减少鼻内窥镜手术中出血量探究.docVIP

减少鼻内窥镜手术中出血量探究 　 作者：严飞鹏，王涂路，熊国平，王学梅 【摘要】 目的 探讨鼻内窥镜手术在治疗慢性鼻窦炎鼻息肉中减少出血量的方法。方法 将Ⅱ型2期、Ⅱ型3期和Ⅲ型慢性鼻窦炎鼻息肉患者135例（225侧）分成综合治疗组和对照组进行研究。结果 综合治疗组的术中出血量为77.3±31.0ml，对照组为109.8±35.6ml，两者比较差异有高度显著性（Plt;0.01），综合治疗组的手术有效率为93.90%，对照组为83.02%，两者比较差异有显著性(Plt;0.05)。结论 术前进行围手术前期处理，术中灵活应用电动切割器、咬切钳、双极电凝等措施互相配合，能有效缩短手术时间、减少术中出血量和提高手术疗效，有一定的临床应用价值。 【关键词】 鼻窦炎；鼻息肉；内窥镜检查；止血，内窥镜；耳鼻喉外科手术 　　Abstract: Objective To explore ways in reducing hemorrhage during endoscopic sinus surgery for chronic sinusitis and nasal polyps. Methods 135 patients (225 sides) suffered from chronic sinusitis and nasal polyps (type 2 stages 2 or 3, or type 3) were divided into two groups: combination treatment group and control group. A comparative study was performed. Results The volume of bleeding during surgical procedures in combination treatment group is 77.3±31.0ml, while 109.8±35.6ml in control group. A comparison of bleeding volume between these two groups showed that there was statistical significant difference (Plt;0.01). The efficacy ratio is 93.90% in combination treatment group, and 83.02% in control group, there was statistical difference (Plt;0.05). Conclusion It is of great significance to be well prepared before surgery, using the apparatus and instruments correctly and completely to cooperate the surgery, such as electric cutting device, grip and cut pincerses and bipolar electric coagulation, which may result in shortening surgery time, reducing the hemorrhage and complication and improving curative effects. 　　Key words: sinusitis; nasal polyps; endoscopy; hemostasis, endoscopic; otorhinolaryngologic surgical procedures 　　随着慢性鼻窦炎鼻息肉经鼻内窥镜手术(Endoscopic sinus surgery, ESS)的广泛开展，有关介绍鼻内窥镜手术治疗慢性鼻窦炎鼻息肉取得良好效果的文献亦越来越多地见于各种杂志，但鼻内窥镜手术中如何减少出血量、减少因此而引起的严重并发症，进一步提高疗效仍然是广大术者仍需解决的问题。为此，我科从2000年1月～2005年3月，对Ⅱ期和Ⅲ期的慢性鼻窦炎鼻息肉患者135例（225侧）分成综合治疗组和对照组，通过对比研究，比较不同治疗措施对鼻内窥镜手术出血量及疗效的影响，现报道如下： 　　1 资料与方法 　　1.1 临床资料 　　慢性鼻窦炎鼻息肉患者135例（225侧），分成两组，甲组为综合治疗组，乙组为对照组。两组术前均行鼻窦CT扫描。甲组82例，其中男50例，女32例，年龄16～70岁，平均46.23岁。按照海口ESS标准［1］分型分期，Ⅱ型2期36例，Ⅱ