鼻内入路同期矫正歪鼻合并鼻中隔偏曲的疗效观察

目的观察鼻内梨状孔外上缘切口入路歪鼻矫正术联合鼻内镜下鼻中隔偏曲矫正术治疗歪鼻的疗效。方法对21例歪鼻合并鼻中隔偏曲的患者同期行全身麻醉下鼻内梨状孔外上缘切口入路歪鼻矫正术+鼻内镜下鼻中隔偏曲矫正术,并进行常规术后复查、随访。结果本组21例患者术后随访18~24个月,其中18例疗效为优,3例疗效为良。术后均无出血、血肿、感染等并发症发生。结论同期行鼻内入路歪鼻及鼻中隔偏曲矫正术术后效果良好;鼻内梨状孔外上缘切口入路行歪鼻矫正术疗效确切,副损伤较小,恢复较快,值得临床推广。     

维系鼻顶拱石区的稳定对预防鼻外伤术后顺应性塌鼻的临床意义

目的探讨鼻内镜手术中保持鼻顶拱石区的稳定对预防鼻外伤术后顺应性塌鼻的临床价值。方法 2013年1月～2018年12月我科对因外伤性鼻骨骨折伴鼻中隔偏曲的87例患者,在外伤后4～10 d同期行经鼻内镜鼻中隔矫正及鼻骨骨折整复术,对术后出现顺应性塌鼻患者的临床资料进行回顾性分析。结果 87例患者术后随访半年,4例患者在术后1个月左右出现顺应性塌鼻。其中3例患者骨折均涉及鼻顶拱石区,1例患者因并发鼻中隔脓肿破坏了鼻顶拱石区的稳定。均行自体肋软骨移植开放鼻综合整形术,术后鼻部形态恢复满意。结论鼻骨骨折伴鼻中隔偏曲同期行鼻内镜下鼻骨骨折整复术及鼻中隔矫正术时,维系鼻顶拱石区的稳定对预防术后顺应性塌鼻有重要意义。     

鼻内镜下治疗鼻骨骨折伴外伤性鼻中隔偏曲的效果与安全性分析

目的探究鼻内镜下治疗鼻骨骨折伴外伤性鼻中隔偏曲的效果与安全性。方法对本院2012年3月至2016年3月期间的76例鼻骨骨折伴外伤性鼻中隔偏曲患者进行鼻内镜下鼻骨骨折复位联合鼻中隔矫正术,观察术后鼻外形和鼻功能改善情况、疗效以及并发症。结果手术后,患者的鼻外形和鼻通气功能VAS评分较手术前均有明显的下降,比较差异具有显著性(P0.05);所有患者手术均一次成功,48例(63.15%)优,28例(36.84)良。结论鼻内镜下同期鼻骨骨折复位手术和鼻中隔矫正术治疗鼻骨骨折伴外伤性鼻中隔偏曲效果显著,鼻外形及鼻腔功能恢复良好,并发症少。     

鼻内镜辅助下同期行鼻整形术和鼻中隔矫正术重建鼻功能疗效探讨

目的:探究在鼻内镜辅助下同期行鼻整形术和鼻中隔矫正术重建鼻功能疗效。方法:纳入2017年2月-2018年2月于笔者医院接受鼻内镜辅助下同期行鼻整形术和鼻中隔矫正术治疗的60例患者作为研究对象。术后对所有患者均进行为期1年的随访观察,分析其临床疗效、术后并发症发生情况,对比手术前后患者对鼻外观的满意度、鼻外形与鼻通气功能评分。结果:60例患者临床治愈33例(55.0%),好转27例(45.0%),无效0例(0.0%),治疗总有效率100.00%(60/60),且鼻中隔位置居中,嵴突消失,鼻尖偏高中线3mm,鼻腔通气症状显著改善。术后随访1年均无鼻腔粘连、鼻中隔穿孔以及塌鼻等并发症发生。术后患者外形十分满意35例(58.3%),较满意25例(41.7%),不满意0例(0.0%),满意度为100.00%(60/60)。术后鼻外形与鼻通气功能评分均低于术前,差异有统计学意义(P0.05)。结论:鼻内镜辅助下同期行鼻整形术和鼻中隔矫正术重建鼻功能疗效显著,且术后并发症发生风险较小,安全性较高,可明显提高患者对术后鼻外观的满意度,值得临床推广应用。     

