儿童鼻窦炎鼻内镜手术后随访与处理

目的回顾性总结儿童鼻窦炎患者实施鼻内镜鼻窦手术后随访结果,对随访中出现的不同问题和处理策略进行分类和探讨。方法儿童鼻窦炎性疾病患者268例(432侧),男186例,女82例,年龄3～17岁,平均14.3岁。188例(305侧)完成超过1年的术后随访。随访以鼻硬性内镜检查为主,记录症状缓解情况和鼻腔黏膜上皮化状况、鼻腔和鼻窦粘连闭锁状况及感染与否等。随访处理在局部麻醉下为主,部分患者在全身麻醉下或神经安定镇痛麻醉下进行。结果随访见鼻腔粘连53例(78/305侧),占25.6%;中鼻甲与鼻腔外侧壁粘连43侧,21侧分离成功;下鼻甲与鼻中隔粘连15侧,9侧分离成功;中鼻甲与鼻中隔、下甲前端与鼻腔外侧壁(下鼻道外侧)粘连各10侧,4侧分离成功。修正手术24例(24/188例),占12.8%;8例(8/188例)接受再次手术,占4.3%。鼻腔粘连分离及修正手术采用全麻8例,采用神经安定镇痛麻醉18例,局麻加表麻51例。再手术者均采用全身麻醉。结论儿童鼻内镜手术后相对成人更易出现鼻腔各部位的粘连,应在恰当麻醉方式前提下,尽早分割粘连;根据症状及术腔恢复情况可对影响手术效果的鼻腔结构进行修正手术;当症状不缓解或复发,且鼻内镜和鼻窦CT提示有病灶存在时,可再次手术。

Approaches to the problems in the follow-up after endoscopic sinus surgery in children

OBJECTIVE To evaluate the follow-up outcomes of endoscopic sinus surgery(ESS)in the children with chronic rhinosinusitis and polyps. The prob- lems and its management during the follow-up are clas- sified and discussed. METHODS A total of 268 chil- dren(432 sides)were included in this study. There were 186 males and 82 females with the age of 3 to 17 years old (average 14.3 years old). 188 cases(305 sides,70.1 %) were followed up for over 1 year after operation. Nasal endoscope was used to manage the problems mainly under local anesthesia during the fol- low-up. Some children were under general anesthesia or by sedation. Adherence condition,epithelization and infection of nasal mucosa of operative cavities were recorded. RESULTS Among 305 sides,78 occurred ad- herence of nasal cavities during the postoperative fol- low - up. The adherence of middle turbinate to lateral wall of nasal cavity was happened in 43 sides and 21 sides were separated. The adherence of inferior turbi- nate to nasal septum was happened in 15 sides and 9 sides of them were separated. The other adherence was between middle turbinate and nasal septum,ante- rior part of inferior turbinate and lateral wall of nasal cavity. Revision surgery was performed on 24 cases(12.8 %, 24 / 188 cases)under l ocal anest hesi a or by sedation. 8 cases were operated again under gen- eral anesthesia due to recurrence. CONCLUSION The adherence in different parts of nasal cavity is more common after ESS in children and should be managed as early as possible under proper anesthesia. Revision sur- gery should be done while there are some situations which could affect the ventilation and drainage. Only when the symptoms are not relieved and the CT scan shows lesions in nasal sinus, the operation should be done again.