鼻内窥镜手术的中鼻甲处理

目的探讨鼻内窥镜手术中鼻甲部分切除和保留中鼻甲与预后的关系。方法４０例双侧慢性鼻窦炎鼻息肉患者,在鼻内窥镜手术中１侧切除部分中鼻甲,另侧保留中鼻甲,观察术后鼻腔清理时间、粘连情况和手术前后嗅觉变化。结果①术后鼻腔清理时间,中鼻甲部分切除侧（平均７．１ｄ）与中鼻甲保留侧（平均９．４ｄ）差异有高度显著性（ｔ＝３８４,Ｐ＜００１）;②中鼻甲保留侧术后发生鼻腔粘连１２例,中鼻甲部分切除侧无１例发生粘连;③中鼻甲部分切除侧嗅觉改善与中鼻甲保留侧差异无显著性,４０例中未见嗅觉下降者。结论鼻内窥镜手术中切除部分中鼻甲的优点：①缩短术后清理时间,促使术腔尽快干燥与上皮化;②防止术后粘连。     

放射治疗后鼻窦炎的鼻内镜手术治疗

目的 探讨鼻咽癌放射治疗后鼻窦炎的治疗方法。方法 对46例放射治疗后鼻窦炎患者进行鼻内镜手术治疗。随访半年以上,观察疗效和并发症。结果 治愈19例,好转27例。术中无大出血等并发症,术后并发症主要是鼻腔粘连,46例病人均有鼻腔粘连发生,经多次换药均痊愈：粘连部位：术腔粘连11例,中鼻甲与鼻中隔粘连24例,下鼻甲与鼻中隔粘连31例。结论 鼻内镜鼻窦手术治疗对放射治疗后鼻窦炎具有良好的疗效,是可行的。手术操作熟练准确,手术后按时换药是成功的重要保证。     

内窥镜鼻窦手术后粘连发生的相关因素及其预防和处理

目的　探讨内窥镜鼻窦手术后粘连发生的相关因素及其预防和处理。方法　分析 3 3 8例 (5 13侧 )内窥镜鼻窦手术中发生术腔粘连的 3 2例 (47侧 )的临床资料。对粘连类型、病变性质、病变程度、中鼻甲气化、中鼻甲病变、中鼻甲处理与否、手术熟练程度和随访处理情况诸因素进行分析。结果　①本组病例粘连的发生率为 9 16% ;②各粘连类型按发生率高低依次是筛窦腔粘连闭塞、中鼻甲与鼻腔外侧壁粘连、中鼻甲与鼻中隔粘连、下鼻甲与鼻中隔粘连 ,未见中鼻甲与下鼻甲粘连 ;③感染性病变、病变严重、中鼻甲气化、中鼻甲病变、手术技巧不够熟练和随访处理经验不成熟以及不按时随访的粘连发生率较高。结论　术前充分认识上述相关因素 ,提高手术技巧 ,正确处理中鼻甲 ,术后按时随访和及时解除粘连是减少粘连发生的关键     

鼻腔粘连

作者对鼻腔术后粘连的发生率进行回顾性分析。60例手术类型有鼻中隔矫正、下鼻甲电凝或全切除、鼻息肉切除及上颌窦开窗术。20例同时作二种手术。鼻腔填塞用石蜡油碘仿纱条或干碘仿纱条,均于术后24～48小时取出。术后门诊观察2周,检查鼻腔时不取痂壳、不作清洁,鼻阻塞以熏气解除。6周时清洁鼻腔确定有无粘连发生。本组完成随访者54例中有6例(11%)发生鼻腔粘连,最早者在2周时已发现,另有21例2周时鼻腔已发现异常,但6周后恢复正常。因此,在2周时鼻腔有异常者,6周时将有22%(6/27)发生粘连。鼻腔粘连者均为下鼻甲全切除,且5例同时作了两种手术。     

