改良切口的鼻中隔成形术疗效观察  

Modified Killian incision for nasal septoplasty

作　　者：李杰恩[1] 唐臻臻 王扬[1] 刘金兰[1] 姚东方[1] 周永[1] 黎木兰[1] 杨颖 陆升[3] 

机构地区：[1]广西医科大学第一附属医院耳鼻咽喉头颈外科,广西南宁530021 [2]运城耳鼻喉医院耳鼻咽喉科,山西运城044000 [3]解放军303医院耳鼻咽喉科,广西南宁530021

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第1期38-42,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：广西壮族自治区卫计委资助项目(Z2013108)

摘　　要：目的观察改良切口的鼻中隔成形术的可行性及疗效。方法选择2009年2月-2013年6月382例鼻中隔偏曲患者,其中单纯鼻中隔偏曲295例,合并慢性鼻鼻窦炎/鼻息肉87例。改良切口与传统Killian切口不同,改良的手术切口位于鼻中隔软骨前方。所有患者均行改良切口的鼻中隔成形术。对合并下鼻甲肥大患者同期行下鼻甲成形术（下鼻甲骨折外移术或下鼻甲黏骨膜下切除术）;合并慢性鼻-鼻窦炎/鼻息肉患者先行鼻内镜下改良切口的鼻中隔成形术后再同期行鼻窦手术。结果 382例鼻中隔偏曲患者行改良切口的鼻中隔成形术手术时间为8-35 min,中位手术时间20 min;术中出血量10-80 ml,中位出血量为30 ml;鼻中隔成形术后随访6-12个月,鼻中隔偏曲矫正良好,临床症状明显改善,无鼻中隔穿孔、鼻中隔血肿、鞍鼻或鼻腔粘连等并发症发生。结论改良切口的鼻中隔成形术保留了较完整的鼻中隔支架,手术方法简便,术中鼻中隔黏膜张力小,术野清楚,具有创伤小、出血少及手术时间短的优点,能安全有效地矫正鼻中隔偏曲,是一种微创手术的新方法。Objective To explore the feasibility and effectiveness of modified Killian incision for nasal septoplasty.Methods From Feb 2009 to June 2013,nasal septoplasty with modified incision was conducted to 382 cases with nasal septum deviation. Of them,295 cases suffered from simple septum deviation,and 87 suffered from septum deviation with chronic sinusitis / nasal polyps. Different from Killian incision,the modified incision was located in front of the nasal septum cartilage. All 382 patients received nasal septoplasty via modified Killian incision. Meanwhile, the patients with hypertrophy of inferior turbinate were treated with inferior turbinotomy（ fracture displacement or submucous resection of inferior turbinate） and those with chronic sinusitis / nasal polyps received functional endoscopy sinus surgery. Results The operation time ranged from 8 to 35 mins with a median time of 20 min. The amount of blood loss ranged from 10 to 80 ml with a median volume of 30 ml. All patients had been followed up for 6 to 12 months postoperatively. Deviation of nasal septum was corrected completely,nasal ventilation got improved in all the patients. No complications such as septum perforation,septum hematoma,saddle nose,or nasal adhesion occurred. Conclusion Modified Killian incision can provide a clear operative field and correct the septum deformity completely in septoplasty. With advantages of reserving cartilage frame of nasal septum,less injury and bleeding,short operative time and less complication,this incision is minimally invasive for septoplasty.

关 键 词：改良切口 鼻中隔 鼻中隔成形术 

分 类 号：R765.3[医药卫生—耳鼻咽喉科]