减少鼻腔通气对鼻内镜术后创面愈合影响.docVIP

减少鼻腔通气对鼻内镜术后创面愈合影响 　【摘要】 采用前鼻孔放置棉球的方法减少鼻腔通气，观察鼻内镜术后创面愈合的情况。方法：2005年1月 2006年1月我们为192例慢性鼻窦炎患者行功能性鼻内镜手术。其中A组30例患者在取出鼻腔填塞物后于前鼻孔放置棉球以减少鼻腔通气；在余下的162例中以鼻窦炎类型为配对标准1∶1抽取未放置棉球的患者30例为B组。分析AB两组在术后1、2、4、12周的鼻内镜检查结果。结果：术后4周，A组鼻腔痂皮明显少于B组。术后12周，A组鼻黏膜水肿和囊泡少于B 组。A组有11侧（单侧9例，双侧1例）鼻腔轻度粘连，B组22侧（单侧10例，双侧6例）轻度粘连，2侧（均为单侧）重度粘连，差异有统计学意义(P＜0.05)。相关性分析显示，术后4周内鼻腔痂皮多者，术后12周易发生鼻腔粘连、鼻黏膜水肿及囊泡形成。结论：鼻内镜手术患者在取出鼻腔填塞物后，于前鼻孔放置棉球是减少鼻腔痂皮形成简单而有效的方法，有利于术腔创面愈合。 【关键词】 鼻窦炎 鼻内镜外科手术 粘连 To study the effects of reducing nasal airflow by placing a cotton ball in the anterior nostrils on wound healing after endoscopic sinus surgery. Methods： Among 192 patients treated with functional endoscpic sinus surgery, 30 patients who received a cotton ball placed in the anterior nostrils after removing the nasal stents were put in group A. Another 30 patients who did not receive a cotton ball placed in the anterior nostrils after removing the nasal stents in the same period were put in group B. The nasal endoscopic recordings at week 1, 2, 4 and 12 after endoscopic sinus surgery were analyzed. Results： Nasal crusts in group A were obviously fewer than in group B at week 4 after surgery. At week 12, the mucosal edema and cyst formation of the nasal cavity in group A were less than in group B. There were 11 cases with mild adhesions in group A and 22 cases with mild adhesions and 2 cases with severe adhesions in group B. Differences between the two groups were significant (P＜0.05). Patients with severe nasal crusts at week 4 after surgery had more severe adhesions, mucosal edema and cyst formation in the nasal cavity at week 12. Conclusions： Anterior nostril cotton placement after removing nasal stents is a simple and effective method to reduce nasal crust formation, which is a benefit to surgical wound healing for patients after endoscopic sinus surgery. ［KEY WORDS］ Sinusitis; Nasal endoscopic surgical procedures， operative; Adhesion 功能性鼻内镜手术（functional endoscopic sinus surgery，FESS）由于其损伤小、疗效好，已成为治疗慢性鼻窦炎的首选手术方式，但仍有7.6% 38%的患