鼻内窥镜术后鼻腔粘连对疗效的影响

目的 :探讨鼻腔粘连对鼻窦内窥镜手术疗效的影响。方法 :应用Storz硬性鼻内窥镜 ,根据不同的病变部位 ,参照Messerklinger鼻内窥镜手术方法 ,行鼻内窥镜手术 84 5例 (15 5 8侧 ) ,术后定期随访 1年以上。结果 :治愈 12 80侧 ,总治愈率为 82 .2 %。其中Ⅰ型病例治愈率达 91%以上 ;Ⅱ型 1期和 2期分别为 98.9%和82 .8% ,3期为 75 .0 % ;Ⅲ型治愈率为 6 1.2 %。在 2 78侧无效病例中鼻腔粘连 15 1侧 ,占 5 4 .3%。结论 :鼻窦内窥镜术后鼻腔粘连以中鼻甲与其周围结构为主 ,导致鼻窦引流不畅 ,以致影响疗效 ,因此 ,减少术后局部粘连是提高手术疗效的关键。术中对中鼻甲的适当处理有助于减少术后粘连 ,提高手术效果     

中鼻甲基板水平部损伤与中鼻甲漂移粘连的关系研究

目的 探讨中鼻甲基板水平部损伤与术后中鼻甲漂移粘连的相关性。方法 采用患者自身对照,观察110例双侧鼻窦炎鼻息肉患者,一侧因病变手术切除部分中鼻甲基板水平部,一侧完整保留中鼻甲基板水平部,观察术后半年患者双侧鼻腔中鼻甲粘连的发生率。结果 110例患者切除中鼻甲基板水平部侧发生粘连19侧（17.8%）,未切除侧发生粘连7侧（6.4%）。结论 保留中鼻甲基板水平部对术后保持中鼻甲的固定,防止术后粘连具有临床意义,建议术中尽可能完整地保留中鼻甲基板水平部。     

单独鼻腔手术治疗阻塞性睡眠呼吸暂停低通气综合征的远期疗效观察

目的：探讨单独鼻腔手术治疗阻塞性睡眠呼吸暂停低通气综合征（0sAHS）的远期疗效。方法：回顾分析23例OSAHS并伴有鼻部相关疾病的患者,经PSG和Epworth嗜睡评估表（ESS）确诊,只行鼻腔手术,其中包括鼻中隔矫正术、鼻甲成形术、鼻窦开放术。术后随访1年以上,PSG和ESS检查评估疗效。结果：23例患者术后随访12-39个月,平均（22．64±9．13）个月,患者主观症状改善明显,ESS分值从13．68降至8．14（t=9．429,P〈0．01）。客观检查方面,患者术前术后平均AHI和LSaO2无明显变化（P〉0．05）。23例中5例治疗有效,总有效率为21．74％（5／23）,鼻腔是主要阻塞部位;其余18例患者无效。结论：OSAHS患者尤其是中、重度患者,上气道往往存在多个阻塞平面,单独行鼻腔手术适合于阻塞平面主要位于鼻腔的患者。     

内镜鼻窦手术中中鼻甲处理及其临床意义

目的 探讨内镜鼻窦手术中中鼻甲处理特点,重申正确处理中鼻甲对内镜鼻窦手术疗效的影响及其临床意义.方法 回顾性分析68例中鼻甲病变合并慢性鼻窦炎鼻息肉患者术前的鼻内镜检查和CT扫描特征等临床资料,了解中鼻甲的形态、病变类型和病变范围,与相邻鼻窦、中鼻道、钩突以及鼻中隔的解剖关系,分析内镜鼻窦手术术中中鼻甲处理特点及其对术后疗效的影响.结果 68例中,23例双侧气化中鼻甲,5例反常曲线中鼻甲(2例单侧,3例双侧),25例中鼻甲息肉样变(15例双侧,10例单侧),6例双侧中鼻甲息肉形成,9例双侧中鼻甲骨质增生.所有病例均不同程度阻塞中鼻道.术后随访半年至1年,粘连出现的时间为:术后2～4周19例(28%),术后5～8周11例(16%),术后9～12周8例(8/68,12%),半年至1年4例(5.9%).粘连部位:与鼻腔外侧壁粘连者30例,与下鼻甲上缘粘连9例,与鼻中隔粘连3例.治愈49例(72%),好转18例(26%),无效1例(1.8%).结论 内镜鼻窦手术中,有必要对中鼻甲不同病变程度、范围和类型进行个体化处理,尤其是中鼻甲成形术对保存其功能及提高内镜鼻窦手术临床疗效有重要的意义.     

