Mohanraj Lekhaa, Lakshmanan Somu, Singh Urvashi
Senior Registrar, ENT & Head and Neck Surgery, Madras ENT Research Foundation (MERF), RA Puram, Chennai, India.
Department of ENT and Head and Neck Surgery,Sri Ramachandra Medical College and Research Institure,Chennai, India.
Iran J Otorhinolaryngol. 2025;37(2):57-63. doi: 10.22038/ijorl.2025.80571.3709.
Endoscopic nasal surgery has numerous potential adverse effects, adhesions are at the top of the list. 5-fluorouracil (5-FU), which is an analogue of pyrimidine, is utilized in a wide variety of areas for the purpose of preventing adhesions. In the present investigation, our purpose was to analyze the impact of intra-operative application of 5-flurouracil in the nasal cavity following FESS, as well as to evaluate both subjective and objective outcomes.
Following the acquisition of institutional ethical approval, a testing procedure that was randomized, prospective, and double-blinded was carried out. After the FESS, a cotton swab soaked in 1 mL of 5-flurouracil at 5 mg/mL was inserted in one side of the nasal cavity and a saline-soaked one in the other. Both of these swabs were kept in place for a period of five minutes. Postoperatively, patients were assessed over 6 months duration, wherein, adhesions, discharge, crustation, edema and polypoidal changes were analyzed. Subjective symptoms such as nasal block, nasal discharge and loss of smell were also assessed.
At the one-week follow-up, the test group had a significantly higher incidence of adhesions (32% vs. 11.76%, respectively) (p = 0.004) than the control group. Mucosal edema, crusting, polypoidal change and nasal discharge continued to significantly diminish in both groups. Furthermore, improvement in smell perception in the test group at the 20th week post-operatively was statistically significant (p= 0.014).
Adhesions are less common in the early postoperative period in individuals who underwent FESS with or without polypectomy when 5-FU is administered topically. There is also an improvement in smell perception with a reduction of mucosal edema, crusting, polypoidal change and nasal discharge enabling better healing.
鼻内镜手术有许多潜在的不良反应，粘连是其中最主要的。5-氟尿嘧啶（5-FU）是嘧啶类似物，广泛用于预防粘连。在本研究中，我们的目的是分析在功能性内镜鼻窦手术（FESS）后术中在鼻腔内应用5-氟尿嘧啶的影响，并评估主观和客观结果。
获得机构伦理批准后，进行了一项随机、前瞻性和双盲的测试程序。FESS术后，将一根浸泡在1 mL浓度为5 mg/mL的5-氟尿嘧啶中的棉签插入一侧鼻腔，另一侧插入浸泡生理盐水的棉签。两根棉签均放置5分钟。术后对患者进行6个月的评估，分析粘连、分泌物、结痂、水肿和息肉样改变情况。还评估了鼻塞、流涕和嗅觉丧失等主观症状。
在一周的随访中，试验组粘连发生率（分别为32%和11.76%）显著高于对照组（p = 0.004）。两组的黏膜水肿、结痂、息肉样改变和流涕情况继续显著减轻。此外，试验组术后第20周嗅觉改善具有统计学意义（p = 0.014）。
在接受FESS手术（无论是否行息肉切除术）的患者中，局部应用5-FU时，术后早期粘连较少见。嗅觉也有所改善，同时黏膜水肿、结痂、息肉样改变和流涕减轻，有利于更好地愈合。
