鼻中隔穿孔不同修补术的临床效果对比分析

目的:比较3种不同鼻中隔穿孔修补术式的临床治疗效果及鼻腔通气功能变化.方法:选取鼻中隔穿孔病人54例,按照术式不同分为自体颞筋膜筛骨垂直板夹层法组(A组)、自体带蒂鼻腔底黏骨膜瓣修补法组(B组)及单蒂黏骨膜或软骨膜瓣翻转联合游离颞肌筋膜瓣修补法组(C组),观察3组手术治疗效果及术后鼻腔通气功能.结果:B组术中出血量、手术时间均少于A、C组(P<0.05~P<0.01),B、C组损伤黏膜面积、创面愈合时间均显著优于A组(P<0.01),C组在创面愈合时间亦优于B组(P<0.05),而3组愈合分期差异无统计学意义(P>0.05);B、C组术后3个月VAS评分均显著低于A组(P<0.05),C组术后3个月及术后1年鼻腔最小截面积均显著高于A、B组(P<0.05~P<0.01).结论:单蒂黏骨膜或软骨膜瓣翻转联合游离颞肌筋膜瓣修补法治疗鼻中隔穿孔在疗效及改善鼻腔通气功能方面均优于自体颞筋膜筛骨垂直板夹层法和自体带蒂鼻腔底黏骨膜瓣修补法.

Comparative analysis of the clinical effects between different repairs in nasal septum perforation

Objective:To observe the clinical effects between three kinds of repairs of nasal septum perforation and nasal ventilation function change.Methods:Fifty-four patients with nasal septum perforation were divided into A,B and C groups.The A,B and C groups were treated with autologous temporal fascia and perpendicular plate of ethmoid bone sandwich technique,autograft with pedicle nasal mucoperiosteal flap repair method,and single pedicle sticky periosteum or perichondrium flip flap combined with free temporalis myofascial flap repair method,respectively.The treatment effects and postoperative nasal ventilation function in three groups were observed.Results:The intraoperative blood loss and operation time in group B were significantly lower than those in A and C groups(P<0.05 to P<0.01).The mucosal injury area and wound healing time in B and C groups were significantly better than those in group A(P<0.05).The wound healing time in group C was shorter than that in group B(P<0.05),and the differences of the healing stage between the three groups were not statistically significant(P>0.05).The minimal cross-sectional area of nasal cavity in group C at postoperative 3 months and 1 year were significantly higher than that in A and B groups.Conclusions:The clinical effect of the single pedicle sticky periosteum or perichondrium flip flap combined with free temporal fascia flap repair method in the treatment of nasal septum perforation is good,which in improving the nasal ventilation function is better than that in autologous temporal fascia and perpendicular plate of ethmoid bone sandwich technique,and autograft with pedicle nasal mucoperiosteal flap repair method.