鼻内镜下鼻中隔矫正术治疗变应性鼻炎合并鼻中隔偏曲

目的观察鼻内镜下鼻中隔矫正术治疗变应性鼻炎合并鼻中隔偏曲的效果。方法对78例变应性鼻炎伴鼻中隔偏曲患者给予鼻内镜下行鼻中隔矫正术。结果 78例患者顺利完成手术,术中及术后未出现鼻中隔穿孔、血肿、鼻腔粘连等并发症。术后随访12个月,术后6个月的治疗有效率为89.74%(70/78),术后12个月的有效率为85.90%(67/78)。结论鼻内镜下鼻中隔矫正术治疗变应性鼻炎合并鼻中隔偏曲,创伤小,症状改善明显,治疗有效率高。     

鼻内窥镜下鼻中隔偏曲矫正术同期歪鼻整形的治疗效果分析

目的:探讨鼻内窥镜下鼻中隔偏曲矫正术同期歪鼻整形的治疗方法及效果。方法:对34例鼻中隔偏曲并歪鼻患者行鼻内窥镜下鼻中隔偏曲矫正术联合歪鼻整形术,观察手术治疗效果。结果:随访8～20个月,34例患者均有不同程度的改善,32例治愈(94.12%),偏曲值均在3mm以下,患者满意率为100%,且均未发生鼻中隔穿孔、鼻腔粘连等并发症。结论:鼻中隔偏曲并歪鼻可经鼻内窥镜同时行鼻中隔偏曲矫正术及歪鼻整容术,具有微创、术野清晰、患者痛苦小、恢复快、并发症少、疗效确切的优点,值得临床推广与应用。     

鼻内镜下鼻中隔偏曲矫正术疗效观察

目的分析鼻内镜下鼻中隔偏曲矫正术的临床治疗效果。方法对34例鼻中隔偏曲患者实施鼻内镜下鼻中隔偏曲矫正术,观察治疗效果。结果 34例患者术后均恢复良好,鼻塞、鼻出血、头痛等症状消失或明显减轻。获随访6~12个月,复查鼻内镜显示鼻中隔居中,双侧鼻腔通气良好。未发生鼻中隔穿孔、鼻中隔血肿、鼻腔黏连、鼻背塌陷等并发症。结论鼻内镜下行鼻中隔偏曲矫正术治疗鼻中隔偏曲,微创、安全性高、并发症少,术后恢复效果好。     

鼻内镜下鼻中隔成形术临床应用观察

目的探讨鼻内镜下鼻中隔成形术的优点.方法鼻内镜下行鼻中隔成形术50例,其中高位和后段偏曲6例.结果50例均一次完成手术,偏曲的鼻中隔均获得彻底矫正.手术时间30～72 min,平均48 min,偏进的鼻中隔获得彻底矫正,随访6～9个月,平均7.1月,治愈45例(90%),好转5例(10%).无鼻中隔血肿、脓肿、穿孔、鼻腔粘连、鼻梁塌陷等并发症发生.结论鼻内镜下鼻中隔成形术,手术时间短,术中出血少,疼痛轻,术后并发症少,可同期行鼻窦手术,完全可以取代传统的鼻中隔黏膜下切除术.     

鼻内窥镜下鼻窦开放术同期行中鼻甲成形术的临床意义

目的:探讨在鼻内窥镜下行鼻窦开放术治疗慢性鼻窦炎的同时对不同病变的中鼻甲进行中鼻甲成形术的疗效,以及对患者病情恢复的临床意义。方法:为72例我科慢性鼻窦炎患者行鼻内窥镜下鼻窦开放术手术,对不同病变的中鼻甲进行中鼻甲成形术,术后通过门诊定期复诊3~6个月,观察中鼻甲形态、鼻腔粘连情况、术后清理时间、手术前后嗅觉变化。结果:术后定期随访3个月~半年,根据海口会议[3]标准,所有患者中,治愈51例,好转或有效17例,无效4例,治愈率为70.8%,无效率5.6%。结论:与传统手术相比,鼻内镜下鼻窦开放术同期对病变中鼻甲行成形术可以缩短术后鼻腔清理时间,促使鼻腔黏膜尽快上皮化,对术后防止鼻腔粘连及提高临床治愈率有积极作用,值得临床推广。     

