尖吻蝮蛇血凝酶在慢性鼻窦炎鼻内镜术中的止血效果观察

目的 观察尖吻蝮蛇血凝酶(苏灵)在慢性鼻窦炎鼻内镜手术中控制创面渗血的疗效.方法 慢性鼻窦炎鼻息肉患者140例,随机分为治疗组(70例)和对照组(70例),均在强化局麻下手术.治疗组术前30分钟肌肉注射尖吻蝮蛇血凝酶1U,对照组则按常规术前处理.比较两组术中出血量及手术持续时间.结果 治疗组术中出血量50～310 ml,平均126.45+10.21 ml;对照组术中出血量80～400 ml,平均210.32+14.5 4ml.治疗组术中平均出血量明显低于对照组.治疗组平均手术时间也短于对照组,差异具有统计学意义(P＜0.01).结论 苏灵对于术野出血具有良好的止血效果,能明显减少鼻内镜手术中的出血量,缩短手术时间,值得临床推广应用.     

鼻内镜术后电凝止血疗效的临床观察

目的探讨鼻内镜术后电凝止血的疗效,探索鼻内镜术后鼻腔不填塞或少填塞的可行性。方法回顾性分析鼻内镜术后采用电凝止血的73例慢性鼻窦炎患者的临床资料,观察止血疗效。结果 73例患者中,47(64.38%)例患者经电凝止血后,术腔无出血;17(23.28%)例患者术腔仍有渗血,加用止血纱布覆盖后,血止;9(12.32%)例患者有活动性出血,加用纱条填塞后,血止。结论鼻内镜术后电凝止血的疗效确切,极大的减少了患者的痛苦。     

鼻腔冲洗在鼻内镜术后的应用观察

随着功能性鼻内镜手术在临床的广泛应用，术后常出现如黏膜肿胀、术腔结痂、分泌物积聚等不良反应。为了解决上述问题，我科开展了鼻内镜术后鼻腔冲洗治疗，取得了明显效果，现总结如下。     

不同鼻腔填塞物对鼻内镜术后伤口疼痛和止血效果的临床观察

鼻内镜手术是近年来鼻科学领域治疗慢性鼻窦炎的主要方法,术后止血常使用凡士林纱条填塞,时有渗血,拔纱条时出血多,填塞及抽取凡士林纱条病人痛苦大。我们通过观察采用凡士林纱条、胶原蛋白海绵、Merocel以及藻酸钙纤维4种填塞材料经鼻腔填塞的病人,通过对填塞期和抽取时病人的舒适程度、鼻出血量两个方面的观察,比较它们的痛苦程度和止血效果,报道如下。1资料与方法1.1临床资料本组病例为2003年6月~2005年6月在我院接受鼻内镜下鼻窦开放术的鼻窦炎病人,共67例,男43例,女24例;年龄17~69岁,平均33.2岁;所有病人均在局麻下接受手术,术前检查…     

鼻内镜术后鼻腔冲洗疗效观察

慢性鼻．鼻窦炎经鼻内镜手术后,其转归在很大程度上取决于窦口阻塞与否和是否能够建立通畅的鼻窦通气和引流,而术后创面出现囊泡、肉芽组织增生是手术后最常见的组织反应,术后创面处理,不仅是创面上皮化的关键所在,也是减少术后复发的重要手段之一,     

膨胀止血海绵在鼻内镜手术中的应用

为探索内镜手术后填塞物的止血效果和病人的反应情况,笔者从2000年3月起分别采用膨胀海绵和凡士林纱条填塞30例作为对照观察。现报道如下。 材料方法:将住院行内镜手术病人随机分组,30例行膨胀海绵填塞止血做为观察组,30例行传统凡士林纱条填塞止血作为对照组。共60例,其中男49例,女11例,平均年龄42岁。根据海口标准,慢性鼻窦炎2型2期11例,2型3期32例,3型17例。均在局麻下行功能性鼻窦内镜手术,术后     

鼻内镜手术后生物蛋白胶止血的临床观察

目的探讨生物蛋白胶在经鼻内镜鼻腔鼻窦手术后,术腔喷洒止血的疗效。方法经鼻内镜下切除鼻息肉,开放筛窦,扩大上颌窦口,开放蝶窦,部分患者切除部分中鼻甲,然后将备好的生物蛋白胶直接喷洒在术腔达到止血的目的。结果除1例中鼻甲部分切除术外,其余21例患者,术后出血约6-8毫升,止血效果好。结论经鼻内镜鼻腔鼻窦手术后,生物蛋白胶局部喷洒止血效果好。     

鼻内镜术后鼻腔膨胀止血海绵填塞的疗效观察

慢性鼻窦炎、鼻息肉内镜术后传统采用凡士林纱条填塞止血,经济实用、效果可靠,但患者痛苦较大,且可出现填塞后并发症,抽纱条时会出现再次损伤及再出血.2002年我科采用膨胀止血海绵代替凡士林纱条行鼻腔填塞止血,经观察效果良好.现报告如下.     

