Modified Mitchellson endoscope holder

Mitchellson's ear speculum holder has been modified to act as an endoscope holder, in order to be used in endoscopic surgery of the nose or ear.     

鼻内镜改良切口的鼻中隔再次矫正术37例临床分析

目的：探讨鼻内镜下改良切口的鼻中隔再次矫正手术的临床疗效。方法：对鼻中隔矫正术火败的37例患者行鼻内镜下改良切口的鼻中隔再次矫正手术，手术切口即在鼻小柱后方、鼻中隔软骨尾端前缘，上自鼻中隔软骨尾端顶部，向下延至鼻腔底部；然后沿此缘依次切开皮肤及黏膜，暴露软骨膜，自前向后将鼻中隔黏膜及粘连的纤维组织切开分离，切除偏曲部分骨质。结果：所有患者随访6～12个月，鼻中隔偏曲矫正良好，临床症状明显改善，无鼻中隔穿孔、鼻中隔血肿、鞍鼻或鼻腔粘连等并发症发生。结论：鼻内镜下改良切口的鼻中隔再次矫正手术改变了以往传统的手术方式，可以对两侧鼻中隔黏膜之间粘连的纤维组织直接进行切开分离，具有…m少、视野清晰、容易分离、黏膜张力小不易损伤、手术时间短等优点，手术操作简单、安全，大大降低了鼻中隔再次矫正术的难度和风险，术后疗效好、并发症少，值得临床推广应用。     

鼻内镜下鼻中隔穿孔修补术

目的探讨经鼻内镜下鼻中隔穿孔修补术影响手术成功率的相关因素。方法23例外伤或手术后鼻中隔穿孔患者采用经鼻内镜下穿孔修补术，术中分别采用筛骨垂直板或颞肌筋膜直接封闭穿孔、翻转黏膜瓣及赝复物夹衬并转移黏膜瓣封闭、下鼻甲带蒂黏膜瓣修补等方法进行修复，并采用硅胶板或塑料膜的保湿物垫衬保护为特点的填塞方式。结果直接封闭7例，翻转封闭5例，转移封闭10例，鼻甲封闭1例。随访4周至7个月，23例鼻中隔穿孔手术修补成功19例（82、6％），4例未成功的病例分别为术后3周黏膜瓣脱落1例、术前存在2个穿孔仅将大穿孔修补成功1例、术后筋膜干燥导致再穿孔1例及转移黏膜瓣太小，穿孔未完全修补成功1例。结论鼻内镜手术是目前修补鼻中隔穿孔的最佳选择之一。     

带蒂鼻腔黏骨膜瓣联合鼻中隔减张皮瓣修补鼻中隔穿孔(附3例报告)

目的探讨鼻中隔穿孔修补术的方法。方法3例鼻中隔穿孔病人采用鼻内镜联合显微镜下,应用带蒂鼻腔黏骨膜瓣翻转联合鼻中隔减张皮瓣修补术,并用保湿物鼻腔填塞方式。结果随访1~2年,3例鼻中隔穿孔手术修补成功。结论鼻内镜联合显微镜下,应用带蒂鼻黏骨膜瓣翻转联合鼻中隔减张皮瓣修补术是修补鼻中隔穿孔行之有效的治疗方法。     

Comparative study of endoscopic aided septoplasty and traditional septoplasty in posterior nasal septal deviations

Patients with deviated nasal septum are advised surgery, which has seen several modifications since its inception. This recent technique of using nasal endoscopes gives better illumination and access to posterior septal deviations. The aim of the study was to identify the nasal septal pathology in relation to lateral nasal wall in a precise way and to correct this with minimal exposure, limited manipulation and least resection. Twenty five patients underwent endoscope aided and 25 conventional septoplasty. Results were graded on subjective and objective improvement. Endoscopic aided septoplasty (Otolaryngol Head Neck Surg, 1999; 120, 678; Laryngoscope 1994, 104, 1507; J Laryngol Otol 1998, 112, 934; Ear Nose Throat J 1997, 76, 622) was found to be safe, effective and conservative approach with better patient compliance, shorter recovery time and greater stability of remaining septum.     

