再次鼻中隔矫正术

目的 探讨鼻中隔矫正术失败而再次手术的技术方法。方法 对1992-2004年鼻中隔矫正术失败的32例患者进行鼻科检查,根据患者鼻中隔偏曲的部位、程度,原有软骨及骨质的残留状况和患者年龄,我们采用3种不同的手术切口（径路）进行矫正：①对5例鼻中隔前端偏曲,1例低位偏曲和14例高位偏曲的患者采用鼻中隔前端“U”形切口;②对8例鼻中隔后端偏曲和2例高位偏曲患者,在偏曲部位的前方作纵向切口,并辅助鼻内镜进行矫正;③对2例鼻中隔前端低位偏曲的青少年患者采用唇龈沟正中横切口,向上揭翻,辅助耳科电钻进行手术。结果 32例患者均获满意矫正,鼻中隔偏曲引起的临床症状消失或明显改善。随访6～36个月,无一例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论 鼻中隔偏曲再次矫正术需针对不同的临床特点选择正确的手术方法,可获满意效果。

Revision of submucous resection of nasal septum

OBJECTIVE: To explore the clinical significance and surgical technique for revisionary submucous resection of nasal septum. METHODS: Thirty-two patients who had undergone nasal septal resection were evaluated rhinologically and the causes of unsuccessful septolasty were analysed . Based on the location and extent of deviation, the status of residual cartilage and bone, and the age of the patients, one of three incisions was choosen during septal surgeries: (1) For 5 cases with anterior, 1 with inferior and 14 with superior deviation, a "U" shaped incision at the left side of anterior edge of septum cartilage was used. (2) For 8 cases with posterior and 2 with superior deviation, the site of the incision was located just anterior to the deviation, with the aid of endoscope. (3) For 2 cases with anteroinferior deviation, because of their young age, a sublabial incision was made to surge the mucosa of the septum and base of nasal cavity, the otological electronic drill was then used. RESULTS: Revision nasal septolasty was successful in all cases. The symptoms resulting from septal deviation disappeared or significantly relieved. Following successful revision surgery, the treatment outcomes of concomitant nasal and/or sinusal diseases also significantly improved. CONCLUSION: Revision nasal septolasty requires different approaches depending on different clinical characteristics. A successful correction of septal deviation can not only relieve the symptoms derived from deviation, but also be of significance for the treatment of concomitant nasal and/or sinusal diseases.