复合鼻黏膜瓣修补鼻中隔大穿孔的临床研究

目的探讨鼻内镜下双侧鼻中隔-鼻底-下鼻甲复合黏膜瓣在修补鼻中隔大穿孔中的应用效果。方法入选患者为2008年6月-2011年6月在我院治疗的8例鼻中隔大穿孔患者。患者取仰卧位,局麻后于双侧鼻中隔穿孔前缘、鼻底及下鼻甲前端黏膜依次切开,鼻内镜下吸引剥离子分离双侧鼻中隔穿孔周围及鼻底黏膜,游离并取出下鼻甲前端骨质,使下鼻甲内、外侧黏膜向鼻底展开,形成双侧鼻中隔-鼻底-下鼻甲复合黏膜瓣,将残留的鼻中隔软骨或筛骨垂直板,部分或完全离断并推移封堵穿孔,将双侧鼻中隔-鼻底-下鼻甲复合黏膜瓣向上、向内牵拉并完全封堵穿孔,用6-0可吸收线将双侧鼻中隔-鼻底-下鼻甲黏膜瓣分别与穿孔上缘黏骨膜对位缝合。结果 8例鼻中隔大穿孔病例均I期愈合,术后随访6～12个月未发生再穿孔。结论该手术方式取材方便、范围广、复合黏膜瓣张力小、血运好、无供体反应、功能恢复好,是治疗鼻中隔大穿孔行之有效的方法之一。

Clinical Research on Repair of Nasal Septum Perforation with Composite Mucosal Flap

Objective To explore the effect of nasal floor,septum and inferior turbinate composite mucosal flap in the repair of nasal septum perforation guided by nasal endoscope.Methods From June 2008 to June 2011,8 patients with nasal septum perforation treated in our hospital were enrolled in this study.Patients were in supine position.After local anesthesia,we cut the front edge of perforation of nasal septum,nasal floor,and the front end of inferior turbinate mucosa in turn.The nasal floor,septum and inferior turbinate composite mucosal flap were made by using detacher with suction tube under the nasal endoscope.The nasal septum perforation was repaired with the composite mucosal flap.The mucoperiosteal of the upper edge of perforations and the composite mucosal flap were sewed up with 6-0 absorbable suture.Results The nasal septum perforation in all 8 cases were with primary healing.There was no re-perforation cases showed by the 6 to 12 months follow up.Conclusion The operation mode is one of the effective methods in treatment of nasal septum perforation with the advantages of easy sampling,wide range,little tension of the composite mucosal flap,good blood circulation,without rejection reactions.