改良鼻内镜下鼻中隔成形术及三种术式比较

目的对鼻内镜下改良鼻中隔成形术及两种传统术式的利弊和适应证进行临床评价。方法回顾性分析342例接受手术的患者,按手术方式分为鼻内镜下改良鼻中隔成形术组(简称A组)、鼻中隔黏膜下切除术组(简称B组)、鼻中隔黏膜下矫正术组(简称C组),观察各组患者的鼻中隔病变、症状消失率、伤口出血、肿胀、疼痛、愈合情况及术后并发症。结果三组症状消失率与伴随症状痊愈率比较无统计学意义(P>0.05);在切口观察指标中,A组与B组、C组间比较有统计学意义(P<0.01);B组与C组比较,除术中出血无统计学意义外,局部肿胀、疼痛、伤口愈合的比较有统计学意义(P<0.01)。结论鼻内镜下改良鼻中隔成形术及外斜“L”形切口目的明确、视野广、创伤小、愈合好、并发症少、疗效确切。     

鼻内镜下鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲

目的 探讨鼻内镜下行鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲的可行性、必要性及手术要点.方法 回顾性分析经鼻内镜下行鼻中隔成形联合鼻骨复位术治疗56例鼻骨骨折伴鼻中隔偏曲的诊疗情况,对手术方式、效果、并发症等进行分析.结果 56例患者鼻部外观满意,鼻腔通气畅,嗅觉良好,1例鼻中隔前端穿孔,经放置软骨支撑愈合.术后无鼻中隔脓肿、血肿,随访半年也无外鼻塌陷等并发症.结论 鼻骨骨折伴鼻中隔偏曲可在鼻内镜下同期行鼻中隔成形联合鼻骨复位术,同期手术具有直视下操作,复位精确,切口灵活,微创、并发症少等优点,同时具有卫生经济学意义,但要知情告知并征得患者同意。     

鼻内镜下鼻中隔术式选择的影响因素

目的 探讨鼻内镜下鼻中隔术式选择的影响因素,合理选择和实施手术方式.方法 对612例鼻中隔偏曲患者,鼻内镜下5种术式选择情况、影响因素和治疗效果等,进行对比观察.结果 黏膜下切除术122例:1例鼻中隔穿孔,2例轻度鼻梁塌陷,1例拍击样中隔;改良黏膜下切除术101例,1例鼻中隔再偏曲;矫正术117例:2例高位、1例后下矫正不彻底;成形术176例:3例中隔再偏曲,其中2例需二次手术;改良成形术96例:术后恢复良好.结论 技术、年龄、器械和设备等因素,会直接影响到鼻内镜下鼻中隔术式的选择与完善.     

鼻内镜在鼻颅底外伤中的运用

目的探讨鼻内镜在鼻颅底外伤处理中的临床运用价值。方法对35例鼻颅底外伤的患者应用鼻内镜技术进行诊治,回顾性分析手术前后的临床资料。结果35例鼻颅底外伤患者中15例合并有鼻大出血,急诊经鼻内镜处理后出血停止。单纯鼻骨骨折3例行鼻内镜手术,术后鼻外观及鼻通气良好。5例鼻骨骨折合并鼻中隔骨折或脱位,4例鼻内镜下行鼻中隔矫正复位术,术后鼻外观及鼻通气良好;1例术后左鼻塞,检查见鼻中隔左偏,1个月后行中隔矫正后鼻塞消失。2例合并鼻泪管断裂,鼻内镜辅助下手术治愈。处理上颌窦（前、上壁）骨折4例、筛窦骨折2例、额筛窦骨折4例（2例伴脑脊液鼻漏）、上颌窦筛窦骨折合并眶纸板骨折4例（2例伴复视）、蝶筛窦骨折6例（1例伴脑脊液鼻漏）。鼻内镜手术后均对位生长愈合良好,无复视及视力障碍,眼球运动正常,外形尚好,窦口引流通畅,鼻腔鼻窦上皮化好。伴脑脊液鼻漏者已愈合。35例中1例鼻腔大出血,虽鼻出血停止但因合并严重脑挫裂伤死亡。结论在处理鼻颅底复杂性外伤中配合应用鼻内镜可以获得较满意疗效。     

面掀翻及改良半面掀翻联合鼻内镜技术在鼻科手术中的应用

目的：探讨面中部掀翻及改良半面掀翻径路鼻内镜辅助治疗鼻科疾病的方法和疗效。方法：30例患者,采用面中部掀翻术4例,半面掀翻术3例,改良术式23例。改良术式采用以患侧为主的上颌窦根治术切口,不作鼻小柱贯通切口,先完整剥离健侧的鼻中隔皮肤、黏软骨膜和骨膜及鼻底黏骨膜,不作健侧前庭切口,保留健侧鼻腔软组织结构的完整性,再作鼻中隔软骨及患侧皮肤、黏软骨膜切口与鼻前庭弧形切口,掀翻患侧半面中部软组织并联合鼻内镜切除病变。结果：所有创口一期愈合。随访6个月～3年,4例面中部掀翻术后鼻前庭狭窄1例;3例半面掀翻术中鼻中隔穿孔1例;改良术式联合鼻内镜23例无并发鼻前庭狭窄和鼻中隔穿孔等症。结论：面中部掀翻及改良半面掀翻径路联合鼻内镜,术野暴露充分,面部不留瘢痕,手术操作方便、安全;改良术式健侧鼻腔术后不必填塞,无鼻前庭狭窄等并发症发生。     

