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可分解性及不可吸收性鼻填塞物對於鼻中隔成形術合併雷射下鼻甲手術之應用

The Application of Bio-degradable and Non-resolvable Nasal Packing on Septoplasty with Laser Turbinectomy

摘要


背景:鼻中隔成形術及雷射下鼻甲手術是耳鼻喉科常見的術式之一,術後鼻填塞物的材質有相當多的選擇;本研究的目的在分析不同的鼻填塞物是否對手術之預後造成影響。方法:此研究共收集2012年1月至2012年12月於本院接受鼻中隔成形術合併雷射下鼻甲手術的206名患者,以病歷回溯方式觀察不同填塞物對於鼻中隔成形術和雷射下鼻甲手術預後的影響。所有研究對象均由資深作者依相同的方式執行手術,並依病患意願選擇傳統高膨脹性填塞材料(Merocel®)或是可分解性鼻填塞物(Nasopore®),術後依相同的原則治療追蹤直到傷口完全復原。其中129名病患使用Merocel®,77名病患使用Nasopore®,就(一)復原進程相關指標(二)術後併發症之發生率(三)醫療資源耗用情形等進行探討,分析兩組之間是否有所差異。連續性變項以T test檢定,雙元變項以Fisher's exact test檢定。結果:206名研究對象中,男性139名,女性67名,平均年齡37.4±11.2歲。結果顯示不論是在復原進程相關指標或是術後併發症之發生率,兩組之間皆無統計上顯著的差異(p>0.05)。至於醫療資源耗用情形的分析可以發現,在病患自費支出以及手術整體醫療費用等方面,Nasopore®組均明顯高於Merocel®組(T test, p<0.05)。結論:自體可分解式(Nasopore®)及傳統之鼻填塞物(Merocel®),於鼻中隔成形術及雷射下鼻甲手術各項臨床預後指標及併發症的發生率並未產生差異;那梭波(Nasopore®)在使用上無需自鼻腔移除,其缺點是病患負擔成本較高。這或許可以為臨床醫師在鼻填塞物的選擇上提供參考。

並列摘要


BACKGROUND: Septoplasty with Laser Turbinectomy is one of the most widely used techniques in patients with septal deviation and chronic hypertrophic rhinitis. The purpose of this retrospective study was to compare the effect of biodegradable and nonresolvable nasal packing on the outcome of this procedure. METHODS: We collect 206 patients who have received Septoplasty with Laser Turbinectomy and adopted Merocel® (non-resolvable) or Nasopore® (biodegradable) as nasal packing during Jan to Dec 2012. For those who adopted Nasopore® (Group N=77 cases), the packing was left in the nasal cavity and broke down spontaneously without any manipulation. For those who used Merocel®, the packing was removed within 3 days (72 hrs) after the surgery. We compare these 2 groups in three aspects: (i) Medical resource consumptions: include the period of hospitalization (days), surcharge for patients (NT dollars) and total surgical expenses (NT dollars) (ii) Outcome associated indicators: include the duration of nasal decongestant used, duration of analgesics delivered, times of follow-up visit and total period of complete recovery (iii) Postoperative complications: include postoperative hemorrhage, adhesion, septal hematoma, septal perforation, wound infection and the use of hemostatic drugs. RESULTS: The analysis of medical resource consumption and prognosis associated parameters, showed no statistic significant difference between these 2 groups except for the "surcharge for patients" and "total surgical expenses' (p<0.05). No significant intergroup differences were observed on the incidence of post-operative complications. CONCLUSIONS: The bio-degradable and non-resolvable nasal packing makes no difference on the outcome and postoperative complications of Septoplasty with Laser Turbinectomy. However, biodegradable packing is more expensive nowadays and may increase the surcharge for patients.

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