鼻内窥镜手术的中鼻甲处理

探讨鼻内窥镜手术中鼻甲部分切除和保留中鼻甲与预后的关系。方法４０例双侧慢性窦炎鼻息肉患者,在鼻内窥镜手术中１侧切除术中鼻甲,另侧保留中鼻甲,观察术后鼻腔清理时间,粘连情况和手术前后觉变化。     

内窥镜鼻窦手术后粘连发生的相关因素及其预防和处理

目的 探讨内窥镜鼻窦手术后粘连发生的相关因素及其预防和处理。方法 分析３３８例（５１３侧）内窥镜鼻窦手术中发生术腔粘连的３２例（４７侧）的临床资料。对粘连类型、病变性质、病变程度、中鼻甲气化、中鼻甲病变、中鼻甲处理与否、手术熟练程度和随访处理情况诸因素进行分析。结果 ①本组病侧粘连的发生率为９．１６％;②各粘连类型按发生率高低依次是筛窦腔粘连闭塞、中鼻甲与鼻腔外侧壁粘连、中鼻甲与鼻中隔粘连、下鼻甲     

鼻内窥镜下鼻窦鼻息肉手术75例疗效观察

目的：观察鼻内窥镜下鼻窦鼻息肉手术治疗的效果。方法：对75例（125侧）慢性鼻窦炎鼻息肉患者行鼻内窥镜下手术，术后随访1年。结果：治愈48例（64.0%），好转20例（26.7%），无效7例（9.3%），总有效率90.7%。术后并发症主要为鼻腔黏连。结论：鼻内窥镜下鼻窦鼻息肉手术治疗具有良好的疗效，术中正确处理中、下鼻甲及鼻中隔，术后定期随访可提高治愈率，减少并发症。     

Nasal conditioning after endonasal surgery in chronic rhinosinusitis with nasal polyps

BACKGROUND: Endoscopic sinus surgery (ESS) is a frequently performed operation for chronic rhinosinusitis (CRS). The aim of this study was to investigate nasal conditioning after ESS with/without septoplasty and turbinoplasty in patients with CRS with nasal polyps and to determine its relation to nasal patency and geometry. METHODS: Twenty-one patients were enrolled into this study. Nasal conditioning, AAR, and acoustic rhinometry were measured before and 4-8 months after endonasal surgery. RESULTS: The temperature and humidity gradient across the nose increased significantly after operation. High nasal volumes and patency were positively correlated with elevated nasal conditioning. No correlation between preoperative and postoperative changes in nasal geometry and nasal airflow with changes in conditioning values was found. CONCLUSION: Patients with CRS with nasal polyps seem to profit from ESS with/without septoplasty and turbinoplasty because nasal conditioning is improved postoperatively. Properly performed ESS has its importance within the variety of nasal surgical procedures ensuring improved nasal function.     

儿童鼻内镜术腔不填塞的初步经验

目的　通过临床实践总结儿童鼻内镜术后术腔不填塞的优势,初步探讨术腔不填塞的临床适应证。方法 观察36例接受全麻鼻内镜手术术腔不填塞的患儿,总结术 后术腔出血情况,分析原因,统计再填塞率,调查术后不适感程度,评估术腔处理的难度。结果　术后不填塞的术腔出血再填塞率低（本观察结果为2.8%）,术后不适症状轻微、术后换药效率高,平均换药耗时14.3 min。结论　儿童鼻内镜术后术腔不填塞对于部分患儿具有明显优势,临床推广具有一定的可行性。     

The effect of FloSeal on mucosal healing after endoscopic sinus surgery: a comparison with thrombin-soaked gelatin foam

BACKGROUND: The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS. METHODS: Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6-8 weeks after surgery. RESULTS: No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation. CONCLUSION: Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.     

