双侧游离下鼻甲黏骨膜瓣联合同种异体鼻中隔四方软骨修补鼻中隔穿孔的临床研究

目的探讨应用双侧游离下鼻甲黏骨膜瓣联合同种异体鼻中隔四方软骨修补鼻中隔穿孔的效果。方法 2008年12月至2013年6月对深圳市石岩人民医院收治的21例鼻中隔穿孔患者进行研究,在鼻内镜下采用鼻中隔黏膜下矫正术的方法分离鼻中隔穿孔周围的黏软骨膜及骨膜,取左右鼻腔合适大小的下鼻甲黏骨膜瓣两片和同种异体鼻中隔四方软骨固定于鼻中隔黏软骨膜下,完全覆盖鼻中隔穿孔。结果术后4⁸周鼻腔黏膜上皮完全覆盖穿孔,15例鼻中隔穿孔Ⅰ期愈合,其余6例Ⅱ期愈合,鼻中隔基本平直,双侧鼻腔通气良好。随访68周鼻腔黏膜上皮完全覆盖穿孔,15例鼻中隔穿孔Ⅰ期愈合,其余6例Ⅱ期愈合,鼻中隔基本平直,双侧鼻腔通气良好。随访6¹8个月,鼻中隔未见再穿孔。结论鼻内镜下双侧游离下鼻甲黏骨膜瓣联合同种异体鼻中隔四方软骨修补鼻中隔穿孔,减少对患者的损伤,取材方便,未见排异现象,无不良反应,成活率高;操作简单易行。

Clinical Research on the Repair of Nasal Septum Perforation by Mucous Membrane and Periosteum Flap from Bilateral Free Inferior Turbinate Combined with Homogeneity Variant Quadratic Carti. lage of Nasal Septum

Objective To explore the effect of using bilateral free inferior turbinate combined with homogeneity variant quadratic cartilage of nasal septum to repair nasal septum perforation. Methods A total of 21 patients with nasal septum perforation admitted in Shiyan People＇s Hospital from Dec. 2008 to Jun. 2013 were treated with diorthosis under nasal septum mucosa to separate mucosal periosteum and perichondrium around nasal septum perforation under endoscope, two slices of mucous membrane and periosteum flap of suitable size from inferior turbinate and homogeneity variant quadratic cartilage of nasal septum were taken and fixed under mucosal periosteum and perichondrium of nasal septum to cover the septum perforation nasal completely. Results Perforation were covered completely by nasal mucosa epithelium 4-8 weeks after treat- ment, 15 patients of nasal septum perforation were healed in phase Ⅰ, the remaining 6 patients were healed in phase Ⅱ , the nasal septa of the patients flatted basically, and their bilateral nasal ventilation was good. Nasal septum perforation did not occur in the following 6-18 months. Conclusion The repair of nasal septum perforation by mucous membrane and periosteum flap from bilateral free inferior turbinate combined with homogeneity variant quadratic cartilage of nasal septum under endoscope has the advantages of less lesions to the patients, easily-obtained material, no transplant reaction and adverse reaction observed, high survival rate, and easily operated.