个体化手术治疗鼻中隔偏曲的疗效分析

目的　根据鼻中隔偏曲的部位和形态分别采用不同的手术方法，观察患者术后疗效。方法　收集南京同仁医院耳鼻咽喉头颈外科2018年9月~2020年6月87例鼻中隔偏曲患者的临床资料，根据鼻中隔偏曲的部位和形态结合鼻小柱情况分为3组：A组采用鼻小柱“V”形切口鼻中隔成形，B组采用Killian切口三线减张鼻中隔成形，C组采用局部棘突切除术。术后随访6个月。结果　A组21例患者术后前鼻孔形态效果均满意，B组除2例患者术后鼻腔通气改善不明显外，其他患者效果均满意，C组23例术后鼻腔、头痛症状明显改善，3组患者术后6个月症状VAS评分及鼻阻力较术前比较，差异均有统计学意义（P 均＜0.05）。结论　针对不同类型的鼻中隔偏曲，将鼻中隔进行分类后个体化选择不同的切口和手术方法，创伤小，疗效显著。     

具有切吸功能的鼻中隔剥离器在鼻中隔成形术中的应用

目的　探讨一种具有切吸功能的鼻中隔剥离器在三线减张鼻中隔成形术中的应用价值。方法　将100例需行鼻中隔成形术的鼻中隔偏曲患者分为2组,观察组（50例）使用具有切吸功能的鼻中隔剥离器,对照组（50例）使用常规鼻中隔剥离器及普通吸引管,比较两组的手术时间、出血量、手术单人完成率及术中吸引管堵塞率。随访半年, 分析疗效。结果　观察组手术时间、出血量及术中吸引管堵塞率均低于对照组,手术单人完成率高于对照组,差异均有统计学意义（P＜0.05）。两组术中单侧黏膜破损率比较,差异无统计学意义（P＞0.05）,两组均无双侧黏膜对穿破损。术后随访半年,两组鼻内镜检查矫正满意率均为100%,均无鼻中隔血肿、鼻中隔摆动、鼻中隔穿孔及鼻背塌陷等并发症。结论　使用具有切吸功能的鼻中隔剥离器进行三线减张及楔形切除嵴/棘突矫正鼻中隔偏曲,操作方便、快捷,视野清晰,大部分手术可单人完成,其手术时间短、出血少、创伤小,术后并发症少,值得向基层推广。     

鼻内镜下完整保留鼻中隔软骨的鼻中隔矫正术128例临床分析

目的总结鼻内镜下鼻中隔矫正术的方法和完整保留鼻中隔软骨的可行性。方法2009年3月~2012年6月鼻内镜下行较完整保留鼻中隔软骨的鼻中隔矫正术128例,根据偏曲部位不同,选择不同的切口部位。鼻中隔软骨部单纯偏曲和/或上颌骨鼻突偏曲行偏曲侧Killian术式切口,复杂型偏曲均行左侧Killian术式切口,筛骨垂直板C型偏曲、棘突和梨骨嵴或棘突行偏曲前方0.5 cm处切口。术后随访6~12个月。结果 128例鼻中隔偏曲均一次性得以矫正,其中治愈112例（87.5%）,好转16例（12.5%）。所有患者术后双鼻腔通气良好。结论鼻内镜下行鼻中隔矫正术,具有视野清晰、微创、精准等优点,对不同类型鼻中隔偏曲选择个性化切口和术式可完整保留软骨支架、出血量少、并发症少,值得推广应用。     

