Okmeydani Education and Research Hospital, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2013 Mar;270(3):939-43. doi: 10.1007/s00405-012-2165-6. Epub 2012 Aug 28.
Although discussions regarding nasal packing are still ongoing, to eliminate any possible complications, surgeons have used nasal packing for many years. Septoplasty is one of the most frequently performed operations by head and neck surgeons. Any methods to diminish the surgical time or bring comfort to the surgeon will be well appreciated. In this study, we attempted to demonstrate the usefulness of the stapler method by comparing preoperative and postoperative results from the visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE), rhinosinusitis quality of life questionnaire (RQLQ), and acoustic rhinomanometry values. In addition, we evaluated pain scores, postoperative complications, and breathing after nasal packing, stapling, and trans-septal suturing techniques. Patients were divided into three groups. In the first group, deviated cartilage was removed or repositioned and mucoperichondrial flaps were closed with a bioresorbable stapler after septoplasty. Four or five staples were placed on the septum. In the second group, the septum was sutured continuously with 4/0 Pegelak (Doğsan TR). In the third group, Merocel packs were used without any sutures and were kept for 48 h. Nasal packing leads to patient discomfort after septal surgery; however, there is no difference in patient comfort between closing the mucoperichondrial flaps by suturing the septum or using a stapler. After surgery, there were no differences between the groups in terms of successful breathing. This situation was assessed by endoscopic examination and acoustic rhinomanometry. Thus, there was no objective or subjective difference. Stapling increases the doctor's comfort level and surgical time is optimized. Although experienced surgeons can easily suture the septum, less experienced ones have some difficulty; therefore, stapling may provide more benefit to the latter. Further, four staples are sufficient to close the septum.
虽然关于鼻腔填塞的讨论仍在继续,但为了消除任何可能的并发症,外科医生多年来一直使用鼻腔填塞。鼻中隔成形术是头颈部外科医生最常进行的手术之一。任何可以减少手术时间或为外科医生带来舒适感的方法都将受到高度赞赏。在这项研究中,我们试图通过比较术前和术后视觉模拟量表(VAS)、鼻腔阻塞症状评估(NOSE)、鼻-鼻窦炎生活质量问卷(RQLQ)和鼻声反射测量值的结果来证明吻合器方法的有用性。此外,我们评估了疼痛评分、术后并发症以及在鼻腔填塞、吻合器和鼻中隔缝合技术后的呼吸情况。患者被分为三组。在第一组中,在鼻中隔成形术后,偏曲的软骨被切除或重新定位,并用生物可吸收吻合器关闭黏膜软骨瓣。在鼻中隔上放置四到五个吻合钉。在第二组中,使用 4/0 Pegelak(Doğsan TR)连续缝合鼻中隔。在第三组中,使用 Merocel 填塞物而不使用任何缝线,并保持 48 小时。鼻中隔手术后,鼻腔填塞会导致患者不适;然而,缝合或使用吻合器关闭黏膜软骨瓣对患者舒适度没有影响。手术后,各组之间的成功呼吸没有差异。这种情况通过鼻内镜检查和鼻声反射测量进行评估。因此,没有客观或主观的差异。吻合器增加了医生的舒适度,并优化了手术时间。尽管经验丰富的外科医生可以轻松缝合鼻中隔,但经验不足的外科医生可能会有些困难;因此,吻合器可能对后者更有益。此外,四枚吻合钉足以关闭鼻中隔。