鼻内镜下黏膜瓣技术联合全降解鼻窦药物支架修复儿童先天性后鼻孔闭锁的远期疗效及安全性观察  

Long-term efficacy and safety of endoscopic mucosal flap technology combined with fully degradable sinus drug stent for repair of congenital choanal atresia in children

作　　者：张薇 葛文彤[1] 唐力行[1] 杨小健[1] 韩阳[1] 肖潇[1] 陈晓旭 王蓬鹏[1] ZHANG Wei;GE Wentong;TANG Lixing;YANG Xiaojian;HAN Yang;XIAO Xiao;CHEN Xiaoxu;WANG Pengpeng(Department of Otolaryngology Head and Neck Surgery,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第2期40-45,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家呼吸系统疾病临床医学研究中心呼吸专项(HXZX-20210501);北京市科学技术委员会、首都临床诊疗技术研究及转化应用(Z20100005520084)。

摘　　要：目的 探讨鼻内镜下后鼻孔闭锁术中黏膜瓣制作联合全降解鼻窦药物支架治疗儿童先天性后鼻孔闭锁的的远期临床疗效、安全性、以及对患儿生长发育的影响。方法 回顾性分析了首都医科大学附属北京儿童医院2018年1月—2021年2月诊治的28例确诊为先天性后鼻孔闭锁的患儿。所有患儿均采用鼻内镜下黏膜瓣技术结合全降解鼻窦药物支架系统,支架系统的指示线固定于外鼻至自行脱落。术后定期随访。记录指示线脱落时间,支架完全吸收时间,鼻塞改善情况,电子鼻咽镜了解术后鼻腔结构有无发育异常、后鼻孔成形情况、再狭窄率及并发症情况,并根据国家卫健委发布的《7岁以下儿童生长标准》WS/T423—2022评估患儿生长发育的情况。结果 所有患儿出院后1周电话问诊,鼻塞症状均已消失。支架系统的指示线脱落时间为(30.55±4.75)d。所有患儿均完成随访2~5年,随访1年内时,所有患儿均未发现与支架置入相关的并发症报道;术后随访1年以上,所有患儿复查内镜示后鼻孔成型效果稳定,未显示再狭窄。除3例综合征患儿身高、体重较同龄患儿较差,其余患儿术后2年生长发育曲线、身高体重均在正常同龄儿区间内,未发现鼻腔局部应用激素对患儿生长发育产生影响。结论 黏膜瓣的制作、骨性后鼻孔的扩大是儿童后鼻孔闭锁手术远期疗效保障的关键,术后全降解鼻窦药物支架的应用是避免短期局部并发症的关键,设置支架系统指示线是安全的辅助方式,临床观察未发现支架系统在鼻腔局部持续释放的小剂量激素对患儿生长发育产生远期影响。Objective To explore the long-term clinical efficacy,safety,and impact on the growth and development of children with congenital choanal atresia treated with mucosal flap fabrication combined with fully degradable sinus drug stent under nasal endoscope.Methods A retrospective analysis was conducted on 28 children diagnosed with congenital choanal atresia from January 2018 to February 2021 at Beijing Children’s Hospital Affiliated to Capital Medical University.All patients were treated with nasal endoscopic mucosal flap technology combined with a fully degradable sinus drug stent system,with the indicator line of the stent system set at the external nose to self shedding.Regwlar follow up after surgery.The indicator line shedding time,the stent full absorption time,and the improvement of nasal congestion were recorded.Electronic nasopharyngoscopy was performed to observe whether the nasal cavity structure was abnormal,the formation of the posterior nostril,the rate of restenosis,and the incidence of complications after surgery.The growth and development of the childen were evaluated according to the National Health Commission’s“Growth Standards for Children Under 7 Years”WS/T423-2022.Results One week after discharge,telephone consultations were conducted and the nasal congestion had disappeared in all patients.The average shedding time of the indicator line was 30.55±4.75 days,and all patients were followed up for 2 to 5 years.Short-term(within one year)follow-up revealed no complications related to stent placement in all patients.Long-term(more than one year)follow-up showed stable shaping effect of the posterior nostril without restenosis.Except for 3 cases with syndrome,the height and weight curves of the other children 2 years after surgery were within the normal range of peers,and no effect of local nasal hormone application was found on the growth and development of the children.Conclusions The preparation of mucosal flap and the expansion of bony choanae are the key to ensure the long-term efficacy

关 键 词：先天性后鼻孔闭锁 黏膜瓣技术 全降解鼻窦药物支架 儿童 

分 类 号：R765.8[医药卫生—耳鼻咽喉科]