鼻中隔缝合在鼻中隔矫正术后的临床应用

目的评价鼻中隔缝合在鼻中隔矫正术后应用的临床疗效。方法选取40例鼻中隔偏曲患者,随机分成2组。缝合组：术后5-0薇乔线贯穿连续缝合鼻中隔黏膜;填塞组：术后以高膨胀海绵填塞鼻腔。分别于术后第1天、第2天对患者主观不适感以视觉模拟评分法（visual analogue scale,VAS）进行评分,并观察术后鼻中隔血肿、鼻腔粘连等临床指标。结果术后第1天、第2天两组患者在鼻塞、头痛、口干、睡眠困难、吞咽困难5个方面的VAS评分均值比较,差异均有统计学意义（P均<0.05）。两组患者在术后3个月内鼻中隔血肿、鼻腔粘连、感染等方面的发生率比较,差异无统计学意义（P均>0.05）。结论鼻中隔偏曲矫正术后,与鼻腔填塞相比,鼻中隔缝合在降低患者痛苦、提高术后舒适度方面具有明显的优势。     

小儿加强型气管插管在鼻中隔偏曲矫正术后鼻腔填塞中的应用

目的：寻求一种简单方便、经济有效、能通气、痛苦小的鼻中隔偏曲矫正术后鼻腔填塞方法。方法选择鼻中隔偏曲及鼻中隔偏曲合并慢性鼻-鼻窦炎需进行鼻中隔偏曲矫正术的患者200例,随机分为实验组和对照组两组。实验组用5.5～6.0号小儿加强型气管插管的前端部分（长8.0～9.0 c m）加1/2块高膨胀海绵（整块纵分为二）进行术后鼻腔填塞;对照组用凡士林油纱条进行术后鼻腔填塞,比较两组患者术后48h头痛、鼻胀痛、鼻塞及48h后撤除鼻腔填塞物时疼痛、并发症情况。结果术后48h：实验组患者头痛、鼻胀痛明显较对照组轻,且鼻腔基本通气,对照组鼻腔不能通气;48h后撤除鼻腔填塞物时：疼痛视觉模拟评分法（visuai analogue scale, VAS）评分,实验组2～4分,对照组6～8分。实验组无并发症;对照组有并发症：11例患者因局部刺激出现虚脱。结论小儿加强型气管插管用于鼻中隔偏曲矫正术术后鼻腔填塞,具有简单方便、经济有效、能通气、痛苦小等特点,尤其适用于基层医院使用。     

鼻腔填塞法和缝合法及负压法在鼻中隔矫正术后应用的效果观察

目的：评价鼻腔填塞法、缝合法和负压引流技术在鼻中隔偏曲矫正术后应用的疗效。方法：选取接受鼻中隔偏曲矫正术和双下鼻甲骨折外移术患者90例,平均分成3组。填塞组：术后以高分子止血海绵填塞鼻腔;缝合组：术后以可吸收缝线缝合鼻中隔黏膜;负压组：术后鼻腔放置负压引流管。对比观察舒适度评分（采用视觉模拟评分法）、术后鼻腔黏膜水肿程度和鼻中隔血肿、脓肿、粘连、术后治愈率等临床指标。结果：术后12、24h内,疼痛视觉模拟评分法读数、鼻塞视觉模拟评分法读数和病情严重程度比较,缝合组和负压组均优于填塞组（P〈0.05）;术后3d鼻腔黏膜评分比较,缝合组和负压组均明显优于填塞组（P〈0.05）;术后1周治愈率,缝合组和负压组均明显优于填塞组（P〈0.05）,术后7d治愈率和并发症发生例数,缝合组和负压组均明显少于填塞组（P〉0.05）,负压组未出现鼻中隔脓肿、血肿病例。结论：鼻中隔偏曲矫正术后,缝合法和负压法均较填塞法能减轻患者痛苦,缩短术后黏膜恢复时间,不增加术后并发症的发生机率。     

鼻中隔偏曲鼻内镜下手术的术式选择及其疗效分析

目的 探讨鼻内镜下鼻中隔偏曲手术治疗的术式选择及其疗效。方法 对212例鼻中隔偏曲患者分别采取4种鼻内镜下手术方式：鼻中隔黏膜下切除术52例,改良鼻中隔黏膜下切除术37例,鼻中隔矫正术58例,鼻中隔成形术65例。结果 4种术式的治愈率及并发症发生率差异无统计学意义。结论 鼻内镜下鼻中隔手术方式的选择以及术后疗效受到术者鼻内镜操作水平和有关理论水平的影响,同时也与鼻内镜器械设备完备程度有关。     

