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鼻中隔成形术后有或无鼻腔填塞患者的生活质量及鼻内水肿比较。

The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty.

作者信息

Kayahan B, Ozer S, Suslu A E, Ogretmenoglu O, Onerci M

机构信息

Ear Nose Throat-Head and Neck Surgery Clinic, Etimesgut Sait Ertürk State Hospital, Ankara, Turkey.

Ear Nose Throat-Head and Neck Surgery Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

出版信息

Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1551-1555. doi: 10.1007/s00405-016-4403-9. Epub 2016 Nov 24.

Abstract

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4 days). However, 1 week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

摘要

鼻中隔成形术是耳鼻喉科最常见的手术之一,常规进行前鼻孔填塞以预防术后出血、鼻中隔血肿或鼻粘连。目前,经鼻中隔缝合术的应用范围更广,不仅用于预防鼻中隔血肿和出血等并发症,还用于闭合鼻中隔黏膜的任何意外撕裂,并为鼻中隔成形术中保留的软骨片提供额外支撑。我们评估了患者术后早期(术后第一周)的生活质量、鼻内镜检查的鼻内水肿情况以及声反射鼻测量法检测的鼻内变化。我们对接受鼻中隔成形术且未行下鼻甲切除术的患者进行了一项前瞻性随机研究。作为填塞材料,分为两组:A组使用手套手指内的纱布,B组使用多伊尔夹板,另外C组仅在鼻中隔软骨间进行4/0可吸收缝线的经鼻中隔缝合。邀请患者在术后第2天、第4天和第7天进行对照检查,以根据疼痛、鼻阻塞感、打喷嚏、流泪、吞咽困难和睡眠障碍的问卷对1至5分进行评分。还对患者进行鼻内镜检查以检测鼻内水肿,并在对照检查期间进行声反射鼻测量法以检测鼻内变化。发现完全闭塞性填塞导致流泪、打喷嚏、吞咽困难的发生率和评分更高,但主要是疼痛,与仅使用带气道的硅胶填塞和经鼻中隔缝合相比。虽然发现带气道的硅胶填塞更舒适,但也会导致打喷嚏和流泪。未进行鼻腔填塞的患者尤其是在术后早期(前4天)更舒适。然而,术后1周,发现有无鼻腔填塞的组在客观和主观参数方面达到平衡。由于未使用鼻腔填塞未观察到任何并发症,因此认为鼻中隔成形术后使用鼻腔填塞并非必要。

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