动力系统与半导体激光下鼻甲部分切除术的比较

目的比较动力系统与半导体激光下鼻甲部分切除术的优缺点.方法比较46例动力系统下鼻甲部分切除术与37例半导体激光下鼻甲部分切除术术中出血量,手术时间,早、中期疗效,术后痂皮情况,术后并发症等.结果动力系统下手术出血量多,手术时间短,近期疗效好(术后2周总有效率为73.9%);半导体激光下手术出血少,患者痛苦轻,但术后痂皮多,近期效果不好(术后2周总有效率只有18.9%),两者比较差异有高度显著性(X2=29.52,P＜0.01),中期效果两者相仿(术后半年动力系统组总有效率为93.5%,半导体激光组总有效率为94.6%,差异无显著性(X2=0.06,P＞0.05),动力系统组与激光组术后并发症发生率分别为2.7%和8.7%,差异亦无显著性(X2=0.85,P＞0.05).结论两种手术方法各有优缺点,中期疗效两者相仿,术后并发症发生率无明显差别.     

微型电动切削器与半导体激光在下鼻甲部分切除术的比较

目的：比较微型电动切削器与半导体激光在下鼻甲部分切除术的优缺点。方法：比较45例用微型电动切削器行下鼻甲部分切除术（切削器组）与37例用半导体激光行下鼻甲部分切除术(激光组)的术中出血量,手术时间,早、中期疗效,术后痂皮情况,术后并发症等情况。结果：两种手术方法术中出血量均极少,术后不必填塞鼻腔,切削器组无并发症,激光组并发症也只有2.7％, 差异无统计学意义。切削器组手术时间短,术后基本无痂皮,近期疗效好（术后2周总有效率为71.1%）,中期疗效欠理想（术后半年总有效率为77.8％）;激光组手术时间稍长,术后痂皮多,近期效果不好（术后2周总有效率只有18.9%, 两组比较χ2=27.01, P＜0.01）,中远期疗效较好（术后半年总有效率为94.6%, 两组比较χ2=6.42, P＜0.05）。结论：两种手术方法术中出血量、术后并发症均极少。切削器组术后早期效果较好,中远期疗效欠理想;而激光组术后早期效果差,中远期疗效满意。     

组织病理学评价下鼻甲部分切除术的适应证

手术治疗鼻甲粘膜肥厚引起的鼻腔通气功能障碍还存在争议。为了分析鼻腔阻塞原因,从病理学角度论证下鼻甲手术适应证。选择61例手术患者,分为血管运动性鼻炎、常年性变应性鼻炎、鼻中隔偏曲下鼻甲代偿性肥大三组。术中取活检,用图像分析系统评估单个血管的平均横截面积和血管数量,按平方像素计算。结果发现:血管运动性鼻炎组平均血管横截面积最大,与     

下鼻甲部分切除术和微波治疗慢性肥厚性鼻炎疗效的比较

慢性肥厚性鼻炎以鼻甲黏膜、黏膜下层、甚至骨质局限性或弥漫性增生肥厚为特点. 1996年1月至2002年12月,我们为30例慢性肥厚性鼻炎患者行下鼻甲部分切除术,38例用微波治疗,现将2种方法治疗结果报告如下.     

钳夹法下鼻甲部分切除术120例报告

自1989年以来,我院对因下鼻甲肥大而导致的鼻腔阻塞性病变采用钳夹法行下鼻甲部分切除术,取得满意疗效。现就有完整随访资料的120例报道如下。1 资料与方法 临床资料:120例(210侧)中,慢性肥厚性鼻炎72例(132侧),变应性鼻炎21例(42侧),下鼻甲息肉样变15例(24侧),鼻中隔偏曲并下鼻甲代偿肥大12例(12侧)。男86例,女34例;年龄16～69岁,平均27岁;病史1～15年,平均4.6年。全部病例均经长期保守治疗无效。     

无血电凝切除部分下鼻甲

目前,对于慢性肥厚性鼻炎、鼻中隔偏曲伴随的下鼻甲代偿性肥大、常年性变应性鼻炎以及下鼻甲息肉样变等所致的机械性鼻塞,最为有效的治疗方法仍然是下鼻甲部分切除术.但通常的手术方法存在术中术后出血较多、鼻腔内需填塞纱条止血、填塞物较多及填塞时间亦较长等问题,因而给患者带来较大的痛苦.自上世纪80年代起,我科采用钳压止血法行下鼻甲部分切除术,即在拟行下鼻甲部分切除处,先用长直血管钳夹紧压迫,2 min后取下血管钳,再沿夹压痕迹行下鼻甲部分切除术,此方法可显著减少术中出血,但仍需填塞鼻腔,术后出血亦无显著减少.为进一步减少术中术后出血,缩短填塞时间或避免填塞,近2年我们设计并施行了下鼻甲无血电凝切除术,取得了满意的疗效.介绍如下.     

