Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
Int Forum Allergy Rhinol. 2013 Jul;3(7):573-80. doi: 10.1002/alr.21136. Epub 2013 Jan 16.
Stenosis of sinus ostia following endoscopic sinus surgery (ESS) is the most common reason for revision surgery. Chitosan-dextran (CD) gel has been shown to be an effective hemostatic agent; however, its effects on ostial stenosis are unknown. This study aims to quantify the effect of CD gel on circumferential scarring following ESS.
A prospective, blinded, randomized, controlled trial was conducted in 26 patients undergoing ESS. Measurements of neo-ostia were taken using a standard-sized measuring probe. CD gel was applied unilaterally, while contralateral sides received no gel. Ostial diameters were measured by a blinded observer at 2, 8, and 12 weeks postoperation. Sinus ostial areas calculated as a proportion of the original were compared for each ostium at each time point.
Intraoperative ostial areas were comparable for CD gel and control sides (38 mm(2) vs 39 mm(2) , 131 mm(2) vs 120 mm(2) , and 203 mm(2) vs 193 mm(2) , in frontal, sphenoid, and maxillary ostia, respectively; p > 0.05). CD gel significantly improved sinus ostial patency. The largest difference was seen when ostial areas at 12 weeks were compared with their corresponding baseline areas (66% vs 31% frontal, p < 0.001; 85% vs 47% sphenoid, p < 0.001; and 74% vs 54% maxillary ostia, p = 0.002). The difference between raw ostial areas reached statistical significance in sphenoid (p < 0.001) and maxillary (p = 0.01), but not in frontal ostia (p > 0.05) at 12 weeks.
CD gel produced significantly less stenosis of all neo-ostia following ESS and may reduce the necessity for revision surgery in patients with chronic rhinosinusitis.
内镜鼻窦手术后（ESS）窦口狭窄是再次手术的最常见原因。壳聚糖-葡聚糖（CD）凝胶已被证明是一种有效的止血剂；然而，其对窦口狭窄的影响尚不清楚。本研究旨在定量评估 CD 凝胶对 ESS 后环状瘢痕形成的影响。
对 26 例行 ESS 的患者进行前瞻性、盲法、随机、对照试验。使用标准尺寸的测量探头测量新窦口的大小。单侧应用 CD 凝胶，对侧不应用凝胶。术后 2、8 和 12 周由盲法观察者测量窦口直径。在每个时间点，比较每个窦口的原始窦口面积计算出的窦口面积比例。
术中 CD 凝胶侧和对照组侧的窦口面积相当（额窦分别为 38mm² 比 39mm²，蝶窦分别为 131mm² 比 120mm²，上颌窦分别为 203mm² 比 193mm²；p>0.05）。CD 凝胶显著改善了鼻窦窦口通畅性。12 周时窦口面积与相应基线面积的差异最大（额窦分别为 66%比 31%，p<0.001；蝶窦分别为 85%比 47%，p<0.001；上颌窦分别为 74%比 54%，p=0.002）。12 周时，蝶窦（p<0.001）和上颌窦（p=0.01）的原始窦口面积差异具有统计学意义，但额窦（p>0.05）无统计学意义。
CD 凝胶可显著减少 ESS 后所有新窦口的狭窄程度，并可能减少慢性鼻-鼻窦炎患者再次手术的必要性。