鼻中隔和多鼻窦联合手术的疗效观察

目的：观察鼻中隔、多鼻窦联合手术的治疗效果并探讨其安全可行性。方法：56例鼻腔鼻窦疾病的患者均在局部麻醉下一次性接受鼻中隔矫正术、上颌窦根治术、鼻息肉切除术、筛窦（额窦、蝶窦）开放术及中、下鼻甲手术,并观察术后的疗效和并发症。结果：56例患者均顺利完成手术,随访6个月～2年,治愈30例（53．57％）,好转23例（41．07％）,无效3例（5．36％）,总有效率94．64％,出现并发症20例（35．71％）,所有并发症经治疗均获痊愈,无鼻中隔穿孔等严重并发症发生。结论：在局部麻醉下能一次性完成鼻中隔、多鼻窦（鼻-鼻窦）联合手术,且不会增加和加重鼻-鼻窦手术的并发症;因该术式疗效好,是一种安全可行的手术方法,能明显减少鼻息肉及鼻窦炎的复发。     

鼻中隔缝合留置通气管与单纯缝合的对比研究[论著]

目的　比较鼻中隔偏曲矫正术后鼻中隔褥式缝合并留置通气管（简称通气管组）与单纯鼻中隔褥式缝合（简称单纯缝合组）两种不同手术操作患者术后舒适程度,以期找到鼻中隔偏区矫正术后患者更为舒适的方法。方法　将80例行鼻中隔偏曲矫正术患者,随机分为通气管组（40例）和单纯缝合组（40例）,通气管组患者常规行鼻中隔偏曲矫正,下鼻甲骨折外移并等离子打孔消融,鼻中隔褥式缝合后双侧鼻腔留置自制通气管;单纯缝合组患者在鼻中隔偏曲矫正术后行鼻中隔褥式缝合,下鼻甲骨折外移并等离子打孔消融,术后双侧鼻腔不予填塞。比较两组患者在术后鼻腔渗出血、鼻腔通气、头痛、流泪、睡眠质量、口干、吞咽困难及术后换药抽取鼻腔留置通气管时的疼痛和出血的VAS评分。术后门诊复诊时,记录患者有无再次出现鼻出血、鼻中隔穿孔、鼻中隔血肿、鼻腔粘连等情况。结果　通气管组患者术后鼻腔通气、口干、睡眠困难的VAS评分均值小于单纯缝合组（P 均＜0.05）,出血、头痛、流泪、吞咽困难差异无统计学差异（P 均＞0.05）,通气管组抽取填塞物时和单纯缝合组患者清理鼻腔换药时的疼痛感和出血量无统计学差异。结论　鼻中隔褥式缝合术后不填塞患者痛苦小,但鼻腔黏膜及下鼻甲术后反应性水肿导致鼻腔通气差;术后留置通气管可有效改善患者鼻塞、口干及睡眠困难,提高患者舒适度,疗效确切,值得推广。     

改良贯穿缝合法在鼻中隔矫正术中的应用体会

目的探讨改良贯穿缝合法在鼻中隔矫正术中应用的临床效果。方法选取内镜下行改良贯穿缝合法鼻中隔矫正术的患者66例，其中男41例，女25例；年龄17~68岁，平均年龄35.6岁。观察患者的术后症状、体征、术后鼻腔处理时疼痛等不适程度。结果术后随访6个月，治愈58例（87.9%），好转8例（12.1%）。处理鼻腔时无明显疼痛等不适，无术后出血、鼻中隔穿孔、鼻腔粘连等并发症。结论在鼻中隔矫正术中，采用改良贯穿缝合法代替鼻腔填塞能改善患者的术后不适，减少并发症，缩短术后愈合过程；改良手术方法简单，易于实行，具有临床应用价值。     