An approach to the nasal septum in children

Surgery of the nasal septum has long been discouraged in the pediatric population. Concerns about growth and development of the nose have led surgeons to adopt an extremely cautious attitude toward the correction of nasal septal deformities in childhood. More recently, studies have shown that with proper preservation of septal cartilage, surgery can be safely undertaken in this area. Frequently, however, exposure to the nasal septum is limited in small children due to the size of the nasal vestibule. Sublabial septoplasty has been safely carried out now in ten patients ranging in age from 4 to 9 years. This approach allows for complete access to the nasal septum while avoiding any external cosmetic deformity. The nasal septum has been preserved in all cases through morsalization and repositioning. Growth and development of the nose has been followed for up to 60 months without evidence of deformity or alteration. Sublabial septoplasty would, therefore, appear to be a safe and cosmetically acceptable approach to the correction of severe nasal septal deformities of childhood.     

鼻中隔连续褥式缝合术在局部麻醉的鼻内镜手术中的临床应用

目的通过局部麻醉下行鼻中隔矫正术后对鼻腔填塞或行鼻中隔连续褥式缝合术的对比,证明鼻中隔矫正术后行鼻中隔连续褥式缝合术更能减轻患者痛苦。方法将2012年5月～2013年4月我科住院行鼻中隔矫正术的成年患者分为甲乙对照组,甲组行鼻中隔矫正术后立即行鼻中隔缝合术不伴鼻腔填塞,乙组行鼻中隔矫正术后行双侧鼻腔膨胀海绵填塞。术后第1、2、3d对患者行视觉模拟评分（visualanalogscale,VAS）,并随访3个月观察有无并发症。所得数据应用SPSSl8．0统计软件进行重复测量的方差分析进行统计学分析。结果：甲乙2组患者在术后第1、2、3d的VAS评分比较,有显著性差异（P=0．000〈0．05）,两组术后＼,AS在术后不同处理方法下随时间有交互作用。即鼻中隔术后鼻中隔缝合术的患者症状随时间减轻的更明显;术后3个月随访,甲乙两组均未发现鼻中隔血肿、鼻中隔穿孔、塌鼻等并发症。结论：通过鼻中隔术后对鼻腔填塞或行鼻中隔缝合术的对比,鼻中隔连续褥式缝合术更能减轻鼻中隔术后的症状。     

鼻腔粘连合并鼻中隔偏曲的手术治疗

目的 探索鼻腔粘连合并鼻中隔偏曲的手术治疗方案.方法 鼻腔粘连合并鼻中隔偏曲患者13例.其中11例在施行粘连分解术的同时行鼻中隔偏曲矫正术和Merocel膨胀海绵持续性填塞鼻腔,1例施行单纯粘连分解术,1例联合施行粘连分解和鼻中隔偏曲黏膜下切除术.术后观察比较鼻腔创伤愈合情况及其功能改善效果.结果 第1组病例均获得痊愈;行单纯粘连分解术的1例症状无改善,改用第1组所用治疗方法后获得成功;第3种术式治疗的病例虽然粘连成功分解,但发生了鼻中隔穿孔.结论 对鼻腔粘连合并鼻中隔偏曲的患者,需在分解粘连的同时施行鼻中隔偏曲矫正术,重建鼻中隔,并行Merocel膨胀海绵持续性鼻腔填塞,有利于创伤愈合.     

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。     

鼻内镜下鼻中隔矫正术后血肿的预防

目的探讨预防鼻内镜下鼻中隔矫正术后鼻中隔血肿的有效方法。方法回顾性分析安徽医科大学第一附属医院2016年1月—2019年4月收治的行鼻内镜下鼻中隔矫正术的220例患者的临床资料。其中90例患者鼻中隔矫正术后鼻中隔两侧黏膜完整为甲组;90例患者术后黏膜完整,行一侧近鼻底处鼻中隔黏膜水平贯穿切开,长约1 cm,本研究称之为黏膜辅助切口为乙组;40例患者术后一侧或两侧鼻中隔黏膜有不对称破损为丙组。术后3组均予膨胀海绵填塞。结果甲组患者出现鼻中隔血肿5例,乙组和丙组患者皆未出现鼻中隔血肿,所有患者均无鼻中隔穿孔。3组之间的鼻中隔血肿发生率差异具有统计学意义(χ2=9.107,P<0.05)。结论对于术后两侧鼻中隔黏膜完整的患者,鼻中隔矫正后行一侧鼻中隔黏膜切开能有效预防鼻中隔术后鼻中隔血肿的发生。     

