鼻中隔鼻道成形術後之微量鼻填塞

Minimal Nasal Packing after Septomeatoplasty

李錦昇(Jimson Lee) ； 黃威雄(Wei-Hsiung Huang)

《台灣耳鼻喉頭頸外科雜誌》 44卷6期 (2009/12) Pp. 171-175

https://doi.org/10.6286/2009.44.6.171

摘要

背景：病人因鼻中隔彎曲併雙側鼻甲肥厚在用藥治療無效後，進而接受鼻中隔鼻道成形手術，這在耳鼻喉科是一個相當常見的手術。但術後爲預防鼻出血需置入鼻填塞物如凡士林紗條或Merocel(上标 ®)等來壓迫止血，也因而造成病人鼻部脹痛、溢淚、耳閉塞感等症狀，且需住院2到3天把鼻填物拿出後才出院。本研究的目的在於評估一種新的技術－微量鼻填塞是否爲一有效的止血方法。
方法：本手術方法是在取下鼻中隔彎曲的軟骨及骨頭後，利用4-0 Dexon把二側的鼻中隔黏膜對縫，以減少鼻中隔血腫的情形發生，另外在雙側下鼻甲切除後，在切口處覆蓋約1.5×5 cm的Surgicel來止血，然後再利用止血夾(hemo-clip)把Surgicel固定住。利用回溯性分析，收集於2005年4月至2006年2月接受鼻中隔鼻道成形手術併微量鼻填塞共57名病人，並選取從2003年1月到2005年3月接受鼻中隔鼻道成形手術併傳統鼻填塞共58名作爲對照組，分析二者術後鼻出血、鼻中隔血腫、住院天數及術後回診次數。
結果：接受傳統鼻填塞58名病人中，5名有術後鼻出血情形，其中4名重新接受鼻填塞、另1名用藥物控制，沒有鼻中隔血腫的情形，平均住院3.1天，平均回診3.23次。而微量鼻填塞的57名病人中，3名有術後鼻出血情形，其中2名接受一般鼻填塞，1名用藥物控制，1名有鼻中隔血腫的情形，平均住院2.28天，平均回診2.74次。
結論：本研究發現微量鼻填塞並不會增加術後鼻出血的機會，鼻中隔血腫的情形也很少見到，其優點可以縮短病患住院天數和回診次數，減少術後病人不舒服的症狀，也無抽紗的疼痛和出血，缺點是手術時間會增加10~20分鐘。

關鍵字

鼻出血 ； 鼻填塞 ； 鼻中隔鼻道成形術

並列摘要

BACKGROUND: Septomeatoplasty is a common surgical procedure for patients with nasal septal deviation and hypertrophic rhinitis after medical treatment has failed. Pressure nasal packings such as Merocel(superscript ®) or vaseline gauze are generally inserted into the nasal cavities for post-operative hemostasis. Patients need to stay in hospital for 2 to 3 days before removal of nasal packing. The purpose of this study is to evaluate the feasibility of minimal nasal packing technique used as post-septomeatoplasty hemostasis.
METHOD: After removing deviated septal cartilage and bone, a through-and-through suture with 4-0 Dexon was used to prevent septal hematoma. After bilateral partial inferior turbinectomy, 1.5 × 5 cm Surgicels were used to cover the wounds of inferior turbinates and the Surgicels were fixed by hemo-clips. Finally, a 0.5×1 cm Surgicel was put over the septal wound to prevent wound bleeding. Fifty-seven patients who underwent septomeatoplasty with minimal nasal packing between April 2005 and February 2006 were recruited for the study group. Fifty-eight patients who underwent the same surgery but used traditional packing between January 2003 and March 2005were recruited for the control. We compared post-operative nasal bleeding, days of hospitalization, number of clinic visits, and incidence of septal hematoma between two groups.
RESULT: In the traditional packing group, 5 patients had post-operative nasal bleeding and 4 of them received re-packing. The mean hospitalization day was 3.1, the mena clinical visit was 3.23 and no septal hematoma was noted. In the minimal nasal packing group, 3 patients had post-operative bleeding and 2 of them had to receive traditional nasal packing, the mean hospitalization day was 2.28, the mean clinical visit was 2.74 and one patient had septal hematoma.
CONSLUSION: No increase in post-operative nasal bleeding was found in the minimal nasal packing group. Nasal septal hematoma was also rare in the minimal nasal packing group. The advantages of minimal nasal packing were reduced hospitalization day and fewer clinical visit. This procedure also reduced the suffering caused by nasal packing and its removal. The disadvantage of minimal nasal packing is longer surgical time with additional 10 to 20 minutes to complete the surgery.

並列關鍵字

nasal bleeding ； nasal packing ； septomeatoplasty