Eloy Jean Anderson, Walker Thomas J, Casiano Roy R, Ruiz Jose W
Department of Otolaryngology-Head and Neck Surgery, University of Miami-Leonard Miller School of Medicine, Miami, Florida, USA.
Am J Rhinol Allergy. 2009 Sep-Oct;23(5):535-9. doi: 10.2500/ajra.2009.23.3330. Epub 2009 Jun 2.
We conducted a pilot study comparing estimated blood loss (EBL) using coblation-assisted endoscopic sinus surgery (CAESS) where coblation is used to debulk nasal polyps before microdebridement with a traditional microdebrider technique in chronic rhinosinusitis (CRS) patients with sinonasal polyps undergoing endoscopic sinus surgery (ESS).
A retrospective analysis was performed at a tertiary care center on patients with nasal polyposis undergoing ESS between January 2008 and July 2008. The University of Miami CT staging system was used preoperatively to evaluate the extent of sinonasal disease. The duration of surgery, blood loss per minute, total EBL, and demographic data were collected.
Twenty-one patients underwent nasal polypectomy/ESS using CAESS and 16 patients underwent nasal polypectomy/ESS using microdebridement. The two groups had comparable University of Miami CT staging scores (p>0.05). The average EBL was 307.1+/-169.8 mL using coblation compared with 627.8+/-424.2 mL using microdebridement (p<0.05). The average duration of surgery using coblation was 116.2+/-41.7 minutes, compared with 125.3+/-48.4 minutes using microdebridement (p>0.05). The average blood loss per minute was 2.8+/-1.7 mL in the coblation group compared with 4.8+/-2.1 mL in the microdebridement group (p<0.05). Subgroup analyses showed a significant decrease in average EBL and EBL/minute to be only significant for revision cases (p<0.05) and not for primary cases (p>0.05).
Coblation-assisted nasal polypectomy/ESS is associated with a statistically significant lower EBL and blood loss per minute when compared with traditional microdebridement technique. Coblation represents a new device that can reduce blood loss in patients with nasal polyposis undergoing traditional revision ESS. Further prospective randomized trials are needed to validate these findings.
我们进行了一项初步研究，比较了在慢性鼻窦炎（CRS）伴鼻息肉且接受鼻内镜手术（ESS）的患者中，使用等离子辅助鼻内镜鼻窦手术（CAESS）（即在使用传统微型切割器技术进行微型清创术前，先使用等离子消融术去除鼻息肉）时的估计失血量（EBL）。
在一家三级医疗中心对2008年1月至2008年7月期间接受ESS的鼻息肉患者进行回顾性分析。术前使用迈阿密大学CT分期系统评估鼻窦疾病的范围。收集手术时间、每分钟失血量、总EBL和人口统计学数据。
21例患者使用CAESS进行鼻息肉切除术/ESS，16例患者使用微型清创术进行鼻息肉切除术/ESS。两组的迈阿密大学CT分期评分具有可比性（p>0.05）。使用等离子消融术时的平均EBL为307.1±169.8 mL，而使用微型清创术时为627.8±424.2 mL（p<0.05）。使用等离子消融术的平均手术时间为116.2±41.7分钟，而使用微型清创术时为125.3±48.4分钟（p>0.05）。等离子消融术组的平均每分钟失血量为2.8±1.7 mL，而微型清创术组为4.8±2.1 mL（p<0.05）。亚组分析显示，平均EBL和每分钟EBL的显著降低仅在翻修病例中具有统计学意义（p<0.05），而在初次病例中无统计学意义（p>0.05）。
与传统微型清创术相比，等离子辅助鼻息肉切除术/ESS在统计学上具有显著更低的EBL和每分钟失血量。等离子消融术是一种新设备，可减少接受传统翻修ESS的鼻息肉患者的失血量。需要进一步的前瞻性随机试验来验证这些发现。