鼻内镜手术对鼻音及鼻腔通气程度的影响

目的:通过对内镜鼻窦手术(ESS)前后鼻音及鼻腔阻力的客观检测,探讨ESS后鼻腔鼻窦共鸣特性的改变及鼻腔阻力的变化特点。方法:对资料记录完整的68例成人鼻息肉鼻窦炎患者,ESS前后使用鼻声图仪和鼻压计分别对鼻音和鼻阻力进行检测。结果:Ⅲ型和Ⅱ型2期、3期患者术后1个月鼻音均明显改善(均P<0.05),但仍低于正常值;术后3个月,Ⅱ型2期、3期鼻音达正常值下限,Ⅲ型仍未恢复正常;而总鼻阻力在术后1个月明显下降(P<0.01),术后3个月恢复正常。Ⅱ型1期患者术后1个月鼻音和总鼻阻力即恢复正常,其值与术前比较,差异无统计学意义(P>0.05)。结论:对于严重的鼻窦或(和)鼻腔病变的患者ESS术后1个月总鼻阻力明显改善,接近正常范围,而鼻音在较长一段时间里仍表现异常。提示ESS术后不能立即改善鼻音状况,相反过多破坏鼻腔、鼻窦正常结构,使鼻腔、鼻窦的共鸣特性发生改变,这对从事语音工作(如播音员、外语及语言老师等)的人可能有较大影响。     

Comparison of intra-operative characteristics and early post-operative outcomes between endoscopic sinus surgery and balloon sinuplasty

Conclusion: In terms of operation time, anesthesia method, and low complication rate, ESS and balloon sinuplasty seemed comparable. The advantages of balloon sinuplasty were shown to be shortness of sick leave, possibility to be performed as an in-office procedure, and lower adhesion formation.

Background: Endoscopic sinus surgery (ESS) has been considered as a treatment of choice for persistent chronic rhinosinusitis (CRS). During the last decade balloon sinuplasty has been introduced as an alternative technique to dilate the ostium. Although balloon sinuplasty is considered relatively safe and efficient, comparative evidence of its putative intra-operative and post-operative advantages remain limited.

Objectives: The aim of this retrospective controlled study was to evaluate intra-operative factors and early post-operative outcomes among CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique.

Materials and methods: Data were collected from 208 patients with CRS treated either with ESS or balloon sinuplasty during the years 2008–2010. Intra- and peri-operative factors were collected from patient records of the patients who met the inclusion criteria (n?=?39 in ESS group and n?=?36 in balloon sinuplasty group).

Results: There was no significant difference in operation time and anesthesia method between the two groups. No complications occurred with either technique. All ESS procedures and 67% of the balloon sinuplasty procedures were done in the hospital setting, whereas 33% of the balloon sinuplasty procedures were done in the office setting. The duration of sick leave and the number of patients with adhesions were significantly higher in the ESS group compared to the balloon sinuplasty group.     

The effect of an expandable polyvinyl acetate (Merocel) pack on the healing of the nasal mucosa of sheep

BACKGROUND: There is a lack of knowledge about the healing of the nasal respiratory mucosa after endoscopic sinus surgery (ESS). Nasal packs often are placed after ESS in an attempt to improve hemostasis and reduce adhesion formation. Most nasal packs need to be removed in the postoperative period. This is uncomfortable for the patient and the affect of these packs on the healing process is unknown. METHODS: We have standardized the sheep as a suitable animal model to examine the healing of the nasal epithelium after ESS. The nasal mucosa of sheep was wounded under endoscopic guidance and either packed with expandable polyvinyl acetate-based pack (Merocel), which was removed at the 5th postoperative day, or left unpacked to serve as control. Serial biopsies of the wounded area were taken every 28 days, up to 112 days postwounding, for examination using light and scanning electron microscopy. RESULTS: There was no significant difference in the rate of reepithelialization between the packed and control sides of the sheep (p > 0.05). There was no significant difference in the total amount of surface cilia coverage between the packed and control sides at any time points (p > 0.05). There was no significant difference in the maturity of the cilia between the packed and control sides at any time points (p > 0.05). CONCLUSION: The use of Merocel packing postoperatively neither impairs nor promotes wound healing in the postoperative period.     