鼻内镜术后中药"五黄液"鼻腔冲洗疗效观察

目的 观察术后"五黄液"术腔冲洗对功能性鼻内镜手术疗效的影响.方法 三个研究中心慢性鼻窦炎、鼻息肉患者131例,随机分为实验组69例和对照组62例.功能性鼻内镜手术后,实验组以"五黄液"冲洗术腔,对照组以生理盐水冲洗术腔,观察比较患者症状和体征评分改善情况及总体疗效.结果 治疗前两组症状体征总评分差异无统计学意义(P>0.05),治疗后"五黄液"治疗组总体疗效优于生理盐水组(P<0.05),主要症状体征消失或改善程度明显(P<0.05),单侧鼻腔积脓和窦口阻塞性变化组间差异无统计学意义(P>0.05).结论 功能性鼻内镜术后应用"五黄液"冲洗鼻腔,可明显提高手术疗效而且安全性好.     

鼻内镜下电凝止血术治疗难治性鼻出血临床观察

目的 总结鼻内镜下双极电凝止血术治疗反复鼻出血的临床经验.方法 回顾性分析2004年9月～2009年9月我科采用经鼻内镜引导下双极电凝治疗50例难治性鼻出血的临床资料.结果 本组50例难治性鼻出血患者均在鼻内镜下找到出血部位,以出院后1月内未再次出血作为治愈标准,1次性治愈48例,2次治愈2例,总有效率100%.结论 鼻内镜下治疗难治性鼻出血具有视野清晰、出血部位明确,止血迅速、疗效确切、术后反应轻等优点,提高了鼻出血治疗的效果和质量.     

改良自制鼻咽通气管在FESS术后填塞中的应用

目的 在功能性内镜鼻窦手术(FESS)后鼻腔填塞的同时使用改良自制鼻咽通气管,研究患者临床症状的改善情况。 方法 收集2013年1月至2015年3月行双侧FESS手术162例的临床资料,其中83例术后鼻腔填塞时使用改良自制鼻咽通气管(观察组),79例不采用通气管(对照组)。记录手术时间等指标,采用视觉模拟量表(VAS)评价患者填塞后头痛、鼻部胀痛、睡眠情况、咽部不适等症状。 结果 在术后24 h的VAS评分比较中,头痛症状观察组为3.1±1.2,对照组为5.2±7.5;鼻部胀痛症状评分观察组为3.5±1.5,对照组为6.1±1.7;睡眠评分观察组为3.3±1.2,对照组为4.8±1.6,差异均有统计学意义(P<0.05)。咽部不适症状评分观察组为4.1±1.5,对照组为4.5±1.6,差异无统计学意义(P=0.10)。 结论 鼻腔FESS手术后应用改良自制鼻咽通气管能有效改善患者术后疼痛等临床症状。     

中医序贯疗法联合FESS治疗慢性鼻窦炎的临床研究

目的观察中医序贯疗法联合功能性内镜鼻窦手术(FESS)治疗慢性鼻窦炎的临床疗效。方法将符合纳入条件的80例慢性鼻窦炎Ⅱ型患者,常规行FESS,术后按1:1随机分为对照组及治疗组,比较两组治疗前、治疗后3月、治疗后6月症状体征积分、鼻黏膜纤毛传输速率指标的差异。结果两组患者症状体征积分、鼻黏膜纤毛传输速率(MTR)治疗后3月、治疗后6月与治疗前比较差异均有显著性(P<0.05)、治疗后6月与治疗后3月比较差异有显著性(P<0.05),两组间治疗后3月、治疗后6月比较差异有显著性(P<0.05);治疗组与对照组疗效相比,差异均有显著性(P<0.05),治疗组疗效优于对照组。结论中医序贯治疗能促进鼻窦炎术后黏膜上皮化、有效预防术后复发。     

FESS术后两性霉素B鼻窦冲洗治疗真菌球型鼻窦炎的疗效观察

目的 观察功能性鼻内镜手术(FESS)术后两性霉素B(AmB)鼻窦冲洗治疗真菌球型鼻窦炎(FBS)的临床疗效.方法 选取2019年6月～2021年5月期间本院收治的50例行FESS的FBS患者,根据治疗方法不同,将患者分为治疗组和对照组每组25例,术后治疗组(n=25)予200μg/ml AmB行鼻窦内冲洗,对照组(n...     

