鼻内镜下鼻中隔术中穿破的及时修复

目的探讨鼻内镜下及时修复鼻中隔术中对穿性破损的方法及临床效果。方法2001年6月～2005年6月在荆州市第一人民医院就诊的20例鼻中隔偏曲合并鼻窦炎、鼻息肉的病人，其中男性14例，女性6例，年龄22～58岁，平均年龄28岁。行鼻窦手术和鼻中隔手术，术中出现鼻中隔黏骨膜对穿性破损，17例立即采用鼻内镜下鼻中隔破损修补术，术中取自体鼻中隔或者鼻甲薄骨片封闭穿孔，复位破损黏骨膜进行修复，采用指套凡士林纱条填塞；2例在头灯照明下常规手术以鼻中隔软骨进行修复，1例未作处理。结果17例立即在鼻内镜下进行修复的病人，随访6个月，术后没有出现鼻中隔穿孔；2例在头灯照明下修复的病人于术后7、10d发现鼻中隔穿孔；1例未处理的病人于术后5周发现鼻中隔穿孔。结论鼻内镜下及时修复鼻中隔手术中出现的对穿性破损，视野清晰，修补可靠；术后局部应慎用激素或者开始使用激素的时间应当延迟。

Immediate endoscopic repair for intraoperative nasal septal perforation

Objective To study the technique and effect of immediate repair under nasal endoscope in patients with intraoperative nasal septal perforation. Methods Seventeen of 20 patients with intraoperative nasal septal perforation were treated immediately under nasal endoscope. The residual osseous septum was adopted to accomplish the closure of perforation. The reconstructed septum was packed by digital glove filled with Vaseline gauze. Two patients were treated with nasal septal cartilage under headlamp. The other one patient was not treated. Results The nasal septal perforation of seventeen patients under endoscopic surgery with the residual osseous septum were successfully repaired and following-up for six monthes. Two patients with intraoperative nasal septal perforation repaired with nasal septal cartilage under headlight were found nasal septal reperforation in seven and ten days respectively. One patient the nasal septal perforation was found in five weeks postoperatively who had not been repaired endoscopically. Conclusion Intranasal endoscopic immediate repairing of intraoperative nasal septal perforation has a definite effect. Steroid should be cautiously administered focally for patients after nasal septum repairing or delayed to applicate.