天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (6): 656-658.doi: 10.11958/j.issn.0253-9896.2015.06.021

• 应用研究 • 上一篇    下一篇

鼻内镜下自体颞肌筋膜包裹筛骨垂直板修补鼻中隔#br# 穿孔疗效观察

庞伟   

  1. 天津市第二医院耳鼻喉科
  • 收稿日期:2014-12-04 修回日期:2015-01-07 出版日期:2015-06-15 发布日期:2015-06-10
  • 通讯作者: 庞伟 E-mail:dpang@sohu.com
  • 基金资助:
    天津市科技基金资助项目 （2010kz14）

Effect of temporal fascia wrapping ethmoid perpendicular plate on repair of nasal septal#br# perforation through endoscopic surgery

PANG Wei   

  1. ENT Department of Tianjin Second Hospital

  • Received:2014-12-04 Revised:2015-01-07 Published:2015-06-15 Online:2015-06-10

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摘要： 目的 观察鼻内镜下应用自体颞肌筋膜包裹筛骨垂直板修补鼻中隔穿孔的手术疗效。方法 回顾性分析 50 例鼻中隔穿孔患者的资料， 其中传统术式组 30 例， 三明治式组 20 例。所有患者术前均行鼻内镜及鼻窦 CT 检查， 并行鼻腔冲洗治疗改善鼻腔黏膜状况。传统术式组行鼻中隔穿孔前切口， 分离中隔黏膜移位修补穿孔； 三明治式组行耳后颞肌附着处皮肤切口切取 2 倍以上穿孔直径的颞肌筋膜， 行鼻中隔前端切口， 分离鼻中隔黏软骨膜至穿孔四周， 并在穿孔四周制作新鲜创面， 以颞肌筋膜包裹自体筛骨垂直板形成硬性支撑 “三明治” 式修补物嵌插入黏软骨膜下封闭鼻中隔穿孔； 术后均予抗感染及鼻腔保湿治疗。记录术后症状恢复情况及随访结果。结果 三明治式组术中的出血量（mL： 3.6±1.2 vs 13.4±2.9）、 手术时间（min： 25.2±6.3 vs 46.5±10.3）、 损伤黏膜范围（mm2： 10.2±3.2 vs20.5±5.3） 及术后黏膜修复时间 （d： 19.5±3.9 vs 30.2±3.1） 均小于传统术式组 （P＜0.05）； 三明治式组的修补成功率高于传统术式组（90.00% vs 46.67%, χ2 =9.780， P＜0.01）； 随访 6 个月～1 年， 均未见穿孔复发。结论 鼻内镜下应用颞肌筋膜包裹自体筛骨垂直板， 形成硬性支撑 “三明治” 式修补物封闭修补鼻中隔穿孔， 可以恢复正常解剖结构的鼻中隔， 疗效肯定。

关键词: 鼻中隔穿孔, 鼻内镜手术, 颞肌筋膜, 筛骨垂直板

Abstract: Objective To observe therapeutic effect of repairing nasal septum perforation with auto temporal fascia wrapping ethmoid perpendicular plate through endoscopic surgery. Methods Retrospective analysis of 50 cases of nasal septum perforation patient, among whom 30 cases were repaired by traditional surgery and 20 cases were repaired by sandwich surgery. All patients were examine by CT scan and nasal irrigation therapy were also performed through nasal endoscopy to improves nasal mucosa situation. Endoscopic procedures were performed in the traditional surgical group under local anesthesia, and septum mucosa was separated and shifted to repair septal perforation. On the other hand, temporal fascia of more than 2 times the diameter of the perforation were isolated then, wrapped around the perforation through front line of nasal incision after separating membrane of the nasal septum cartilage. Now， temporal fascia wrapping autologous ethmoid perpendicular plates form a rigid vertical "sandwich prosthesis" and were inserted into perichondrium of septal to repair perforation. Anti- infection and nasal moisturizing treatment were given after operation. Postoperative symptoms and the performance in follow-ups were recorded. Results Intraoperative blood loss (mL: 3.6±1.2 vs 13.4±2.9), operative time (min: 25.2±6.3 vs 46.5 ±10.3), mucosal damage range (mm2: 10.2±3.2 vs 20.5±5.3) and mucosal repair time postoperation (d: 19.5±3.9 vs30.2±3.1) were all less in sandwich group than those in traditional group (P < 0.05). Successful rate in sandwich group is also higher than that in the traditional surgical group (90.00% vs 46.67%, χ 2 =9.780, P <0.01) . No recurrence was found during follow-up from 6 months to 1 year in both groups. Conclusion Application of autologous temporalis fascia wrapping perpendicular plate of ethmoid bone to form a rigid "sandwich prosthesis" to repair nasal septal perforation by endoscopic surgery were effective. It can restore the normal anatomy of the nasal septum.

Key words: nasal septum perforation, endoscopic sinus surgery, temporal fascia, ethmoid perpendicular plate