تأثير اسپري كرايوتراپي و فلوتيكازون در ترميم بافتي پس از جراحي اندوسكوپيك سينوس در بيماران مبتلا به پوليپوز بيني: يك مطالعه ي كارآزمايي باليني

The Effect of Cryotherapy Spray with Fluticasone on Tissue Repair after Endoscopic Sinus Surgery in Patients with Nasal Polyposis: A Randomized Clinical Trial Study

ﻣﻘﺪﻣﻪ: ﺑﻪ ﺗﺎزﮔﯽ، اﺳﺘﻔﺎده از اﺳﭙﺮي ﮐﺮاﯾﻮﺗﺮاﭘﯽ در ﺟﺮاﺣﯽ ﻫﺎي ﮔﻮش و ﺣﻠﻖ و ﺑﯿﻨﯽ، ﺑﺴﯿﺎر ﻣﻮرد ﺗﻮﺟﻪ ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ، اﻣﺎ ﻣﻄﺎﻟﻌﺎت اﻧﺠﺎم رﻓﺘﻪ در ﺧﺼﻮص ﻣﯿﺰان ﺗﺄﺛﯿﺮ آن ﻣﺤﺪود ﻣﯽ ﺑﺎﺷﺪ. از اﯾﻦ رو، ﻣﻄﺎﻟﻌﻪ ي ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﻣﻘﺎﯾﺴﻪ ي ﺗﺄﺛﯿﺮ ﺑﺮرﺳﯽ اﺛﺮ اﺳﭙﺮي ﮐﺮاﯾﻮﺗﺮاﭘﯽ ﺑﺎ اﺳﭙﺮي ﻓﻠﻮﺗﯿﮑﺎزن در ﺗﺮﻣﯿﻢ ﺑﺎﻓﺘﯽ ﭘﺲ از ﺟﺮاﺣﯽ اﻧﺪوﺳﮑﻮﭘﯿﮏ ﺳﯿﻨﻮس در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﭘﻮﻟﯿﭙﻮز ﺑﯿﻨﯽ اﻧﺠﺎم ﺷﺪ. روش ﻫﺎ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ي ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ، 45 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﭘﻮﻟﯿﭗ ﺑﯿﻨﯽ در ﺳﻪ ﮔﺮوه 15 ﻧﻔﺮه ﺗﻮزﯾﻊ ﺷﺪﻧﺪ. ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ از ﻋﻤﻞ ﺟﺮاﺣﯽ، ﮔﺮوه ﻫﺎي اول، دوم و ﺳﻮم ﺑﻪ ﺗﺮﺗﯿﺐ ﺗﺤﺖ درﻣﺎن ﺑﺎ اﺳﭙﺮي ﮐﺮاﯾﻮﺗﺮاﭘﯽ، اﺳﭙﺮي ﻓﻠﻮﺗﯿﮑﺎزون و اﺳﭙﺮي ﻧﺮﻣﺎل ﺳﺎﻟﯿﻦ ﺑﻪ ﻣﯿﺰان 4 ﭘﺎف ﻗﺮار ﮔﺮﻓﺘﻨﺪ. اﺳﺘﻔﺎده از اﺳﭙﺮي ﻓﻠﻮﺗﯿﮑﺎزون ﺑﺮاي ﺳﻪ ﮔﺮوه ﺑﻪ ﻣﺪت 2 ﻫﻔﺘﻪ ﺑﻌﺪ از ﻋﻤﻞ اداﻣﻪ ﯾﺎﻓﺖ. وﺿﻌﯿﺖ ﺗﻨﻔﺴﯽ ﺑﯿﻤﺎران ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺶ ﻧﺎﻣﻪ ي آزﻣﻮن ﭘﯿﺎﻣﺪ ﺑﯿﻨﯽ ﺳﯿﻨﻮﺳﯽ )22-Sino-nasal outcome test ﯾﺎ 22-SNOT( در ﻓﻮاﺻﻞ 1 و 3 ﻣﺎه ﺑﻌﺪ از ﻋﻤﻞ در ﺳﻪ ﮔﺮوه، ﺗﻌﯿﯿﻦ و ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮه ي 22-SNOT در ﺳﻪ ﮔﺮوه ﺑﻌﺪ از ﻋﻤﻞ ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽ داري ﮐﺎﻫﺶ ﯾﺎﻓﺖ و در ﻓﻮاﺻﻞ زﻣﺎﻧﯽ 1 و 3 ﻣﺎه ﺑﻌﺪ از ﻋﻤﻞ، اﺧﺘﻼف ﺳﻪ ﮔﺮوه، ﻣﻌﻨﯽ دار و ﻧﻤﺮه ي 22-SNOT در ﮔﺮوه ﮐﺮاﯾﻮﺗﺮاﭘﯽ ﮐﻤﺘﺮ از ﺳﺎﯾﺮ ﮔﺮوه ﻫﺎ ﺑﻮد )0/050 < P(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﺑﻪ ﻧﻈﺮ ﻣﯽ رﺳﺪ اﺳﺘﻔﺎده از اﺳﭙﺮي ﮐﺮاﯾﻮﺗﺮاﭘﯽ ﻧﺴﺒﺖ ﺑﻪ ﻓﻠﻮﺗﯿﮑﺎزون ﺗﺄﺛﯿﺮ ﺑﯿﺸﺘﺮي در ﮐﺎﻫﺶ اﻟﺘﻬﺎب و ﺑﻬﺒﻮد ﺗﺮﻣﯿﻢ ﺑﺎﻓﺘﯽ ﺑﻌﺪ از ﻋﻤﻞ در ﺑﯿﻤﺎران ﺗﺤﺖ ﻋﻤﻞ اﻧﺪوﺳﮑﻮﭘﯽ ﺳﯿﻨﻮس داﺷﺘﻪ ﺑﺎﺷﺪ.

Background: Recently, spray cryotherapy has been used in otorhinolaryngology surgeries. Therefore, due to limited studies in this field, this study aimed to evaluate the effect of spray cryotherapy on tissue repair after endoscopic sinus surgery in patients with nasal polyposis, and compare this method with fluticasone and normal saline spray. Methods: In this clinical trial study, 45 patients with nasal polyps were enrolled according to the inclusion criteria of the study. Then, the patients were randomly assigned into three equal groups. The first group was treated with spray cryotherapy, the second group was treated with fluticasone spray, and the third group received normal saline spray after the operation with four puffs for each group. It should be noted that fluticasone spray was maintained for two weeks after surgery for the three groups. Subsequently, the results of this study were evaluated using Sino-nasal Outcome Test (SNOT-22) questionnaire at intervals of one and three months after the surgical operation. Findings: The mean SNOT-22 score after the surgery significantly decreased in the three groups. There was a significant difference between the three groups concerning the SNOT-22 scores at intervals of one and three months after the surgery, as the SNOT-22 score in the cryotherapy group was lower than the other groups (P < 0.05). Conclusion: Using spray cryotherapy is a safe and effective method after endoscopic sinus surgery compared to the corticosteroid and normal saline spray.