鼻内窥镜手术中的轮廓化问题

目的探讨鼻腔轮廓化的方法与效果。方法回顾性分析行鼻腔轮廓化109例患者的临床资料,其中下鼻甲肥大16例,中鼻甲肥大14例,中、下鼻甲均肥大35例,鼻中隔偏曲17例,下鼻甲肥大合并鼻中隔偏曲16例,泡状中鼻甲合并鼻中隔偏曲6例;鼻中隔偏曲同时伴有下鼻甲肥大及泡状中鼻甲5例。83例鼻腔或中鼻道见息肉样组织。先在鼻内镜下分别行鼻腔息肉切除,鼻中隔偏曲矫正、下甲外移或部分粘膜下骨切除、中甲部分切除后,再行鼻窦开放手术。结果经鼻腔轮廓化后,鼻窦手术视野扩大,操作顺利。术后5例失访,其余均随访满6个月。除1例鼻腔通气不佳外,余术后鼻腔均清理方便、通气满意。89例窦口上皮化良好;10例窦口不畅;5例复发。结论通过鼻内镜行鼻腔轮廓化后再行鼻窦手术,视野宽阔,操作方便,术后清理方便,使鼻窦炎手术效果更佳。     

鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术

目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法. 方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁, 鼻内镜与显微镜联合切除病变. 结果 10例孤立性蝶窦炎术后症状消失.6例蝶窦囊肿、脑膜瘤均一次手术切除.32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗.48例术后随访6个月～3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症. 结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好.     

Frontal skull base surgery combined with endonasal endoscopic sinus surgery

BACKGROUND: Postoperative infection remains a serious complication after radical resection of anterior skull base lesions because intracranial, nasal, and paranasal cavities are opened during surgery. To prevent complications from postoperative infection, we combined endonasal endoscopic sinus surgery (ESS) with the frontal transbasal approach in patients with skull base lesions. METHODS: Patients (n = 16) with anterior skull base lesions extending to the paranasal or nasal cavity underwent surgical resection via the frontal transbasal approach. After removal of the lesion via the transcranial approach, enlargement of the ostium or sinusotomy was performed bilaterally using our endonasal ESS procedure. The main purpose of ESS is the establishment of a wide drainage route to avoid dead space and postoperative infection. Furthermore, we confirmed the absence of residual lesion and leakage of cerebrospinal fluid (CSF), endoscopically. RESULTS: The frontal transbasal approach combined with endonasal ESS was performed in 16 patients with frontal skull base lesions. There were 8 malignant tumors, 6 benign tumors, and 2 mucoceles. Although 11 patients had preoperative active paranasal sinusitis, most frequently at the ethmoid sinus, none experienced postoperative infection. There was no complication related to ESS procedure. Furthermore, leakage of CSF and extracranial residual tumor were not found. CONCLUSION: Endonasal ESS after frontal skull base surgery is a highly useful technique for preventing postoperative infection, especially for the cases with large skull base tumors extending into other regions involving the paranasal sinuses or nasal cavity and with active paranasal sinusitis.     

阿司匹林对鼻内镜手术围术期出血影响的临床观察

目的探讨阿司匹林对鼻内镜手术围术期出血的影响。方法回顾性分析2018-10—2021-03于郑州大学第一附属医院鼻科行鼻内镜手术并长期口服阿司匹林的67例患者的临床资料。根据围术期阿司匹林用药情况分为持续用药组(31例)和停药组(36例)。选取同期行鼻内镜手术未口服阿司匹林的中老年患者为对照组(30例)。记录术中出血量、血栓弹力图、术后出血情况及并发症,并对影响长期口服阿司匹林患者行鼻内镜手术的危险因素行Logistic回归分析。结果(1)3组患者中两两间的最大振幅(MA)、凝血综合指数(CI)差异均有统计学意义(P<0.05)。3组术后均有1例发生出血,行数据方差分析,3组间差异无统计学意义(P>0.05)。(2)鼻窦炎伴鼻息肉患者中,以及单纯鼻窦炎患者中,3组患者两两间的术中出血量差异均无统计学意义(P>0.05)。当显著性水平为0.05时,影响鼻内镜手术的独立危险因素为停用阿司匹林和BMI值。结论阿司匹林对鼻内镜手术围术期出血无明显影响,长期口服阿司匹林患者鼻内镜手术前可不停用阿司匹林。     

Schwannoma of the nasal septum removed with endoscopic surgery

A 50-year-old woman presented with a 30-year history of nasal obstruction. She had been treated for paranasal sinusitis at other hospitals and she was referred to our hospital for further examination. Flexible endoscopy revealed a mass in the posterior aspect of the right nasal cavity to the posterior aspect of the left nasal cavity around the posterior edge of the nasal septum.     

