鼻内镜下钬激光治疗放射性后鼻孔闭锁的疗效观察

放射性后鼻孔闭锁系鼻咽癌放疗后出现的常见并发症之一,其发病原因与外照射联合腔内后装治疗有关〔1〕。我科2004-10-2010-11收治22例鼻咽癌放射后并发后鼻孔闭锁患者,其中19例为双侧,3例为单侧。我们采用鼻内镜直视下钬激光治     

鼻咽癌放疗后后鼻孔闭锁的治疗

目的：探讨鼻内窥镜下放射性后鼻孔闭锁成形术的治疗效果。方法：回顾分析19例行鼻内窥镜下放射性后鼻孔闭锁成形术的临床资料。结果：19例手术均顺利完成,无并发症,随访2-3年,后鼻孔直径均大于1．0cm,鼻腔通气良好,无再狭窄和闭锁。结论：此法具有操作简便、术野清晰、组织损伤轻、随访方便等优点,放射性后鼻孔闭锁的临床分型对该术式的围手术期处理有指导意义。     

鼻内窥镜下电切并射频治疗鼻咽癌放疗后鼻后孔闭锁2例

鼻咽癌 ( NPC)放疗后引起鼻后孔闭锁 ,通常是全麻下经鼻腔径路或硬腭径路进行手术 ,术中损伤大 ,出血多 ,术后恢复慢。新近 ,我科在鼻内窥镜下将全自动鼻窦电动手术器械与射频技术相结合 ,即以电动切削并射频热凝治疗 2例 NPC放疗后鼻后孔闭锁 ,取得良好疗效。现报告如下。1　资料与方法1 .1　临床资料例 1　男 ,54岁。因双鼻进行性阻塞 1年 ,加重伴头痛 3个月入院。患者于 1 996年因患 NPC放疗。1年前出现鼻呼吸不畅 ,逐渐加重。 6个月前行第 2次放疗 ,3个月以后双鼻完全不通气 ,同时伴头痛 ,外院久治无效入我科。检查 :双下、中鼻甲与…     

鼻内镜下修复双侧先天性后鼻孔闭锁

双侧先天性后鼻孔闭锁的修复有多种方法,如经鼻、腭、鼻中隔的方法,经腭法术野暴露良好,成功率高,但也有术时长、出血多、腭瘘、腭肌功能和颌面活动障碍等缺点,随鼻内镜外科技术的应用和经验的积累,为修复双侧先天性后鼻孔闭锁提供了一种新方法。该作者采用鼻内镜技术修复双侧先天性后鼻孔闭锁9例,其中女7例,男2例,8例出生时即被确诊,1例出     

鼻咽癌放疗后鼻窦炎内镜鼻窦手术治疗的临床观察

近年来有学者研究了有关鼻咽癌(nasopharyngeal carcinoma，NPC)放疗后鼻窦炎的发病情况，表明鼻咽癌放疗后鼻窦炎的发病率很高，但对NPC放疗后鼻窦炎的治疗及疗效情况的报道较少。2000年12月～2002年12月我科对18例NPC放疗后鼻窦炎经保守治疗无效者进行手术治疗，疗效满意，现报告如下。     

内镜下后鼻孔成形术治疗儿童双侧先天性后鼻孔闭锁的疗效观察

目的:探讨内镜下后鼻孔成形术治疗儿童双侧先天性后鼻孔闭锁的临床疗效.方法:回顾性分析经纤维鼻咽镜及鼻窦CT检查确诊为双侧先天性后鼻孔闭锁6例患儿的临床资料,患儿均行内镜下后鼻孔成形术,术后放置6个月自制硅胶鼻腔支撑管,取出支撑管后门诊随访复查评估有无再闭锁.结果:6例双侧先天性后鼻孔闭锁患儿术后鼻腔通气都得到有效改善,...     

