正常和病理状态下鼻气道阻力在鼻腔中的分布

目的探讨正常和病理状态下鼻瓣区的确切位置。方法研究正常成人鼻黏膜减充血前、后以及慢性鼻炎和鼻中隔偏曲手术前、后鼻气道阻力（nasal airway resistance,NAR）在鼻腔中的分布。结果正常成人鼻黏膜减充血前,NAR最大部位位于梨状孔,而在减充血后,则位于内孔区。慢性鼻炎患者手术前、后NAR最大部位分别位于梨状孔和内孔区。鼻中隔偏曲矫正术前、后则分别位于偏曲部位和梨状孔。结论鼻瓣区在正常情况下位于梨状孔和下鼻甲前端,当鼻腔存在阻塞性病变时则位于病变部位。鼻瓣区的部位不是固定不变的,而是和鼻黏膜舒缩状态以及鼻腔的开放程度密切相关。     

下鼻甲黏膜下骨质切除术联合骨折外移术对慢性肥厚性鼻炎治疗满意度及鼻通气功能的影响

目的 研究下鼻甲黏膜下骨质切除术联合骨折外移术对慢性肥厚性鼻炎（CHR）治疗满意度、鼻通气功能的影响。方法 选取我院62例CHR患者,随机分组,各31例,传统组给予传统下鼻甲部分切除术、给予联合组下鼻甲黏膜下骨质切除+骨折外移术。比较2组疗效、术前和术后6个月鼻通气主观感觉[视觉模拟量表（VAS）评分]、鼻通气功能[鼻腔最小横截面积至前鼻孔距离（DCAN）、鼻腔容积（NCV）、鼻腔最小横截面积（NMCA）、鼻气道阻力（NAR）]及治疗满意度。结果 总有效率、治疗满意度联合组较传统组高（P<0.05）;VAS术后联合组较传统组低（P<0.05）;与传统组比较,联合组术后6个月NCV、DCAN与NMCA较高,NAR较低（P<0.05）。结论 下鼻甲黏膜下骨质切除术联合骨折外移术治疗CHR疗效满意,可改善鼻通气功能,患者鼻通气主观感觉优良。     

功能性鼻腔扩大术的临床应用

目的:探讨具有创新性、实用性的手术方法,治疗长期采用多种方法治疗无效的各类重症鼻炎,包括慢性肥厚性鼻炎,药物性鼻炎,血管运动性鼻炎,季节性变应性鼻炎,常年性变应性鼻炎(或伴发支气管哮喘).方法:手术采用口内(3+3)上唇龈沟粘膜切口,梨状孔进路,沿梨状孔缘粘骨膜下分离鼻腔前中部粘膜,保留鼻腔粘膜和鼻腔正常解剖结构完整,粘膜下矫正骨性鼻腔解剖变异,扩大骨性鼻内孔,扩大骨性鼻腔前中部和下鼻道,达到保留和恢复鼻腔正常生理功能的目的.结果:完成手术50例,术后随访2～20个月,近期和远期疗效均满意,总显效率为92%,有效率为8%.结论:手术方法设计合理,具有创新性和实际应用价值.     

扩大鼻瓣膜区治疗鼻瓣膜区狭窄性鼻阻塞

目的:研究治疗鼻瓣膜区狭窄性鼻阻塞的新方法.方法:32例鼻瓣膜区狭窄患者,行下鼻甲前端切除术10例,鼻外侧软骨凸出矫正术4例(左侧2例、双侧2例),骨性梨状孔狭窄扩大术6例(左侧2例、双侧4例),观察手术前后鼻通气改善情况以判定疗效.结果:32例患者经半年～2年随访,疗效显著26例,占81.2,好转6例,占18.8%,总有效率为100%,无手术并发症.结论:手术扩大狭窄鼻瓣膜区符合鼻腔解剖和生理功能,手术操作简单,术野清晰,组织损伤小,出血少,术后反应轻,痛苦小,无手术并发症.     

等离子射频消融术在鼻腔手术中的联合应用

目的:探讨在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎的疗效。方法:91例伴下鼻甲肥大及变应性鼻炎的鼻中隔偏曲或鼻息肉患者,行鼻中隔成形术或鼻内镜下鼻息肉摘除加筛窦开放术后,其中62例行等离子射频消融术(消融组),29例未行等离子射频消融术(对照组)。术前及术后3个月应用视觉模拟评分表(VAS)评价鼻塞的主观感觉。根据1997年海口会议疗效评定标准判断变应性鼻炎的疗效。结果:消融组术前鼻塞VAS评分左、右侧分别为(89.5±8.7)%和(90.3±10.5)%,术后3个月分别为(26.2±8.7)%和(32.1±10.3)%,左、右侧分别与术前比较,差异有统计学意义(均P<0.01);32例变应性鼻炎患者,显效31例(96.9%),有效1例(3.1%)。对照组术前鼻塞VAS评分左、右侧分别为(90.5±8.0)%和(89.9±11.5)%,术后3个月分别为(39.2±8.9)和(48.1±8.1)%,左、右侧分别与术前比较,差异均有统计学意义(均P<0.01);16例变应性鼻炎患者,显效4例(25.0%),有效10例(62.5%),无效2例(12.5%)。两组术后VAS评分差异有统计学意义(P<0.01)。结论:在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎安全、有效。     