内镜下两种鼻中隔成形术的对比观察

目的：比较鼻中隔成形术和改良鼻中隔成形术的方法及疗效，以进一步完善鼻中隔成形术的相关操作。方法：回顾分析176例鼻中隔成形术、124例改良鼻中隔成形术的临床资料。结果：176例鼻中隔成形术中，3例再偏曲，2例需二次手术。124例行改良鼻中隔成形术者均恢复良好。结论：改良鼻中隔成形术，可保留更多的鼻中隔骨和软骨，且术后恢复良好，操作简便易行。     

三维CT辅助下三线减张鼻中隔矫正术疗效观察

目的探讨三维CT辅助鼻内镜下三线减张鼻中隔矫正的手术技巧及其疗效观察。方法回顾性分析78例鼻中隔偏曲患者,全部行鼻内镜下三线减张鼻中隔矫正术,术前采用三维CT重建技术对鼻中隔偏曲部位进行评估,术中选择性地将鼻中隔方形软骨尾端、鼻中隔软骨与筛骨垂直板结合处、鼻中隔软骨下端与犁骨、上颌骨鼻嵴与腭骨鼻嵴结合处等部位形成的三条张力线分离,将应力区软骨和骨质按照事先设计方案进行切除,消除导致鼻中隔偏曲的应力,从而达到矫正鼻中隔的效果。结果所有患者术后均随访3个月以上,其中治愈57例,好转21例。结论鼻内镜下三线减张鼻中隔矫正术安全可靠,效果满意,最大限度保留了鼻中隔正常组织结构。术前利用三维CT重建技术对手术方式进行具有设计,具有手术精细,并发症少等优点,值得临床推广。     

Surgery of the nasal septum

A modification of the 'maxilla-premaxilla' approach for nasal septum surgery is described. With this modification the mucosal elevation in the area of the two inferior tunnels is performed from above along the crests of the vomer, maxillary and premaxillary bones, instead of from below through the undermined base of the nose as in the 'maxilla-premaxilla' approach. This mucosal elevation is performed under direct vision in the intraseptal area instead of by blind elevation as in the 'maxilla-premaxilla' approach where the progress of the elevator beneath the nasal mucosa is followed through the nasal chambers. It gives the surgeon the increased advantage of working under the perichondrium and periosteum and of overcoming any difficulty arising from malformations in the anterior (caudal) area of the septal cartilage, premaxillary wings and maxillary crest. With this modification, extensive undermining of the base of the nose is also avoided. Finally the septal framework is fully exposed as in the 'maxilla-premaxilla' approach but in a more easy and safe way while all the advantages of the 'maxilla-premaxilla' approach are preserved.     

Cartilage regeneration in the rabbit nasal septum

OBJECTIVE: Rhinoplasty frequently includes harvesting of nasal septal cartilage. The objective of this prospective basic investigation is to determine whether cartilage can regenerate after submucosal resection (SMR) of the nasal septum in the rabbit. Neocartilage formation has not heretofore been described in this model. METHODS: By lateral rhinotomy, SMR was performed on 17 rabbits followed by reapproximation of the perichondrium. After 7 months, septi were fixed, sectioned, and examined histologically. Findings were photographed and data tabulated according to location and extent. RESULTS: Sites of matrix-secreting isogenous chondrocyte islands were identified between the perichondrial flaps of every animal, principally in the anterior inferior septum. The width of the islands averaged 190 microm, and the mean neocartilage height was found to be 840 microm. The newly formed cartilage consisted of chondrocytes within chondrons and was comparable in shape and structure to native septal cartilage. CONCLUSIONS: After SMR, rabbit cartilage tissue can regenerate and form matrix within the potential space created by surgery. The surrounding stem cell-rich perichondrium may be the site of origin for these chondrocytes. These findings suggest that after SMR of the human nasal septum, it may be possible for new cartilage tissue to develop provided the mucosa is well approximated. This biologic effect may be enhanced by insertion of cytokine-rich tissue scaffolds that exploit the native ability of septal perichondrium to regenerate and repair cartilage tissue.