鼻中隔软骨黏膜下部分切除＋下鼻甲部分切除术治疗常年性变应性鼻炎的疗效分析

目的对常年性变应性鼻炎合并鼻中隔偏曲的患者行鼻中隔软骨黏膜下部分切除术＋下鼻甲部分切除术观察常年性变应性鼻炎疗效。方法56例常年性变应性鼻炎合并鼻中隔偏曲的患者分成治疗组和对照组分别于鼻内镜下行鼻中隔软骨黏膜下部分切除术斗下鼻甲部分切除术及药物治疗。结果3及6个月后对2组患者进行疗效评定,3个月时治疗组有效率为91．6％对照组有效率N31．2％（P〈0．05）。6个月时治疗组有效率为95．8％,对照组有效率为21．8％（P〈0．05）。差异有统计学意义。结论鼻中隔软骨黏膜下部分切除术斗下鼻甲部分切除术治疗常年性变应性鼻炎具有良好的疗效。     

鼻内窥镜引导半导体激光下鼻甲部分切除术的临床探讨

目的：探讨鼻内窥镜引导下行半导体激光下鼻甲部分切除术的应用价值。方法：回顾分析56例慢性肥厚性鼻炎患者在鼻内窥镜引导下行半导体激光下鼻甲部分切除术的临床资料。结果：术后半年复查,总有效率94．64％,术中无出血,术后无并发症。结论：半导体引导下激光下鼻甲部分切除术方法简便、快捷、有效,是治疗慢性肥厚性鼻炎的有效方法。     

下鼻甲部分切除术和Nd：YAG激光术治疗慢性肥厚性鼻炎的比较

目的 比较和评价下鼻甲部分切除术和Nd:YAG激光术治疗慢性肥厚性鼻炎的效果。方法 回顾性分析96例患者接受下鼻甲部分切除术和Nd:YAG激光术的结果。其中46例行下鼻甲部分切除术,50例行Nd:YAG激光术。结果 术后3个月随访,下鼻甲部分切除术总有效率86．96％,Nd:YAG激光术总有效率88．0％,二者无显著性差异（P＞0．05）;前者术后并发出血者19．6％,后者为4．0％。结论 下鼻甲部分切除术与Nd:YAG激光术治疗性肥厚性鼻炎效果相似。两者均在局麻下进行,非常安全、有效、但Nd:YAG激光具有简单、无切口、操作容易、术后出血少等特点。     

等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术

目的比较等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术对慢性肥厚性鼻炎患者术中、术后的影响。方法等离子组患者25例,对照组14例。等离子组用低温等离子射频消融系统连接45号刀头,行下鼻甲前、后部中隔侧的4～6通道消融。对照组用吸切钻自前向后切割下鼻甲肥厚黏膜,术后需填塞止血2日。术后患者对疼痛和鼻堵程度采用VAS评分。术前、术后1个月、3个月、6个月均由医师对每侧下鼻甲进行评分,由患者评估鼻堵程度和频度。结果等离子组术中出血较对照组明显减少,术后疼痛和鼻堵程度较轻。术后1个月等离子组和对照组的鼻堵程度、鼻堵频度和下鼻甲体积较术前均有明显改善,二者改善的程度无明显差别。术后3个月两种术式均疗效稳定且等离子组鼻堵频度进一步改善。术后6个月两种术式疗效依然稳定。结论等离子下鼻甲部分消融术创伤小,术中、术后出血少,痛苦小;术后1个月患者主观症状与客观体征均有明显改善;术后3个月患者主观症状进一步改善;术后6个月内疗效均稳定且与吸切钻下鼻甲部分切除术疗效相当。     

Inferior turbinectomy versus submucosal diathermy for inferior turbinate hypertrophy

