Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Am J Rhinol Allergy. 2010 Jan-Feb;24(1):70-5. doi: 10.2500/ajra.2010.24.3422.
Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). Continued bleeding risks airway compromise from the inhalation of blood clots and from the aspiration of blood-stained vomitus. Additionally, adhesion formation is the most common reason for patients requiring revision surgery. This study aimed to determine the efficacy of a novel chitosan/dextran (CD) gel on hemostasis and wound healing after ESS.
A randomized controlled trial was performed involving 40 patients undergoing ESS for chronic rhinosinusitis. Immediately after surgery a baseline Boezaart Surgical Field Grading Scale was taken. Computer randomization was performed with one side receiving CD gel and the other side receiving no treatment (control). Boezaart bleeding scores were then calculated for each side every 2 minutes. Patient's endoscopic features of wound healing were assessed at 2, 6, and 12 weeks after surgery.
CD gel achieved rapid hemostasis with the mean time to hemostasis at 2 minutes (95% CI, 2-4 minutes) compared with 10 minutes (95% CI, > or =6 minutes) for the control (p < 0.001). There were significantly less adhesions at all time points with CD gel versus control: 2 versus 18 at 2 weeks (p < 0.001), 3 versus 16 at 6 weeks (p < 0.001), and 2 versus 12 at 3 months (p < 0.001). There was no significant difference between CD gel and control with respect to crusting, mucosal edema, infection, or granulation tissue formation.
CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation, addressing two of the most common complications of sinus surgery.
内镜鼻窦手术（ESS）后最常见的两种并发症是术后出血和粘连形成。持续出血会导致气道因吸入血凝块和带血呕吐物而受到影响。此外，粘连形成是患者需要接受翻修手术的最常见原因。本研究旨在确定新型壳聚糖/葡聚糖（CD）凝胶在 ESS 后止血和伤口愈合方面的疗效。
对 40 例接受 ESS 治疗慢性鼻-鼻窦炎的患者进行了一项随机对照试验。手术结束后立即进行基线 Boezaart 手术视野分级。采用计算机随机分组，一侧使用 CD 凝胶，另一侧不接受治疗（对照组）。然后，每 2 分钟计算一次每侧的 Boezaart 出血评分。术后 2、6 和 12 周评估患者的内镜伤口愈合特征。
CD 凝胶可迅速止血，止血时间为 2 分钟（95%CI，2-4 分钟），而对照组为 10 分钟（95%CI，≥6 分钟）（p＜0.001）。与对照组相比，在所有时间点，CD 凝胶的粘连明显更少：2 周时为 2 比 18（p＜0.001），6 周时为 3 比 16（p＜0.001），3 个月时为 2 比 12（p＜0.001）。CD 凝胶与对照组在结痂、黏膜水肿、感染或肉芽组织形成方面无显著差异。
CD 凝胶在 ESS 后可立即止血，并预防粘连形成，解决了鼻窦手术最常见的两种并发症。
