两种填充材料在鼻内镜下泪囊鼻腔吻合术中应用效果的对比研究
A comparative study of two wound dressings applied in endonasal endoscopic dacryocystorhinostomy
冯雪莹 1单凤梅 1李洁 1杨莎 1王富华1
作者信息
- 1. 山东第一医科大学附属眼科研究所 山东第一医科大学附属眼科医院(山东省眼科医院)眼眶病眼整形科,济南 250000
- 折叠
摘要
目的 对比温敏型羟丁基壳聚糖(HBC)护创敷料和明胶海绵在鼻内镜下泪囊鼻腔吻合术(EES-DCR)中的应用效果.方法 前瞻性随机对照研究.纳入山东省眼科医院 2021 年 1 月至2022 年 5 月慢性泪囊炎患者共 51 例(53 只眼).所有患者均行EES-DCR,按随机数字表法分为试验组(24 例)和对照组(27 例).试验组术中应用温敏型HBC护创敷料填塞泪囊鼻腔吻合口;对照组术中应用明胶海绵填塞泪囊鼻腔吻合口.随访期间,试验组失访 3 例,对照组失访 5 例,最后试验组有效样本 21 例(23 只眼),对照组有效样本 22 例(22 只眼).记录术中应用吻合口填充材料的耗时,术后随访 6～12 个月比较两组患者的手术治愈率、手术有效率、上皮化率以及术后并发症.结果 术中吻合口填充敷料耗时试验组为 90.00(74.25,121.00)s,对照组为 200.00(178.75,206.50)s,差异有统计学意义(Z=-4.98,P<0.05).手术治愈率为试验组 78.26%(18/23),对照组 72.72%(16/22),两组差异无统计学意义(χ2=0.00,P=1.000);试验组手术有效率为 95.65%(22/23),对照组为90.91%(20/22),两组差异无统计学意义(χ2=0.32,P=0.569).术后 4 周两组患者吻合口上皮化90%以上的患者试验组为 16 只眼(69.57%),对照组为 15 只眼(68.18%),差异均无统计学意义(χ2=0.01,P=0.920).术后鼻腔渗血患者试验组 15 例(65.22%),对照组 7 例(31.82%),差异无统计学意义(χ2=0.58,P=0.445);术后鼻腔异味患者试验组 0 例,对照组 8 例(36.36%),差异有统计学意义(χ2=10.17,P=0.001);术后鼻塞患者试验组 0 例,对照组 5 例(22.73%),差异有统计学意义(χ2=5.88,P=0.015);术后鼻腔异物感患者试验组 4 例(17.39%),对照组 7 例(31.82%),差异无统计学意义(χ2=1.27,P=0.206);术后吻合口变狭窄患者试验组 1 例(4.35%),对照组 2 例(9.09%),差异无统计学意义(χ2=0.41,P=0.524).术后吻合口狭窄者给予扩张吻合口,其余未特殊处理.结论 在EES-DCR术中应用温敏型HBC护创敷料和明胶海绵治疗慢性泪囊炎均有效,相较于明胶海绵,温敏型HBC护创敷料更易于操作,且术后并发症较少、术后不适症状较轻.
Abstract
Objective To compare the efficacy of the temperature-sensitive hydroxybutyl chitosan(HBC)wound dressing and gelatin sponge in endonasal endoscopic dacryocystorhinostomy(EES-DCR).Methods This was a prospective randomized controlled study.Fifty-three eyes of 51 patients with chronic dacryocystitis who underwent EES-DCR in Shandong Eye Hospital from Jan.2021 to May 2022 were included.All cases were divided into two groups based on random number table methods.There were 24 cases in the trial group and 27 cases in the control group.The trail group was applied with thermosensitive HBC wound dressing during EES-DCR,and the control group was applied with gelatin sponge during EES-DCR.During the follow-up period,the trial group lost 3 cases and the control group lost 5 cases.Finally,there were 23 eyes of 21 effective samples in the trial group and 22 eyes of 22 effective samples in the control group.The time consumed for applying intraoperative anastomotic filling material was recorded.Cure rate,effective rate,epithelialization rate,and postoperative complications were compared between the two groups during the postoperative follow-up for 6-12 months.Results The anastomosis applying time was 90.00(74.25,121.00)seconds in the trial group and 200.00(178.75,206.50)seconds in the control group,and the difference was statistically significant(Z=-4.98,P<0.05).The surgical cure rate was 78.26%(18/23)in the trial group and 72.72%(16/22)in the control group.The efficiency rate was 95.65%(22/23)in the trial group and 90.91%(20/22)in the control group.There was no significant statistical difference in cure rate(χ2=0.00,P=1.000)and efficiency rate(χ2=0.32,P=0.569)between the two groups.The anastomotic epithelialization of 90%or more at 4 weeks postoperatively occurred in 16 eyes(69.57%)in the trial group and 15 eyes(68.18%)in the control group,and the difference was not statistically significant(χ2=0.01,P=0.920).There were 15 cases(65.22%)with postoperative nasal exudation in the trial group and 7 cases(31.82%)in the control group,and the difference was not statistically significant(χ2=0.58,P=0.445);there were no case with postoperative nasal odor in the trial group but 8 cases(36.36%)in the control group,with a statistically significant difference(χ2=10.17,P=0.001).There were no patient with postoperative nasal congestion in the trial group but 5 patients(22.73%)in the control group,the difference was statistically significant(χ2=5.88,P=0.015).There were 4 cases(17.39%)in the trial group and 7 cases(31.82%)in the control group with postoperative nasal foreign body sensation,the difference was not statistically significant(χ2=1.27,P=0.206);there were 1 case(4.35%)in the trial group and 2 cases(9.09%)in the control group with postoperative anastomotic stool narrowing,the difference was not statistically significant(χ2=0.41,P=0.524).Dilation was given to patients with anastomotic stool narrowing,and the rest were not treated specially.Conclusion Application of both temperature-sensitive HBC and gelatin sponge in EES-DCR for chronic dacryocystitis is effective,whereas temperature-sensitive HBC is easier to manipulate with fewer postoperative complications and less postoperative discomfort compared with gelatin sponge.
关键词
泪囊鼻腔吻合术/泪囊炎/内窥镜,鼻/壳聚糖/明胶海绵Key words
Dacryocystosinostomy/Dacryocystitis/Endoscopes,nose/Chitosan/Gelatin sponge引用本文复制引用
出版年
2024
NETL
NSTL
万方数据