下鼻甲等离子消融术对鼻黏膜组织学及纤毛功能改变的初步研究

目的探讨等离子下鼻甲消融术对鼻黏膜组织学及纤毛功能的影响。方法对40例慢性肥厚性鼻炎患者行低温等离子下鼻甲消融术(coblation inferior turbinate reduction,CITR),测定手术前及术后6个月患者的鼻腔黏膜纤毛传送速率并行比较,取12例患者的下鼻甲黏膜行HE、Masson染色及扫描电镜检查。结果手术前后鼻腔黏膜纤毛传送速率(mucociliary transport rate,MTR)差异无统计学意义(P>0.05)。HE染色显示术后的鼻黏膜表面纤毛有部分脱落,Masson染色显示术后的鼻黏膜中胶原纤维含量较术前增高,扫描电镜显示等离子术后黏膜表面纤毛部分脱落。结论 CITR对鼻黏膜及纤毛可能产生局部损伤,但对鼻腔整体纤毛运动功能无明显影响。     

复位性鼻成形术与鼻通气:用声反射鼻腔测量法测定鼻腔横截面积变化

鼻通气的感觉与鼻腔的大小有关，美容性鼻复位成形术（ARRP）有使鼻腔横截面积缩小的可能，研究用声反射鼻腔测量法评估ARRP前后鼻腔内气腔大小。37例中，男13例，女24例。17～48岁，平均年龄29岁。ARRP类型：驼峰鼻骨截除11例；鼻尖成形术包括软骨分离法17例，软骨切除法9例。术前、术后6月和滴血管收缩剂前后分别测量共4次。测量以距前鼻孔的距离不同横截面积结果：鼻瓣区最小横截面积ARRP术后较术前减少22％～25％；梨状孔区（距前孔3．3cm）和中鼻甲前区（距前孔4．0cm）均减少11％～13％；鼻腔后部（距前孔6．4cm）和总气腔容量…     

单纯下鼻甲消融术对鼻中隔偏曲伴慢性肥厚性鼻炎患者疗效的回顾性分析

目的探讨单纯下鼻甲消融术对鼻中隔偏曲伴慢性肥厚性鼻炎患者的治疗效果。方法对56例鼻中隔偏曲伴慢性肥厚性鼻炎的患者进行下鼻甲等离子消融术。结果术后随访1年，鼻通气显效37例（66％），好转16例（29％），无改善3例（5％）；头痛消失26例（26／39,67％），减轻12例（12／39，31％），无效1例（1／39，2％），总有效率95％。结论对鼻中隔偏曲较轻、偏曲范围小、偏曲的部位较靠后，以下鼻甲黏膜的肥厚增生为主者，单纯进行下鼻甲低温等离子消融术也能取得较好的治疗效果。     

鼻内镜下等离子消融联合下鼻甲骨折外移治疗慢性肥厚性鼻炎105例

目的 观察下鼻甲等离子射频消融联合下鼻甲骨折外移治疗肥厚性鼻炎的疗效.方法 105例慢性肥厚性鼻炎患者均在鼻内镜下行下鼻甲等离子消融联合下鼻甲骨折外移.术前及术后6个月均应用VAS评分标准评价患者鼻塞的主观感觉,并观察术后鼻黏膜修复情况及鼻腔干燥、出血、粘连等并发症.结果 患者术前鼻塞VAS评分为8.31±0.78,术后6个月为2.59±0.95(P<0.01),仅5例术后略有干燥感,无明显并发症.结论 下鼻甲等离子射频消融联合骨折外移术中出血少,患者痛苦小,黏膜损伤轻,并发症少,具有较好的临床应用价值.     