改良鼻中隔缝合联合等离子下鼻甲消融在鼻中隔偏曲矫正术中的选择性应用

目的 鼻中隔偏曲矫正术后使用改良鼻中隔缝合技术,等离子消融下鼻甲,术后不填塞鼻腔,比较其与传统方法的疗效.方法 80例行鼻中隔偏曲矫正术患者分为填塞组和缝合组,行鼻中隔矫正术后,填塞组吸切钻切削下鼻甲后行鼻腔填塞,缝合组行改良鼻中隔缝合、等离子消融下鼻甲,无填塞.比较两组患者术后症状、体征评分.结果 填塞组在手术后鼻部...     

Role of endoscopic septoplasty in the treatment of atypical facial pain

BACKGROUND: An endoscopically performed septoplasty enables correction of deformities under superior visualization with limited tissue trauma and offers marked teaching advantages. OBJECTIVE: To investigate the role of endoscopic septoplasty in the treatment of atypical facial pain caused by septal contact points. In addition to describing the technique, we also intended to outline favourable selection criteria for patients who may benefit from this procedure. METHOD: Thirteen patients with unilateral facial pain and septal contact points with lateral nasal wall structures who met our inclusion criteria were selected for endoscopic septoplasty. RESULTS: The follow-up period ranged from 7 to 20 months postoperatively. There were no intraoperative or postoperative complications. Seven of 13 (54%) patients were "completely cured" of their facial pain and another 5 patients (38.5%) were "significantly improved." Only one patient did not improve following surgery. CONCLUSIONS: Endoscopic septoplasty is a useful approach for dealing with some septal abnormalities and can be very effective in the treatment of atypical facial pain in the appropriately selected patient.     

Long-term results after septal surgery--submucous resection versus septoplasty

Postoperative controls, 5-9 years after surgery, were made in two groups of patients who had undergone submucous septal resection and septoplasty, respectively. The rate of subjective improvement after septoplasty was higher (77%) than after septal resection (66%). In the septoplasty group, however, the experienced surgeons had an improvement rate of 90%, whereas the untrained surgeons had no better results than after submucous septal resection. Postoperative complications, including septal perforation and deformation of the external nose, were significantly fewer after septoplasty. There were no clear-cut correlations between rhinoscopy findings and subjective results at postoperative examinations. The septoplasty technique is advocated, but in the hands of a trained surgeon.     

Acoustic rhinometry in the objective evaluation of childhood septoplasties

OBJECTIVE: The aim of this study was to evaluate results of septoplasty during childhood objectively with the help of acoustic rhinometry (AR). METHODS: Twenty-six children aged between 6 and 15 years who had septoplasty for nasal septal deviation during year 2002 were included in this study. Twenty-one patients who had no nasal septal deformities and nasal symptoms were included as control group. The study group was divided into two subgroups: Group 1 with only anterior septal deviation (8 patients) and Group 2 with both anterior and posterior septal deviations (18 patients). Acoustic rhinometry was performed one day preoperatively and 4 months postoperatively. Preoperative and postoperative minimal cross-sectional areas (MCSA), total volumes (TV), MCSA and TVs on pathologic side were compared. Acoustic rhinometry was performed 2 months interval in control group. Patients and parents were asked about the effectiveness of surgery subjectively. RESULTS: There was a statistical significance between preoperative and postoperative MCSAs of Groups 2 and 1+2. There was no statistical significance for Group 1. There was statistical significance between control group and Groups 1, 2, 1+2 in terms of MCSAs, MCSAs on pathologic side and TVs on pathologic side. There was statistical significance in terms of preoperative and postoperative MCSAs, TVs, MCSAs and TVs on pathologic side in patients with subjective well being postoperatively. There was no statistical significance in patients without any subjective postoperative improvement in terms of preoperative and postoperative MCSAs and MCSAs on pathologic side while TVs and TVs on pathologic side were statistically significant. CONCLUSIONS: Surgery is successful in children. But it should be restricted to only the pathologic area and should be conservative. Acoustic rhinometry is an objective method for the evaluation of nasal septal deformities and surgical success. Further studies are needed to see long-term success of septal surgery in children.     