慢性鼻窦炎I型患者鼻内镜术后鼻音及鼻腔通气程度的变化

目的通过对慢性鼻窦炎I型患者行内窥镜鼻窦手术(endoscopic sinus surgery,ESS)前后鼻音及鼻腔阻力检测,探讨ESS后鼻腔鼻窦共鸣特性的改变及鼻腔阻力的变化特点。方法对资料记录完整的75例成人慢性鼻窦炎I型患者(1期38例,2期15例,3期22例),ESS前后使用鼻声图仪和鼻压计分别对鼻音和鼻阻力进行检测。结果I型1期患者术后1月鼻音和总鼻阻力与术前无明显变化;进一步研究发现,单侧上颌窦炎对鼻音有一定影响,手术后1月及3月基本恢复正常;单侧额窦炎或蝶窦炎对鼻音无明显影响。I型2期和3期患者术后1月总鼻阻力无明显改变,而鼻音较术前改善(P<0.05),但仍低于正常范围,术后3月术腔上皮化后,鼻音基本恢复正常。结论对于慢性鼻窦炎I型患者,ESS术后虽然总鼻阻力正常,鼻音仍在一段时间里表现异常。若术中过多破坏鼻腔、鼻窦正常结构,使鼻腔、鼻窦的共鸣特性发生了改变,可能对从事语音工作者(如播音员、外语及语言老师)的语音产生影响。     

鼻内镜手术治疗后鼻孔息肉

目的探讨后鼻孔息肉的起源部位,分析鼻内镜下治疗后鼻孔息肉的疗效。方法回顾性分析1999～2006年间行鼻内镜手术的63例后鼻孔息肉患者的临床资料。结果59例上颌窦后鼻孔息肉,42例可在上颌窦内确切定位起源部位,其中起源于内上壁16例,后壁为9例,前壁为3例,下壁为3例,外侧壁为2例,上壁2例,前内壁为4例,前外侧壁1例,后上壁1例,外下壁1例;2例起源于鼻中隔;1例起源于蝶窦;1例起源于前组筛窦。所有病例均在鼻内镜下手术切除。术后随访6～30个月,4例复发,经二次手术治愈。5例并发鼻腔粘连,经松解后解除粘连。结论后鼻孔息肉多原发于上颌窦内侧壁。采用鼻内镜手术治疗安全、有效。术前明确后鼻孔息肉的起源部位对手术方式的选择至关重要。     

慢性鼻及鼻窦炎鼻内镜手术疗效及黏膜上皮化分析

目的总结鼻内镜手术治疗慢性鼻及鼻窦炎的疗效和术腔黏膜上皮化规律,探讨影响疗效和术后黏膜上皮化的相关因素。方法对520例慢性鼻及鼻窦炎接受鼻内镜手术患者的手术疗效和术后黏膜上皮化规律进行临床分析。疗效分析应用X~2检验,黏膜上皮化时间分析用非参数秩和检验。结果治愈率74.4%,好转率21.0%,总有效率95.4%。术后平均黏膜上皮化时间为14.0周。疾病的分型分期、是否合并哮喘、变应性鼻炎和疗效与黏膜上皮化时间有相关性(P<0.05)。结论鼻内镜手术治疗慢性鼻及鼻窦炎是有效和安全的,术后黏膜上皮化时间平均需要3个月。病情重、合并哮喘或变应性鼻炎的患者疗效较差,黏膜上皮化时间长。鼻腔粘连通过定期合理的复查和处理,大多数能够得到有效的解除。