鼻内镜下鼻咽癌放疗性后鼻孔闭锁的手术治疗  

Transnasal endoscopic surgery of choanal atresia after radiotherapy for nasopharyngeal carcinoma

作　　者：曾亮[1] 叶菁[1] 罗五根[1] 江红群[1] Zeng Liang;Ye Jing;Luo Wugen;Jiang Hongqun(Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Nanchang Universty,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院耳鼻咽喉头颈外科,330006

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第6期599-603,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨鼻内镜下后鼻孔成形术治疗鼻咽癌放疗性后鼻孔闭锁的疗效。方法回顾性分析2011年1月至2018年12月南昌大学第一附属医院耳鼻咽喉头颈外科收治的19例后鼻孔闭锁患者,男性12例,女性7例,年龄33~59岁,既往有鼻咽癌放疗史,均经电子鼻咽镜及影像学检查确诊为后鼻孔闭锁。其中单侧闭锁3例,双侧闭锁16例,均为后鼻孔完全膜性闭锁。所有患者均在全身麻醉下接受鼻内镜下后鼻孔成形术,术中咬除鼻中隔后端部分犁骨,保留创面边缘正常黏膜,同时使用黏骨膜瓣进行修复。术后1周患者开始进行生理盐水鼻腔冲洗,定期鼻内镜下清理及观察。采用描述性统计学方法分析结果。结果随访观察1年后,通过电子鼻咽镜检查发现19例患者均未再发生后鼻孔闭锁,16例后鼻孔宽敞,3例缩窄(超过成形术后初始的50%)但通气正常。结论内镜下进行鼻咽癌放疗性后鼻孔闭锁的手术疗效肯定,术中用鼻中隔正常黏膜修复后鼻孔、鼻咽损伤黏膜,可避免后鼻孔再次闭锁。Objective To discuss the effect of endoscopic dilatation and plasty for choanal atresia after radiotherapy for nasopharyngeal carcinoma.Methods Nineteen patients with choanal atresia who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Nanchang University from Jan. 2011 to Dec. 2018 were reviewed, with 12 males and 7 females aging from 33 to 59 years old. All of the patients had a history of radiotherapy for nasopharyngeal carcinoma and were confirmed by electronic nasopharyngoscope and nasopharyngeal imaging. Among 19 patients, there were 3 cases of unilateral occlusion and 16 cases with bilateral atresia, and all of them were membranous atresia. All patients received the transnasal endoscopic surgery of resecting partial vomer bone while trying to keep normal mucosa tissues and using the septonasal mucoperiosteal flap to repair under general anesthesia. One week after operation, the patients were told to do physiological saline nasal irrigation and received regular clean and observation under endoscope. Descriptive statistical method was used to analyze the outcome.ResultsThe patients were followed up for 1 year postoperatively by electronic nasopharyngoscopic examination. There was no failure case in all the 19 patients including 16 patients with a wide choana and 3 patients had narrowing of the choana (<50%), with adequate and satisfactory airway.Conclusions Transnasal endoscopic surgery was an effective treatment for choanal atresia after radiotherapy for nasopharyngeal carcinoma. Application of septonasal mucoperiosteal flap for repairing nasal and nasopharyngeal mucosa would avoid recurrence.

关 键 词：后鼻孔闭锁 鼻咽癌 鼻内镜手术 鼻中隔黏骨膜瓣 

分 类 号：R739.63[医药卫生—肿瘤]