鼻内镜手术治疗真菌性鼻窦炎19例

目的探讨鼻内镜手术冶疗真菌性鼻窦炎的疗效。方法2000年1月～2003年12月对19例真菌性鼻窦炎在鼻内镜下清理中鼻道息肉或肉芽，切除钩突，扩大各窦口，清除窦内病变。术中3％H2O2反复冲洗窦腔。中隔偏曲致病侧中鼻道狭窄影响窦口引流，一期行鼻中隔矫正术。结果术后5例症状缓解，14例症状消失。19例随访6～48个月，平均14个月，17例未复发，2例复发，再次行Caldwell-Luc手术，无一例并发症发生。结论鼻内镜手术治疗非侵袭型真菌性鼻窦炎有较好的临床疗效，但对严重上颌窦真菌病仍不能替代Caldwell-Lues手术。     

The utility of concurrent rhinoplasty and sinus surgery: a 2-team approach

OBJECTIVE: To evaluate the safety and efficiency of and patient satisfaction with a 2-team approach for combined rhinoplasty and sinus surgery. METHODS: We conducted a retrospective medical chart analysis of consecutive patients with sinus disease and functional nasal obstruction. Forty-four patients (29 women and 15 men; age range, 22-75 years) had severe nasal obstruction with chronic sinusitis and were found to have indications for this procedure. All patients were followed up for a minimum of 6 months after surgery. Patients completed a standardized questionnaire at the time of medical chart review, and 36 patients completed a telephone interview. RESULTS: All 44 patients underwent rhinoplasty with an endoscopic sinus procedure. Twenty-seven procedures (61%) were endonasal, whereas 17 (39%) were open rhinoplasty. Patients with internal nasal valve collapse underwent 28 butterfly grafts, 6 spreader grafts, and 8 batten grafts. The endoscopic sinus procedures consisted of maxillary antrostomy (30/44 [68%]) and ethmoidectomy (28/44 [63%]). Overall, 20 (65%) of 31 patients reported a postsurgical nasal airway that was significantly improved. Most sinus symptoms were resolved postoperatively, with 25 (71%) of 35 patients describing their improvement as significant. Thirty-two (92%) of 36 patients stated that they would recommend the concurrent procedure. CONCLUSION: Patients presenting with nasal obstruction and chronic sinusitis tolerated combined rhinoplasty and sinus procedures without added morbidity.     

If functional sinus surgery fails: A radical approach to sinus surgery

Radical surgery of the nose and paranasal sinuses was performed in 56 patients as a last resort for severe recurrent treatment-resistant rhinosinusitis. Surgery consists of removal of all walls between the nasal fossa and the paranasal sinuses, creating one cavity. All patients were permanently relieved of sinusitis and nasal obstruction, and other symptoms were greatly reduced. Morbidity is low in relation to preoperative symptoms. We conclude that radical sinus surgery is an effective last resort if functional sinus surgery repeatedly fails. (Otolaryngol Head Neck Surg 1996;114:745-7.)     