鼻内窥镜微波治疗放疗性后鼻孔闭锁(附3例报告)

目的：探讨治疗鼻咽癌放疗后后鼻孔闭锁的新方法。方法：采用鼻内窥镜下微波手术,对３例鼻咽癌放疗后后鼻孔膜性闭锁的患者进行治疗。结果：３例均获满意疗效,随访７￣１３个月无复发。结论：该方法的优点是在局麻下进行,术中毋需切口,对正常组织损伤小,术中视野清晰,出血少,患者痛苦少,膜性闭锁凝固气化彻底,术后不需扩张,疗效稳定。     

额外鼻孔伴鼻后孔骨性闭锁1例

患者,男,15岁,自出生时发现三鼻孔.入院体检:右侧鼻腔结构正常,通气好,右鼻翼组织部分缺损,其上方见多余鼻孔,孔径0.4 cm×0.3 cm,深2 cm,不与鼻腔相通,有少许黏液性分泌物,左侧鼻腔结构正常,鼻后孔闭锁.鼻窦CT扫描示:左侧鼻后孔骨性闭锁,右上颌窦变小.     

微波联合湿润烧伤膏治疗鼻内镜术后粘连疗效观察

我科于1997年6月～2000年6月应用湿润烧伤膏(MEBT/MEBO)治疗鼻内镜术后鼻腔粘连,取得良好疗效,现报告如下。1 临床资料1.1 一般资料:66例患者均为鼻内镜术后2周查见鼻腔粘连,并随机分为两组:A组(MEBO)36例,其中男34例,女2例,年龄在18～65岁。B组(常规治疗组)30例,男26例,女4例,年龄在20～68岁,病程2周～3年。     

鼻内窥镜下微波治疗后鼻孔膜性闭锁

目的 探讨对后鼻孔膜性闭销的治疗新方法。方法 鼻内窥镜结合微波对５例不同原因引起的后鼻孔膜性闭锁进行治疗,并用自行设计的“Ｕ”型扩张管扩张。结果 ５例效果满意,随访一年以上均无复发。鼻腔通气正常。结论 本文法兼有鼻内窥镜和微波的优点,局麻下手术、视野清晰、出血少、损伤小、治疗彻底、不易复发,对各种原因引起的后鼻孔膜性闭锁均有效。     

鼻内窥镜下经鼻手术治疗先天性后鼻孔闭锁

报告２例鼻内窥下经鼻手术治疗先天性后鼻孔闭锁。结果表明，鼻内窥检查结合轴位ＣＴ扫描是诊断本病的理想方法，认为鼻内窥下经鼻手术具有视野、操作准确、切除闭锁组织彻底、鼻咽侧粘膜易于完整保留和利用，手术损伤小、出血少及成功率高等优点，并指出术后定期鼻内窥检查及时去除创面肉芽和粘连，以保持后鼻孔通畅，是保证手术成功的重要一环。     

鼻内镜下低温等离子微创治疗婴儿双侧先天性后鼻孔闭锁

目的探讨治疗婴儿双侧先天性后鼻孔闭锁的手术方法及疗效。方法采用鼻内镜下经鼻入路低温等离子微创治疗4例婴儿双侧先天性后鼻孔闭锁,术后未放置扩张管,给予抗感染、雾化吸入及生理性海水清洁鼻腔,随访24个月,对疗效进行评价。结果4例均获满意疗效,鼻内镜检查后鼻孔均通畅,鼻腔通气良好,未发生再闭锁及肉芽增生,未出现任何并发症。结论鼻内镜下经鼻低温等离子微创治疗婴儿先天性后鼻孔闭锁,对正常组织损伤小,出血少,未发生再闭锁,临床应用疗效满意。     

Contact-diode laser repair of bony choanal atresia: a preliminary report

OBJECTIVES: To demonstrate the use of the contact-diode laser (CDL) at 810 nm wavelength for the transnasal endoscopic repair of bilateral bony choanal (BBCA) in low-weight newborns. METHODS: Prospective study at a tertiary-care pediatric institution of four neonates with BBCA aged 3-5 days, weighing on average 2.34 kg. BBCA was opened by transnasal delivery of CDL through a 600 microm diameter glass fiber. Children were stented post-operatively, and revision surgery performed when needed. RESULTS: All children were successfully treated for BBCA with CDL. Two children needed only one surgery, one child needed two surgeries, and one patient required three procedures, in order to establish patient choanae at last follow-up ranging from 16 to 30 months. CONCLUSION: We found the fiber-delivered contact-diode laser to permit correction of BBCA in four low-birth weight neonates. To the best of our knowledge, this report is the first to demonstrate the successful use of CDL for the management of BBCA.     

