momethasone furoate gelatin sponge is the same as that of infiltrating Biprofen gelatin sponge, which can effectively improve the subjective symptoms of chronic sinusitis with nasal polyps after nasal endoscopic surgery, accelerate mucosal recovery and epithelialization, and VEGF expression in mucosal tissue is significantly decreased. Thus, the clinical application of infiltrating Biprofen gelatin sponge is safe.