Valentine Rowan, Wormald Peter-John
Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Curr Opin Otolaryngol Head Neck Surg. 2010 Feb;18(1):44-8. doi: 10.1097/MOO.0b013e3283346f36.
Nasal dressings are commonly used following endoscopic sinus surgery in an attempt to prevent ongoing bleeding and to modulate the wound healing process. Experience with nasal dressings in the otolaryngologic literature spans more than half a century; however, despite this, there is still little agreement between surgeons on the optimal choice of nasal dressings following endoscopic sinus surgery, or whether nasal dressings are required at all. This paper briefly reviews the past research and examines recent advances in the area of nasal dressings.
The ideal nasal dressing is one that is absorbable, hemostatic and improves healing. Although a number of currently available materials may address one of these features, none address all. Currently available dressings that achieve hemostasis worsen wound healing outcomes. However, recent research shows promise with microporous polysaccharide hemospheres and chitosan gel having promising effects on hemostasis, and chitosan gel showing a significant adhesion prevention effect.
The sinus surgeon must be aware of the potential advantages and limitations of currently available nasal dressings. The area of wound healing and adhesion prevention remains an area of active research and more prospective controlled trials are needed to define any benefits biomaterials may have.
鼻内敷料常用于鼻内镜鼻窦手术后，旨在预防持续出血并调节伤口愈合过程。耳鼻喉科文献中关于鼻内敷料的经验已有半个多世纪；然而，尽管如此，外科医生对于鼻内镜鼻窦手术后鼻内敷料的最佳选择，或者是否根本需要鼻内敷料，仍未达成太多共识。本文简要回顾过去的研究，并审视鼻内敷料领域的最新进展。
理想的鼻内敷料应具备可吸收、止血和促进愈合的特性。尽管目前有多种材料可能具备其中某一特性，但尚无材料能同时满足所有特性。目前可用的能实现止血的敷料会恶化伤口愈合结果。然而，近期研究显示微孔多糖微球和壳聚糖凝胶在止血方面有潜在效果，壳聚糖凝胶还显示出显著的预防粘连作用。
鼻窦外科医生必须了解目前可用鼻内敷料的潜在优势和局限性。伤口愈合和预防粘连领域仍是活跃的研究领域，需要更多前瞻性对照试验来确定生物材料可能具有的任何益处。
