摘要：

The aim of this study was to determine whether there was any benefit or detrimental consequences of placing a hyaluronic acid pack (Merogel) into the middle meatus after endoscopic sinus surgery (ESS).MethodsA randomized controlled blinded study was performed in 42 patients with chronic sinusitis undergoing ESS. The patients were randomized to receive Merogel on one side and no packing on the other side. Patients were assessed at 2, 4, and 6–8 weeks after surgery and the presence of synechia, edema, and infection was noted with the observer blinded to the side that had received the Merogel.ResultsAt 2 weeks the side packed with Merogel had 35% synechiae, 83% edema, and 30% mucopurulent discharge and on the control side the figures were similar with 22.5% synechiae, 83% edema, and 28% mucopurulent discharge. In both groups these figures improved over the observation period but percentages in the groups remained similar. At no time point was the difference between the packed and unpacked sides statistically significant for any of the measures when assessed with Fisher's exact test.ConclusionMerogel nasal packing has no significant beneficial or detrimental effect in terms of synechia, edema, or infection when placed in the middle meatus after ESS.ReferencesSection:1. Toffel, P. Secure endoscopic sinus surgery with middle meatal stenting. Operative Techniques. Otolaryngol Head Neck Surg 6: 157–162, 1995. Google Scholar, Crossref2. Josephson, J.S., Balwally, A.N., and Josephson, F. Complications in functional endoscopic sinus surgery. Insight Otolaryngol 7: 1–8, 1992. Google Scholar3. Garth, R., and Brightwell, A. A comparison of packing materials used in nasal surgery. J Laryngol Otol 108: 564–566, 1994. Google Scholar, Crossref4. Davidson, J., Nanney, L., Bradley, K. Hyaluronate derivatives and their application to wound healing: Preliminary observations. Clin Mater 8: 171–177, 1991. Google Scholar, Crossref5. McIntosh, D., Cowin, A., Adams, D. The effect of a dissolvable hyaluronic acid-based pack on the healing of the nasal mucosa of sheep. Am J Rhinol 16: 85–90, 2002. Google Scholar, 6. Watelet, J., Bachet, C., Phillipe, G., and Cauwenberge, P. Wound healing of the nasal and paranasal mucosa: A review. Am J Rhinol 16: 77–84, 2002. Google Scholar, 7. Pirnazar, P., Wolinski, L., Nachnani, S. Bacteriostatic effect of hyaluronic acid. J Periodontal 70: 370–374, 1999. Google Scholar, Crossref8. Clark, R. Wound repair. An overview and general considerations. In The Molecular and Cellular Biology of Wound Repair, Chap. 1. Raf, C. (Ed). New York: Plennum Press, 1996. p. 1–45. Google Scholar9. Jacob, A., Faddis, B., and Chole, R. Merogel hyaluronic acid sinonasal implants: osteogenic implications. Laryngoscope 112: 37–42, 2002. Google Scholar, Crossref10. Catalano, P., and Roffman, E. Evaluation of middle meatal stenting after minimally invasive sinus techniques (MIST). Otolaryngol Head Neck Surg 128: 875–881, 2003. Google Scholar, SAGE Journals11. Miller, R.S., Steward, D.L., Tami, T.A. The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 128: 862–869, 2003. Google Scholar, SAGE Journals12. Maccabee, M., Trune, D., and Hwang, P. Effects of topically applied biomaterials on paranasal sinus mucosal healing. Am J Rhinol 17: 203–207, 2003. Google Scholar, 13. Rajapaksa, S., Cowin, A., Adams, D., and Wormald, P.J. The effect of a hyaluronic acid based nasal pack on mucosal healing in a sheep model of sinusitis. Am J Rhinol. In press. Google Scholar14. Cowin, A., McIntosh, D., and Wormald, P.J. Healing of wounds created in the nasal mucosa following endoscopic sinus surgery can be affected by different nasal packing materials. Prim Intent 10

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