功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则.docVIP

功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则 文章来源： 　　　　 2006-7-26 9:34:48 ? 功能性内窥镜鼻窦手术后术腔粘膜转归阶段的划分及处理原则 中华耳鼻咽喉科杂志 1999年第5期第34卷 临床研究 作者：许庚　李源　谢民强　史剑波　李华斌 单位：510630 广州 中山医科大学第三临床学院耳鼻咽喉科(许庚、李源、谢民强、李华斌)；暨南大学医学院第一附属医院耳鼻咽喉科(史剑波) 关键词：手术后期间；手术后护理；鼻粘膜；；内窥镜检查 　　摘要　目的　探讨内窥镜鼻窦手术后粘膜的转归过程并对此过程进行阶段划分。方法　 对328例(均为双侧)功能性内窥镜鼻窦手术患者术后粘膜形态学进行连续观察。结果　90%以上的术腔在1～2周内清洁，80%以上的术腔在3～10周内有水肿、囊泡、肉芽、息肉生长和纤维结缔组织增生、粘连等去粘膜化反应或再生病变发生，并与上皮化呈竞争性生长。90%的术腔在经过恰当的处理后可完成上皮化，其中接近60%的术腔是在术后11～14周完成上皮化。结论　将术后粘膜转归过程划分为3个阶段：术腔清洁阶段、粘膜转归竞争阶段和上皮化完成阶段。提出对术后各阶段进行正确的局部处理是保证手术整体疗效的重要组成部分。 Staging of mucous membrane outcome in operative cavity after functional endoscopic sinus surgery XU Geng, LI Yuan, XIE Minqiang, et al. 　　Department of Otorhinolaryngology, Third Affiliated Hospital, Sun Yet-sen University of Medical Sciences, Guangzhou 510630 　　Abstract　Objective　To investigate the character of transitionary process of mucosa in sinu cavity after functional endoscopic sinus surgery (FESS) and divide it into different stages.Method　 The morphological character of mucosa in sinus cavity after FESS was surveyed continuously. Results　Over 90% of nasal and sinus cavity got clean within 1 to 2 weeks postoperatively. About 80% of patients had the De-mucous reaction from the 3rd to 10th week , such as mucous edema, vesicles, granulation tissue, mini-polyps, fibrous hyperplasia, and adhesion or regenerated diseases may appear in this stage. All of these diseases competed with mucous epithelization. There were 90% of nasal and sinuous cavity brought to stage of complete epithelization, 11 to 14 weeks were need in about 60% of them.Conclusion Three stages were divided after FESS. They are stage of clean operative cavity, stage of mucous competition and stage of complete epithelization. Proper local care in each stage is essential to the whole curable effect of FESS. 　　 　　Key words　Postoperative period 　　Postoperative care 　　 Nasal mucosa 　　Endoscopy 　　随着功能性内窥镜鼻窦手术的广泛开展和技术的逐渐成熟，临床注意力开始向手术后术腔护理及综合性治疗倾斜。单纯依靠手术而不注重手术后的处理并不能获得可靠疗效的观点已经得到广泛的共