中西医结合治疗药物性鼻炎80例

药物性鼻炎是长期滥用鼻血管收缩药物引起的鼻黏膜反跳性综合征。临床上以持续性鼻塞为主要症状，我们采用中西医结合的方法，对50例因长期使用鼻腔血管收缩剂而出现的药物性鼻炎患者采用鼻内镜下鼻甲等离子消融术加中药煎汤口服治疗，报道如下。     

Effects of the nasal muscles on the nasal airway

BACKGROUND: The nasal muscles and their function are not clearly defined. The nasal muscles generally are thought to act synergistically to produce mimetic motion and affect the nasal airway. We proposed direct examination of the effects of the nasal muscles on the nasal airway. METHODS: Rhinomanometry was performed on volunteers. After paralysis of the nasal muscles with lidocaine, rhinomanometry was performed again to measure nasal airway function with the patient at rest and attempting to flare his/her nostrils. Each patient's rhinomanometric results (at rest and attempting to flare the nostrils) taken before injection of lidocaine served as the control for comparison of his/her results postinjection. The structural tension of the ala at rest and with active flaring of the nostril was measured also, and the results pre- and postparalysis with lidocaine were compared. RESULTS: The data from both the stiffness (structural tension) and the airflow portions, taken together, support the following conclusions. First, the paralysis was significant, although not complete. Clinical and stiffness data supported complete paralysis. Airflow data, which we think most sensitive, support a statistically significant affect of the injection, although incomplete paralysis. CONCLUSION: All of the evidence supports an important role for the nasal muscles when actively used to increase nasal airflow. Second, the majority of the evidence supports an important resting nasal muscle tension that opens the nasal airway.     

Improvement of the nasal airflow by the nasal dilator Nozovent

The lateral wall of the nostril is considered as the functional unit in the regulation of the nasal resistance causing more than half of the total resistance. In 16 test-subjects both nostrils were dilated with a plastic nasal device, Nozovent, and the airflow through the nose was measured with and without the device. In each object the mean value of ten inspirations at 150 Pa was calculated. Before the application the mean value of the subjects was 0.68 l/sec and with the device 0.84 l/sec. The improvement of airflow was comparable with that of treatment with nose-drops. The device ought to be helpful in patients with or without collapsing ala nasi during the night to increase nasal airflow when sleeping.     

鼻瓣区的鼻中隔偏曲矫正术

2003-2010年我们对单纯鼻瓣区的鼻中隔偏曲及鼻腔并鼻瓣区鼻中隔偏曲患者进行了鼻瓣区鼻中隔偏曲矫正术,效果良好,报告如下。     

鼻内镜手术治疗鼻腔及鼻窦内翻性乳头状瘤的疗效观察

目的：观察鼻内镜手术治疗鼻腔及鼻窦内翻性乳头状瘤的疗效。方法：病理和临床诊断为鼻腔及鼻窦内翻性乳头状瘤16例,术前做鼻内镜检查及鼻窦CT扫描,全身麻醉鼻内镜下行鼻腔及鼻窦内翻性乳头状瘤切除术。结果：术后随访1～2年,16例患者术后复发2例。结论：鼻内镜手术是治疗Krouse Ⅰ～Ⅱ级鼻腔及鼻窦内翻性乳头状瘤的一种较好的方法,此方法的优点为视野清楚、创伤少、出血量少、复发率低、避免了面部切口。     

The influence of nasal flow aerodynamics on the nasal physiology

The ability of the human nose to warm and humidify the respiratory air is important to maintaining the internal environment of the lungs, since ambient air is conditioned to nearly alveolar conditions (body temperature and fully saturated with water vapour) upon reaching the nasopharynx. Because of very short time of the inspiratory phase duration, as well as expiratory phase, only the rich vascularization of the nasal mucosa and specific organization of the submucosal vessels are not able to assure such effective physiological activity. Therefore the type of airflow during the respiration is essential to understanding the functional possibilities of the nasal mucosa. Most studies have investigated the airflow only in steady-flow conditions, where the laminar flow was observed. Anatomically accurate physical models of real nasal cavities and particle image velocimetry allow evaluation of the entire flow field in the nasal cavity. In these investigations a partially turbulent flow was observed even at low air velocities in most part of the nasal cavity. From a physiological perspective, a turbulent flow would seem sensible, since it enhances contact between air and the mucosal layer. By doing so, the nasal physiological functions - humidification, cleaning and warming are optimized.     

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance was assessed in 15 subjects. A single blind parallel group trial was undertaken in 30 subjects, with lignocaine as the active drug, and normal saline as the placebo. Fifteen subjects were included in each group. Both agents were infiltrated bilaterally into the floor of the nasal vestibule on each side via the sublabial route. Local anaesthesia of the nasal vestibule by infiltrating lignocaine produced a sensation of nasal obstruction in 9 out of 15 subjects (P less than 0.02). The infiltration of normal saline had no such effect. The difference between the effect of the 2 agents on nasal airflow sensation was significant (P less than 0.05). Neither injection had any significant effect on nasal resistance to airflow as assessed by active anterior rhinomanometry.