异体脱细胞真皮基质黏膜组织补片修补鼻中隔穿孔

目的探讨修补直径大于1.0 cm的鼻中隔穿孔的最佳手术入路及修补材料。方法鼻内镜下联合唇龈沟入路应用双层瓣膜,即左侧为鼻中隔鼻底及下鼻道黏软骨膜/骨膜,右侧为异体脱细胞真皮基质黏膜组织补片(acellular dermal matrix,ADM),应用医用耳脑胶(EC胶)粘合修补鼻中隔穿孔。结果修补36例,成功率达100%,分别随访6个月～2年均无再穿孔。结论本手术中瓣膜面积大、根蒂宽、血供丰富,ADM无排斥反应,具有良好的生物相容性,EC胶粘合双层瓣膜成活率高。术式视野清晰,取材方便易行,缩短手术时间,减少供区创伤,是修补鼻中隔穿孔的最佳手术方案。

Clinical application of acellular dermal matrix in repair of nasal septal performation

OBJECTIVE To investigate the optimal surgical approach and compatible material for large nasal septal perforation.METHODS Operations were underwent via labiogingival groove approach under endoscope.Double layer of flaps were perichondrium of nasal septal cartilage,base of nasal cavity and inferior nasal meatus on the left and acellular dermal matrix (ADM) on the right and the two flaps were adhered with ear-cerebral glue (EC).RESULTS All of 36 cases were successfully repaired and no reperforation occurred after following-up for 3 months to 2 years.CONCLUSION Large mucosal flaps with wide pedicel and abundant blood supply and ADM of good biocompatibility provide a higher survival rate of the flaps.This method has the advantages of wide field of vision,less damage of the donated area and short time of operation.It is an optimal and practical method for repair of the large nasal septal perforation.