Avaliação da mitomicina C como inibidor de sinéquias e estenoses em cirurgias endoscópicas funcionais dos seios paranasais.
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Data
2006
Autores
Yamaoka, Wellington Yugo [UNIFESP]
Orientadores
Gregório, Luiz Carlos [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivo: Avaliar a efetividade da Mitomicina C (MMC) tópica na prevenção e retardo da formação de sinéquias e estenose após manipulações endoscópicas funcionais dos seios paranasais em humanos. Forma de Estudo: Randomizado controlado. Método: 14 pacientes portadores de Rinossinusite Crônica foram submetidos a cirurgias endoscópicas funcionais dos seios paranasais, ao final das quais era colocado cotonóide
neurocirúrgico com 1 ml de Mitomicina C (1,0 mg/ml) em um dos meatos médios e outro com 1 ml de solução salina no meato médio contralateral, que servia de controle, ambos por 5 minutos, de forma randomizada, sem que o autor tivesse conhecimento dos lados. O seguimento foi realizado pelo autor, cego em relação aos lados. Foi avaliada a
presença de sinéquias em meatos médios e estenoses nas antrostomias. Resultados:
Um total de 12 sinéquias (42,86 %) foram identificadas em 10 dos 14 pacientes (p = 0,57).
Oito pacientes tiveram sinéquias unilaterais e dois, bilaterais. Dentre as 8 sinéquias
unilaterais, somente 1 ocorreu no lado com MMC contra 7 no lado controle (p = 0,07). Ao
final de um ano, no grupo MMC, houve 3 (21,43 %) sinéquias contra 9 (64,29 %) no grupo
controle (p = 0,054). No lado com MMC todas as 3 (21,43 %) sinéquias foram parciais,
enquanto no grupo controle houve 4 (28,57 %) parciais e 5 (35,71 %) totais (p = 0,025).
Não houve sinéquias totais no grupo MMC (p = 0,034). Em relação às antrostomias, 1
(7,14 %) ipsilateral à MMC teve estenose, enquanto no grupo controle foram 9 (64,29 %)
(p = 0,004). No grupo com MMC a única ocorrência (7,14 %) foi da forma parcial,
enquanto que no controle foram 4 (28,57 %) parciais e 5 (35,71 %) totais (p = 0,006). Não
houve diferença em relação ao tempo médio de ocorrência de sinéquias entre os grupos
(p= 0,055), somente para o tipo total (p = 0,034). O tempo médio para aparecimento de
estenoses nas antrostomias foi maior no grupo MMC (p = 0,0015), assim como a média
para aparecimento de estenose total (p = 0,016). Conclusão: A Mitomicina C não foi
eficaz na prevenção e retardo da formação de sinéquias parciais, porém, preveniu e
retardou a formação de sinéquias totais e estenoses nas antrostomias, no pós-operatório
de cirurgia endoscópica funcional dos seios paranasais em humanos. Tendo em vista a
facilidade de seu uso na forma tópica, em dose única intra-operatória, com poucos efeitos
colaterais, somados ao benefício que ela pode trazer, nossos resultados apresentam uma
nova perspectiva para a diminuição dos insucessos da cirurgia endoscópica funcional dos
seios paranasais.
Purpose: To assess the efficacy of topical Mitomycin C (MMC) in the prevention and delay of synechiae and stenosis formation after functional endoscopic sinus surgery in humans. Method: At the end of functional endoscopic sinus surgery in 14 patients, a cotton pledget soaked in 1 mL of 1 mg/mL MMC was randomly placed into the middle meatus of one nasal cavity for 5 minutes and an identical saline-soaked pledget was placed in the contralateral side in each patient. The author was blinded for the side of the substances. Patients were followed postoperatively by a blinded observer for the presence of synechiae in the middle meatus and stenosis of the maxillary antrostomy. Synechiae were rated as partial when not totally closed, and total when completely closed. Stenosis were rated as partial when smaller than a diameter of 3 mm, and total when completely closed. Results: 12 synechiae (42,86 %) were identified in 10 of 14 patients (p = 0,057). They were unilateral in 8 patients and bilateral in 2. Unilateral synechiae were observed on only 1 side treated with MMC and 7 controls (p = 0,07). After a follow-up of 1 year, 3 sides (21,43 %) treated with MMC and 9 controls (64,29%) had synechiae (p = 0,054). On the MMC side all of them were partial, while on the control side 4 (28,57 %) were partial, and 5 (35,71 %) were total (p = 0,025). One side (7,14%) treated with MMC had stenosis, compared with 9 (64,29%) controls (p = 0,004). The time of occurrence of synechiae was not statistically different between the groups (0,055). However, the time of occurrence of the total type was longer in the MMC group (p = 0,034). The medium time of appearance of stenosis was statistically longer in the MMC group (p = 0,0015). All patients improved their symptoms at the end of our study. Moreover, none needed revision procedure or referred adverse effects. Conclusion: MMC was not efficient in the prevention and delay of synechiae formation. However, it was efficient in preventing and delaying total synechiae and stenosis formation after functional endoscopic sinus surgery in humans. Our results present a new perspective to achieve favorable success rates in functional endoscopic sinus surgery.
Purpose: To assess the efficacy of topical Mitomycin C (MMC) in the prevention and delay of synechiae and stenosis formation after functional endoscopic sinus surgery in humans. Method: At the end of functional endoscopic sinus surgery in 14 patients, a cotton pledget soaked in 1 mL of 1 mg/mL MMC was randomly placed into the middle meatus of one nasal cavity for 5 minutes and an identical saline-soaked pledget was placed in the contralateral side in each patient. The author was blinded for the side of the substances. Patients were followed postoperatively by a blinded observer for the presence of synechiae in the middle meatus and stenosis of the maxillary antrostomy. Synechiae were rated as partial when not totally closed, and total when completely closed. Stenosis were rated as partial when smaller than a diameter of 3 mm, and total when completely closed. Results: 12 synechiae (42,86 %) were identified in 10 of 14 patients (p = 0,057). They were unilateral in 8 patients and bilateral in 2. Unilateral synechiae were observed on only 1 side treated with MMC and 7 controls (p = 0,07). After a follow-up of 1 year, 3 sides (21,43 %) treated with MMC and 9 controls (64,29%) had synechiae (p = 0,054). On the MMC side all of them were partial, while on the control side 4 (28,57 %) were partial, and 5 (35,71 %) were total (p = 0,025). One side (7,14%) treated with MMC had stenosis, compared with 9 (64,29%) controls (p = 0,004). The time of occurrence of synechiae was not statistically different between the groups (0,055). However, the time of occurrence of the total type was longer in the MMC group (p = 0,034). The medium time of appearance of stenosis was statistically longer in the MMC group (p = 0,0015). All patients improved their symptoms at the end of our study. Moreover, none needed revision procedure or referred adverse effects. Conclusion: MMC was not efficient in the prevention and delay of synechiae formation. However, it was efficient in preventing and delaying total synechiae and stenosis formation after functional endoscopic sinus surgery in humans. Our results present a new perspective to achieve favorable success rates in functional endoscopic sinus surgery.
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Citação
YAMAOKA, Wellington Yugo. Avaliação da mitomicina C como inibidor de sinéquias e estenoses em cirurgias endoscópicas funcionais dos seios paranasais. 2006. 56 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2006.