Effects of functional endoscopic sinus surgery on the treatment of bronchiectasis combined with chronic rhino-sinusitis

Conclusion: Idiopathic bronchiectasis is closely associated with chronic rhino-sinusitis. It can effectively control bronchiectasic symptoms to treat chronic rhino-sinusitis by FESS in the cases with bronchiectasis and chronic rhino-sinusitis. Objective: To explore the effect of functional endoscopic sinus surgery (FESS) on the treatment of bronchiectasis combined with chronic rhino-sinusitis. Methods: In this study, a total of 161 cases with bronchiectasis and chronic rhino-sinusitis were divided into medication group and operation group according to the therapeutic method for chronic rhino-sinusitis selected by them. For the treatment of chronic rhino-sinusitis, the cases in the operation group received FESS, but in the medication group cases took drugs alone. The score of clinical symptoms for bronchiectasis, forced expiratory volume in one second (FEV₁), SNOT-22 score, and Lund-Mackay score were evaluated for all cases before and after treatment, respectively, and then the value changes in the score of clinical symptoms, FEV₁, SNOT-22 score, and Lund-Mackay score between both time points were calculated. The frequency of acute exacerbation for bronchiectasis was also recorded within the 6-month follow-up. Results: In this study, 58.9% of cases with bronchiectasis had chronic rhino-sinusitis. Follow-up lasted 6 months. Compared with pre-therapy, post-therapy score of clinical symptoms, SNOT-22 score, and Lund-Mackay score were all significantly decreased (all p?< 0.05), but post-therapy FEV₁ failed to significantly improve (p?> 0.05) in both groups. During the 6-month follow-up, the frequency of acute exacerbation was significantly less in the operation group than in the medication group (p?p?< 0.01), SNOT-22 score (p?< 0.05), and Lund-Mackay score (p?< 0.05) also were all significantly less in the operation group than in the medication group. However, there was no significant difference in post-therapy FEV₁ between the two groups (p?> 0.05).     

When FESS fails: the inflammatory load hypothesis in refractory chronic rhinosinusitis

Through recent advances in research, our understanding of chronic rhinosinusitis (CRS) has evolved to consider it as an inflammatory condition of the mucosa brought about by multiple factors. However, surgical management is still ruled by the classical concepts of functional endoscopic sinus surgery (FESS), which emphasizes the importance of ostial obstruction and sinus ventilation. These concepts fail to provide sufficient explanation for the presence of a subset of patients with refractory CRS who fail to respond to conventional FESS. Recent outcome studies have shown that high-grade mucosal inflammation often results in a poor outcome and that this patient group may show improved results with more radical surgery. This review examines the "inflammatory load hypothesis" as a possible explanation. We hypothesize that the grade of the inflammation is the most important predictor of long-term outcomes. Surgery, therefore, has a significant role not only in reestablishing ventilation, but also with removing the inflammatory load in the affected sinuses. We suspect that in these severely diseased patients, a more radical removal of local proinflammatory factors during surgery may improve patient outcomes.     

Administering of pregabalin and acetaminophen on management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery

Background: Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS).

Materials and methods: In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n?=?35) was treated under pregabalin 50?mg TDS and the acetaminophen group (n?=?35) was treated under tablet acetaminophen 500?mg/6?h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72?h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation.

Results: In this study, there was no significant difference between two groups according to VAS in onset (p?=?.37); however, VAS in 12, 24, 48 and 72?h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p?p?Conclusions: Pregabalin has more effect, safely and usefully than acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.     

A rare case of Rosai-Dorfman disease of the paranasal sinuses

An unusual case of a 6-year-old male child presenting with a history of bilateral nasal obstruction of 3 years duration is reported. Endoscopic surgery was performed and the specimen sent for histopathological examination. The report revealed the surprise diagnosis of Rosai-Dorfman disease. This case of isolated extranodal involvement (paranasal sinuses) by this disease is presented and the literature available reviewed.     

Treatment of allergic fungal sinusitis: A comparison trial of postoperative immunotherapy with specific fungal antigens

Objective: To determine the effect of immunotherapy (IT) with fungal antigens on clinical outcome in patients with allergic fungal sinusitis (AFS). Study Design: Prospective case control. Methods: In this comparison study, 22 patients meeting the diagnostic criteria of allergic fungal sinusitis (AFS) were evaluated after a mean of 33 months' therapy. All received similar treatment consisting of endoscopic sinus surgery, corticosteroids, and antibiotics as needed for complicating purulent sinusitis. Eleven patients received postoperative immunotherapy (IT) with fungal and nonfungal antigens to which sensitivity had been demonstrated, while the remaining 11 received no immunotherapy. Results: The effect of IT was to significantly improve patient outcome as assessed objectively by an AFS endoscopic mucosal staging system (P < .001) and a sinusitis-specific quality-of-life scale, the Chronic Sinusitis Survey (P = .002). In addition, IT was shown to reduce reliance on systemic (P < .001) and topical nasal (P = .043) corticosteroid therapy to control disease. Follow-up was similar in the two groups and was not a determinant of differences in outcome (P = .7). Conclusions: Results from this study indicate that specific IT with fungal antigens improves patient outcome in AFS. Laryngoscope, 108:1623–1627, 1998