A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery

This study aimed to evaluate the usefulness and reliability of a new endoscopic multilayer reconstruction using nasal septal flap (NSF) to prevent high-flow cerebrospinal fluid leak after endoscopic endonasal surgery. This study was a retrospective review on 97 patients who underwent multilayer reconstructions using NSF combined with fascia graft dural suturing after endoscopic endonasal surgery between July 2012 and March 2014. Patients were divided into two groups, third ventricle opening group and nonopening group, based on the presence of a direct connection between the third ventricle and the paranasal sinus after tumor removal. Furthermore, we compared this procedure with our previous reconstruction after resection of craniopharyngioma. Finally, we checked the patients who had postoperative prolonged discomfort of the nasal cavity for over a year. Postoperative cerebrospinal fluid (CSF) leak occurred in three patients (3.1 %): one from the third ventricle opening group and the remaining two from the nonopening group. External lumbar drain was performed after surgery in only seven patients (7.2 %). The incidence of postoperative CSF leak was similar in both groups, whereas the rate of craniopharyngioma in the third ventricle opening group was significantly higher. The incidence of postoperative CSF leak after resection of craniopharyngioma was not statistically significant but obviously higher in the previous group (12.2 %) compared with that in the present group (2.3 %). Twelve patients (12.4 %) had postoperative nasal discomfort of the nasal cavity for over a year. Multilayer reconstruction using NSF combined with fascia graft dural suturing is a more reliable method for preventing postoperative high-flow CSF leakage after endoscopic endonasal surgery even if there is a direct connection between the third ventricle and the paranasal sinus. However, we should pay close attention especially to prolonged discomfort of the nasal cavity after harvesting NSF.     

鼻内镜下鼻中隔-歪鼻整形术后疗效评估方法的综合应用

目的：探讨鼻内镜下鼻中隔-歪鼻整形术后疗效的综合评估方法。方法：选择2006年12月～2011年12月入住我院整形科和耳鼻喉科需手术治疗的176例歪鼻并鼻中隔偏曲患者,应用VAS主观评估鼻外形满意度及鼻塞情况、鼻外形分度、鼻阻力测定、外鼻相关指标测量的方法对该组患者进行疗效评估。结果：176例患者术后鼻外形满意度为96.02%,100%患者鼻塞改善。从鼻外形分度来看,92.04%患者鼻外形恢复正常,100%的患者治疗有效。鼻阻力测定术后鼻腔0～5cm容积较术前明显增大;术后阻塞侧鼻腔的鼻气道阻力较术前也明显降低,差异具有统计学意义（P〈0.05）。外鼻相关指标的测量,鼻长、鼻深术后较术前有所增加,鼻背坡长、鼻面角、鼻额角、鼻翼角术后较术前有所缩小,差异具有统计学意义（P〈0.05）。结论：对于鼻内镜下鼻中隔-歪鼻整形术后疗效的评估,建议运用综合的评估方法,包括主观鼻外形满意度、鼻塞改善程度,鼻外形分度,鼻阻力测定,外鼻相关指标测量。     

Routine histopathology in uncomplicated sinus surgery: is it necessary?

OBJECTIVE: To evaluate the incidence of occult pathology in routine, uncomplicated endoscopic sinus surgery, and to suggest guidelines for when to send specimens for histopathologic exam. STUDY DESIGN AND SETTING: Retrospective analysis of case records of 790 patients who underwent 868 endoscopic sinus surgeries at a tertiary care center from 1986 to 2003. Indications were chronic sinusitis, recurrent acute sinusitis, nasal polyposis, or combinations of these diagnoses. All cases were considered routine and did not involve preoperative suspicion of neoplasm or other complicating factors. Charts were reviewed for surgical indication, patient age, laterality of disease, history of prior sinus surgery, intraoperative suspicion of tumor, and final histopathology. RESULTS: In 868 cases of endoscopic sinus surgery, occult neoplasm was diagnosed in 2 patients (0.23%). In one patient, the initial surgery cured the lesion. Final histopathology of the remaining 866 (99.8%) specimens was consistent with inflammation and/or nasal polyposis. In 121 cases of unilateral sinusitis, none was positive for neoplasm. In 277 cases involving bilateral nasal polyposis and 13 involving unilateral polyposis, no neoplasms were found. Intraoperative suspicion of neoplasm occurred in 12 cases, with all specimens read as consistent with sinusitis and/or polyposis. CONCLUSIONS: Histopathologic review of every specimen obtained in routine sinus surgery for sinusitis and/or nasal polyposis is not indicated. Submission of specimen is indicated in routine cases when: 1) there is intraoperative suspicion of tumor, 2) unilateral nasal polyposis is present, 3) unilateral sinus opacification is present, and 4) additional diagnostic information is needed (eg, presence of eosinophils, fungal forms, etc.). SIGNIFICANCE: Establishes a safe and reasonable standard of care, with potential cost savings and medico-legal ramifications.