Kim Dong-Kyu, Rhee Chae Seo, Kim Jeong-Whun
Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital and Nano-Bio Regenerative Medical Institute, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Am J Rhinol Allergy. 2016 May;30(3):91-4. doi: 10.2500/ajra.2016.30.4285.
Nasal packing is commonly performed after functional endoscopic sinus surgery (FESS). However, nasal packing is associated with higher cost (owing to the cost of packing materials), patient discomfort, delayed wound healing, and concern about toxic shock syndrome. Some surgeons have been performing FESS without packing, but there are few studies that show its safety.
The purpose of this study was to evaluate the safety of electrocauterization and no packing.
A total of 490 patients who underwent bilateral FESS for chronic rhinosinusitis were included in this retrospective study, 242 in the nasal packing group and 248 in the electrocauterization and no-packing group. Electrocauterization was performed by using a suction coagulator. Rates of immediate (first 24 hours after surgery) and delayed postoperative bleeding were compared. Patient characteristics, including concomitant disease and medication history, and Lund-Mackay computed tomography score were also assessed Results: There were no significant differences in age; sex; Lund-Mackay score; use of anticoagulant drugs; or prevalence of hypertension, diabetes, or asthma between the two groups. In the electrocauterization and no-packing group, there were fewer patients with allergic rhinitis and more smokers. Primary bleeding did not occur in the nasal packing group, but 11 patients (4.4%) had delayed bleeding. Primary bleeding occurred in four patients (1.7%) in the electrocauterization and no-packing group, and five patients (2.1%) had delayed bleeding. There were no significant differences in primary (p = 0.058) and secondary bleeding (p = 0.142) between the two groups. All bleeding was minor and easily controlled. Multivariate logistic regression analysis ruled out significant correlation between no packing and postoperative bleeding.
This study provided evidence that, in terms of postoperative hemorrhage, the safety of the electrocauterization and no-packing technique after FESS was comparable with that of nasal packing.
功能性鼻内镜鼻窦手术（FESS）后通常会进行鼻腔填塞。然而，鼻腔填塞会带来更高的成本（由于填塞材料的费用）、患者不适、伤口愈合延迟以及对中毒性休克综合征的担忧。一些外科医生一直在进行不填塞的FESS手术，但很少有研究表明其安全性。
本研究的目的是评估电凝止血且不进行鼻腔填塞的安全性。
本回顾性研究纳入了490例因慢性鼻窦炎接受双侧FESS手术的患者，其中鼻腔填塞组242例，电凝止血且不填塞组248例。使用吸引电凝器进行电凝止血。比较了即刻（术后24小时内）和延迟性术后出血的发生率。还评估了患者特征，包括伴随疾病和用药史，以及Lund-Mackay计算机断层扫描评分。结果：两组在年龄、性别、Lund-Mackay评分、抗凝药物使用情况以及高血压、糖尿病或哮喘的患病率方面均无显著差异。在电凝止血且不填塞组中，过敏性鼻炎患者较少，吸烟者较多。鼻腔填塞组未发生原发性出血，但有11例患者（4.4%）出现延迟性出血。电凝止血且不填塞组有4例患者（1.7%）发生原发性出血，5例患者（2.
