鼻内镜下自体颞肌筋膜包裹筛骨垂直板修补鼻中隔穿孔疗效观察  

Effect of temporal fascia wrapping ethmoid perpendicular plate on repair of nasal septal perforation through endoscopic surgery

作　　者：庞伟[1] 

机构地区：[1]天津市第二医院耳鼻喉科,300141

出　　处：《天津医药》2015年第6期656-658,I0004,共4页Tianjin Medical Journal

基　　金：天津市科技基金资助项目(2010kz14)

摘　　要：目的：观察鼻内镜下应用自体颞肌筋膜包裹筛骨垂直板修补鼻中隔穿孔的手术疗效。方法回顾性分析50例鼻中隔穿孔患者的资料，其中传统术式组30例，三明治式组20例。所有患者术前均行鼻内镜及鼻窦CT检查，并行鼻腔冲洗治疗改善鼻腔黏膜状况。传统术式组行鼻中隔穿孔前切口，分离中隔黏膜移位修补穿孔；三明治式组行耳后颞肌附着处皮肤切口切取2倍以上穿孔直径的颞肌筋膜，行鼻中隔前端切口，分离鼻中隔黏软骨膜至穿孔四周，并在穿孔四周制作新鲜创面，以颞肌筋膜包裹自体筛骨垂直板形成硬性支撑“三明治”式修补物嵌插入黏软骨膜下封闭鼻中隔穿孔；术后均予抗感染及鼻腔保湿治疗。记录术后症状恢复情况及随访结果。结果三明治式组术中的出血量（mL：3.6±1.2 vs 13.4±2.9）、手术时间（min：25.2±6.3 vs 46.5±10.3）、损伤黏膜范围（mm2：10.2±3.2 vs 20.5±5.3）及术后黏膜修复时间（d：19.5±3.9 vs 30.2±3.1）均小于传统术式组（P＜0.05）；三明治式组的修补成功率高于传统术式组（90.00%vs 46.67%,χ2=9.780，P＜0.01）；随访6个月～1年，均未见穿孔复发。结论鼻内镜下应用颞肌筋膜包裹自体筛骨垂直板，形成硬性支撑“三明治”式修补物封闭修补鼻中隔穿孔，可以恢复正常解剖结构的鼻中隔，疗效肯定。Objective To observe therapeutic effect of repairing nasal septum perforation with auto temporal fascia wrapping ethmoid perpendicular plate through endoscopic surgery. Methods Retrospective analysis of 50 cases of nasal septum perforation patient, among whom 30 cases were repaired by traditional surgery and 20 cases were repaired by sand-wich surgery. All patients were examine by CT scan and nasal irrigation therapy were also performed through nasal endosco-py to improves nasal mucosa situation. Endoscopic procedures were performed in the traditional surgical group under local anesthesia, and septum mucosa was separated and shifted to repair septal perforation. On the other hand, temporal fascia of more than 2 times the diameter of the perforation were isolated then, wrapped around the perforation through front line of na-sal incision after separating membrane of the nasal septum cartilage. Now,temporal fascia wrapping autologous ethmoid per-pendicular plates form a rigid vertical＆quot;sandwich prosthesis＆quot;and were inserted into perichondrium of septal to repair perfora-tion. Anti-infection and nasal moisturizing treatment were given after operation. Postoperative symptoms and the perfor-mance in follow-ups were recorded. Results Intraoperative blood loss （mL：3.6±1.2 vs 13.4±2.9）, operative time （min：25.2± 6.3 vs 46.5 ±10.3）, mucosal damage range （mm2：10.2±3.2 vs 20.5±5.3） and mucosal repair time postoperation （d：19.5±3.9 vs 30.2±3.1） were all less in sandwich group than those in traditional group （P〈0.05）. Successful rate in sandwich group is also higher than that in the traditional surgical group （90.00%vs 46.67%, χ2=9.780, P〈0.01） . No recurrence was found during follow-up from 6 months to 1 year in both groups. Conclusion Application of autologous temporalis fascia wrapping per-pendicular plate of ethmoid bone to form a rigid＆quot;sandwich prosthesis＆quot;to repair nasal septal perforation by endoscopic sur-gery were effective. It can restore the norma

关 键 词：鼻中隔穿孔 鼻内镜手术 颞肌筋膜 筛骨垂直板 

分 类 号：R765.34[医药卫生—耳鼻咽喉科]