In order to compare and evaluate bilateral inferior turbinectomy (BIT) and submucosal diathermy (SMD), we retrospectively examined these two well-known techniques for treatment of nasal obstruction due to bilateral congestion of the inferior turbinates. One hundred patients with bilateral nasal obstruction were divided into 4 groups according to their nasal airflow patency. Forty-nine patients underwent BIT, and 51 patients underwent SMD. All 100 patients were followed for 2 months after surgery. Patients with difficult postoperative courses were followed up to 1 year after surgery, in order to decide on the necessity of operative revision. Postoperative improvement in nasal breathing after BIT was reported for 96% of patients 2 weeks after surgery, and for 88% 2 months after surgery. Only 1 BIT patient had to undergo revision operation. Diathermy showed good results in 78% of cases 2 weeks after surgery. The efficacy of the procedure was reduced to 76% 2 months after surgery. Twenty percent of SMD patients were advised to undergo operative revision. Postoperative bleeding occurred in 20% of BIT patients and in only 4% of SMD patients. We found that the extent of postoperative improvement does not depend on preoperative conditions; therefore, it is impossible to predict the extent of postoperative improvement on the basis of the results of preoperative assessment. Both procedures can be performed under local anesthesia, are relatively safe and effective, and do not need expensive instrumentation that may not be available in many medical centers.     

低温等离子消融术与下鼻甲成形术治疗慢性鼻炎的对比研究

目的 通过研究低温等离子消融术与下鼻甲成形术术后患者鼻塞改善情况和对鼻腔黏膜纤毛功能的影响,探讨治疗慢性鼻炎更有效的方法。方法 选取慢性鼻炎患者40例,随机分为两组,分别行等离子消融术(A组)与下鼻甲成形术(B组)。术前,术后1周、1个月、3个月分别用VAS评分评价患者鼻腔症状。糖精试验评价术前及术后3个月患者鼻腔黏膜纤毛传送功能。结果 等离子组术中出血、手术时间较下鼻甲成形组明显减少,且术后并发症较少;术后3个月两组患者鼻塞均有明显改善;两种手术方式对鼻腔黏膜纤毛功能无影响。结论 对单纯黏膜肥厚的慢性鼻炎,等离子消融疗效显著;对鼻甲骨质肥厚或形态异常的慢性鼻炎,下鼻甲成形术效果好。     

Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is a common cause of nasal airway obstruction. In cases unresponsive to conservative treatment, various surgical techniques are commonly performed, but the issue of the optimal surgical procedure is still controversial. The objective of the present study was to evaluate the effectiveness and safety of ultrasound treatment of the hypertrophied inferior turbinates, which is a technique recently applied in rhinologic surgery. We aimed, also, to compare this method with the radiofrequency cold coblation turbinate reduction and the traditional submucosal monopolar inferior turbinate cauterization. We studied prospectively 60 patients with chronic hypertrophic rhinitis of nonallergic etiology, who underwent different surgical methods of turbinate reduction, divided into two groups: (1) in 30 patients, inferior turbinate volume reduction using ultrasound procedure on the left side and monopolar diathermy on the right was performed; (2) in 30 patients, radiofrequency coblation technique on the left side and ultrasound turbinate reduction on the right side was undertaken. Subjective evaluation of nasal obstruction and pain was performed using visual analog scales and objective evaluation of the surgical outcome was obtained using active anterior rhinomanometry and acoustic rhinometry. Examinations were performed preoperatively, and 1, 3 and 6 months after surgery. Both subjective and objective evaluation showed significant postoperative improvement in all cases. The best results were obtained with the ultrasound procedure, and second with the radiofrequency technique. The least improvement was observed in the electrocautery group, although its results did not differ significantly from the radiofrequency group. It may be, thus, concluded that ultrasound turbinate reduction is an effective and safe procedure for the management of chronic hypertrophic rhinitis, in patients failing to respond to medical treatment. Using this method, better results were obtained in decreasing subjective symptoms and nasal obstruction, in comparison with radiofrequency and electrocautery.     

The early complications of inferior turbinectomy

A retrospective study has assessed the early complications occurring in 90 patients who underwent inferior turbinectomy during a 3-year period. The operation was complicated by haemorrhage, adhesions, crusting, infection and septal perforation in a proportion of cases, the overall incidence being 20 per cent, and that of significant reactionary or secondary haemorrhage was 9 per cent. Attention has been directed towards possible aetiological factors and measures proposed that may minimise the occurrence of complications.     

Infected inferior turbinate pneumatization

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.