Endoscopic transnasal repair of choanal atresia

OBJECTIVES: To present our experience with a new endoscopic technique for transnasal repair of choanal atresia. METHODS: Seventeen patients aged 2 months to 13 years with choanal atresia, bilateral in 6 and unilateral in 11, underwent endoscopic repair using a mucoperichondrial flap developed from the nasal septum. The bony stenosis was opened with a surgical curette or drill, and the raw surface was covered by the flap. All patients in these case series with bilateral atresia had been treated with dilatation at birth and had restenosis. RESULTS: A total of 23 choanae were operated. Follow-up ranged from 10 to 60 months. There was one case of complete restenosis and one of partial restenosis, for a success rate of 91%. CONCLUSIONS: Endoscopic repair of choanal atresia is a safe and rapid procedure even in very young children, with no complications and a high rate of success.     

The use of adjunctive topical mitomycin in endoscopic congenital choanal atresia repair

Objective

To evaluate the efficacy of topical mitomycin in providing the patency of the neochoanae in children undergoing transnasal endoscopic congenital choanal atresia (CA) repair.

Methods

A retrospective analysis of surgical results in CA patients who were treated in Selcuk University, Meram Medical Faculty, Department of Otolaryngology between November 2002 and November 2009 was performed. All patients underwent transnasal endoscopic approach using nasal telescopes and traditional sinus instrumentation together with a microdebrider. Mitomycin was used according to the senior surgeon's preference, and certainly not in a randomized fashion. After completion of surgery, mitomycin 0.4 mg/ml was applied to the neochoanae for 3 min. Postoperative stenting was performed in all patients.

Results

CA was unilateral in 8 subjects (mean age 71.8 ± 41.7 months; range 18 months-144 months) and bilateral in 12 subjects (mean age 4.6 ± 1.3 days; range 3-7 days). Among the subjects, 75% was female in both groups. Fourteen subjects under endoscopic repair without mitomycin, whereas mitomycin was used in 6 patients (4 bilateral, 2 unilateral). Stents were left at least 3 weeks postoperatively (mean 31 ± 10 days; range 21-45 days). The patients were followed-up at least 6 months (range 6-72 months). No symptomatic restenosis requiring further dilatations was seen in patients treated with preoperative mitomycin, whereas restenosis was detected in 6 subjects (42.9%) treated without mitomycin postoperatively within 6 months period (Fisher's Exact Test 2-sided, p = 0.12). These subjects underwent revision endoscopic repair with mitomycin and had no need for further dilatations with acceptable control of symptoms during a follow-up period ranging between 14 and 78 months.

Conclusion

Mitomycin improves the surgical treatment outcome of CA and reduces the rate of restenosis significantly without any complications. However, further prospective randomized studies are needed to fully investigate the benefits of mitomycin therapy in CA surgery.     

先天性后鼻孔闭锁的治疗进展

先天性后鼻孔闭锁是指后鼻孔解剖学上的闭合,临床上表现为无鼻腔呼吸气流,CT的典型表现为犁骨、翼突内侧板骨质增生以及后鼻孔骨性、混合性或膜性闭锁。根据病变范围,可以分为双侧或单侧闭锁,前者往往需要及时治疗。首选治疗方式为经鼻内镜下手术治疗,其安全性及有效性在过去的十余年间得到认证。然而术后狭窄仍然是最主要的并发症,传统支架与丝裂霉素的应用是否有利于避免术后狭窄一直存在争议。目前,一些预防术后狭窄的新方法(糠酸莫米松药物洗脱支架、球囊扩张、羧甲基纤维素钠盐凝胶的局部应用)还在不断出现,可能为后鼻孔闭锁的治疗带来良好的前景。