鼻中隔偏曲矫正术后贯穿连续缝合技术的应用与效果分析

目的　评价鼻腔填塞法和鼻中隔贯穿连续缝合技术在鼻中隔偏曲矫正术后应用的疗效及效果分析。方法  选取行鼻中隔偏曲矫正术患者158例,随机分成2组。填塞组：术后以高分子止血海绵填塞鼻腔;缝合组：术后以可吸收缝线立即行贯穿连续缝合鼻中隔黏膜。术后对患者主观不适感以视觉模拟评分法（visual analogue scale,VAS）进行评分,观察术后鼻腔黏膜水肿程度和鼻中隔血肿、粘连、术后治愈率等临床指标。结果　术后48 h内两组患者在鼻部疼痛、头部疼痛、溢泪、耳鸣/耳闷、睡眠困难、吞咽困难 6个方面的VAS评分均值比较,差异均有统计学意义。两组在术后出血量、鼻中隔血肿、鼻腔粘连、穿孔、感染等方面比较差异无统计学意义。结论　鼻中隔偏曲矫正术后缝合法较填塞法能减轻患者痛苦,不增加术后并发症的发生机率。     

唇腭裂术后鼻唇畸形修复同期行鼻中隔偏曲矫正术对鼻气道阻力的影响

目的：探讨唇腭裂患者二期鼻唇畸形修复同期行鼻中隔偏曲矫正术对鼻气道阻力的影响。方法：应用主动性前鼻测压法,测定18例唇腭裂患者二期鼻唇畸形修复时同期行鼻中隔偏曲矫正手术前后鼻气道阻力和主观鼻开放感觉的评分情况。结果：18例患者术前鼻气道阻力为（0．664±0．200）kPa／（s·L）;术后6个月为（0．304±0．180）kPa／（s·L）,12个月为（0．396±0．250）kPa／（s·L）,术后6个月和12个月分别与术前比较,差异均有统计学意义（均P〈0．01）。术前主观鼻开放感觉评分为7．5±1．5,术后6个月为2．1±2．0,12个月为3．0±2．4,术后6个月和12个月分别与术前比较,差异均有统计学意义（均P〈0．01）。结论：鼻中隔偏曲的矫正应视为唇腭裂鼻唇畸形整复的重要内容之一,可显著降低患者的鼻气道阻力,同时患者的鼻通气功能也得到了明显改善。     

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.     

A new classification of septal deviations

STATEMENT OF PROBLEM: Existing nomenclatures of septal deviation deal with the deformation of the nasal septum exclusively and are rarely used in daily clinical work. The aim of this study was to develop a classification of septal deviations based upon the anatomical structures of the nasal septum and common clinical concepts. METHODS OF STUDY: We included patients undergoing septoplasty alone or in combination with rhinoplasty or functional endonasal sinus surgery by reason of septal deviation. Immediately after surgery, the surgeon recorded intraoperative findings of the nasal septum and the nasal turbinates in a data sheet and a standardized drawing for every patient. MAIN RESULTS: Data from 1088 patients were analyzed. Six types of septal deviations were identified. This new classification of septal deviations was developed with special regard to clinical anatomical findings. Leading as well as concomitant pathological findings were assigned to the six types of septal deviation. The frequencies of occurrence of hyperplasia of the inferior turbinate and concha bullosa of the middle turbinate were specified. PRINCIPAL CONCLUSION: The systematic assessment of relevant structures may help to develop improved surgical strategies. Furthermore, the systematic teaching of young surgeons to perform septal surgery may be facilitated.