Bugten Vegard, Nordgård Ståle, Steinsvåg Sverre
Department of Otolaryngology, Head and Neck Surgery, St. Olav University Hospital of Trondheim, and Norwegian University of Science and Technology, Trondheim, Norway. vegard@
Laryngoscope. 2006 Nov;116(11):2037-43. doi: 10.1097/01.mlg.0000241362.06072.83.
OBJECTIVES/HYPOTHESIS: The aim of this randomized, partly blinded, controlled clinical trial was to evaluate the effects of debridement 6 and 12 days after endoscopic sinus surgery.
Sixty patients (male/female = 26/34; mean age, 43.5 years; age range, 23-73 years) with chronic or acute recurrent rhinosinusitis were included. The patients were randomized to postoperative debridement or not. Primary outcome variables were adhesions between the middle turbinate and the lateral nasal wall 10 to 14 weeks after surgery judged by blinded evaluation of endoscopic video recordings. Secondary outcome variables were crusts in the nasal cavity 12 days after surgery and pain caused by debridement.
We found a significant reduction in adhesions in the group that underwent debridement (P < .001). At 12 weeks, bilateral adhesions were observed in nine control patients but in only one debridement patient. Unilateral adhesions were found in 11 control patients and in nine debridement patients. Twelve days after surgery, we found significantly less severe crusts in the debridement group (P < .01). Patients with severe crusts in the middle meatus 12 days after surgery had more adhesions 12 weeks postoperatively. The debridement group used more analgesics the days after the first debridement (3.7 days [standard deviation 2.3] vs. 2.3 days [standard deviation 2.6] in the control group, P < .041).
Crusts in the middle meatus after sinus surgery is associated with postoperative adhesions. Debridement of the nasal cavity reduces crusts and postoperative adhesions significantly compared with saline irrigation only. However, the procedure induces more postoperative nasal pain.
目的/假设：本随机、部分盲法、对照临床试验的目的是评估鼻内镜手术后6天和12天进行清创术的效果。
纳入60例慢性或急性复发性鼻-鼻窦炎患者（男/女 = 26/34；平均年龄43.5岁；年龄范围23 - 73岁）。患者被随机分为术后是否进行清创术两组。主要结局变量是术后10至14周通过对鼻内镜视频记录进行盲法评估判断的中鼻甲与鼻外侧壁之间的粘连情况。次要结局变量是术后12天鼻腔内的痂皮以及清创术引起的疼痛。
我们发现接受清创术的组粘连情况显著减少（P <.001）。在12周时，9例对照组患者观察到双侧粘连，而清创术组仅1例患者出现双侧粘连。11例对照组患者和9例清创术组患者发现单侧粘连。术后12天，我们发现清创术组痂皮严重程度明显较轻（P <.01）。术后12天中鼻道有严重痂皮的患者术后12周粘连更多。清创术组在首次清创术后几天使用更多镇痛药（3.7天[标准差2.3]，而对照组为2.3天[标准差2.6]，P <.041）。
鼻窦手术后中鼻道的痂皮与术后粘连有关。与仅用生理盐水冲洗相比，鼻腔清创术可显著减少痂皮和术后粘连。然而，该操作会引起更多的术后鼻痛。
