鼻中隔双向黏骨膜瓣应用于成人难治性后鼻孔闭锁的手术治疗

目的:探讨鼻中隔双向黏骨膜瓣治疗成人难治性后鼻孔闭锁的效果。方法:9例后鼻孔闭锁患者,其中先天性闭锁2例,鼻咽癌放疗后闭锁7例。所有患者均接受了鼻内镜下后鼻孔成形术,术中使用鼻中隔双向黏骨膜瓣,术后未放置硅胶扩张管。观察患者术后的症状改善程度及是否发生后鼻孔再狭窄或闭锁。结果:9例患者术后鼻塞、张口呼吸等症状明显改善。在平均19.3个月的随访时间内,新成形后鼻孔通畅,黏膜瓣无移位及坏死,亦无后鼻孔再狭窄或闭锁发生。其中2例患者出现鼻腔粘连,1例出现后鼻孔边缘肉芽组织增生,经鼻内镜处理后无复发。结论:鼻内镜下后鼻孔成形术中,鼻中隔双向黏骨膜瓣的应用可降低再狭窄或闭锁的发生率,术后可不用放置硅胶扩张管。

The application septonasal bidirectional mucoperiosteal flap in treatment of refractory choanal atresia in adults

Objective:To explore the effects of septonasal bidirectional mucoperiosteal flap in the treatment of refractory choanal atresia in adults.Method:Analysis of 9 cases for choanal atresia was conducted.Two cases were of congenital origin and 7 cases of acquired origin,which was a complication of radiotherapy for nasopharyngeal carcinoma.The patients received transnasal endoscopic surgery using the septonasal bidirectional mucoperiosteal flap,without positioning the postoperative expansion tube.After the operation,the changes of symptoms were observed and the recurrent rate of restenosis or atresia was investigated in the follow-up time.Result:The symptoms of nasal obstruction and mouth breathing improved significantly in the 9 patients.At an average follow-up time of 19.3 months,the new forming posterior nare remained patent.The mucoperiosteal flap had no shift or necrosis.No restenosis or atresia happened.Nasal adhesion occurred in two patients.Granulation tissue hyperplasia was found in 1 patient,who underwent endoscopic revision without recurrence.Conclusion:The application of mucoperiosteal flap in transnasal endoscopic surgery for the choanal atresia can reduce the incidence of restenosis or atresia.Postoperative expansion tube is not mandatory.