Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity
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摘要: 目的 分析鼻内镜辅助下鼻小柱入路同期鼻中隔偏曲及歪鼻畸形矫正手术的临床效果。方法 收集2016年1月—2019年6月在空军军医大学第一附属医院耳鼻咽喉头颈外科手术的33例鼻中隔偏曲伴歪鼻畸形患者的临床资料。所有患者均在全身麻醉下手术，采用鼻小柱倒“V”型切口暴露松解，并在鼻内镜辅助下切除偏曲的鼻中隔软骨及骨质，12例(36.4%)患者同时进行鼻骨和上颌骨额突的截骨术，13例(39.4%)患者使用自体的鼻中隔对鼻尖、鼻背及外鼻重新塑形。结果 随访18~60个月，患者对术后鼻功能满意30例(90.9%)，基本满意3例(9.1%)；对术后鼻外形满意23例(69.7%)，基本满意8例(24.2%)，不满意2例(6.1%)。所有患者术后均未出现鼻腔粘连、鼻中隔穿孔、鼻中隔血肿及鼻背塌陷等并发症。结论 鼻内镜辅助下鼻小柱入路同期鼻中隔偏曲及歪鼻畸形矫正手术，同期改善了鼻部畸形和鼻腔通气，实现了美容和功能的统一，同时减少了手术治疗的次数和费用，效果好，患者受益大。Abstract: Objective To analyze the clinical effect of nasal endoscope-assisted nasal columella approach in the correction of nasal septum deviation and crooked nose deformity.Methods The clinical data of 33 patients with deviation of nasal septum with crooked nose deformity in First Affiliate Hospital of Air Force Military Medical University from January 2016 to June 2019 were collected. All patients underwent surgery under general anesthesia. Nasal columella inverted "V" incision was used to expose and release. The deviated nasal septum cartilage and bone were removed with the assistance of nasal endoscope. Twelve(36.4%) patients underwent osteotomy of nasal bone and frontal process of maxilla at the same time, 13(39.4%) patients used autologous nasal septum to reshape the tip, back and external nose.Results During a follow-up of 18 months to 60 months, 30(90.9%) patients were satisfied with the improvement of postoperative nasal function, 3(9.1%) patients were basically satisfied; 23(69.7%) patients were satisfied with the appearance of the nose after operation, 8(24.2%) patients were basically satisfied, and 2(6.1%) patients were dissatisfied. No postoperative complications such as nasal adhesion, nasal septum perforation, nasal septum hematoma and nasal dorsal collapse occurred in all patients.Conclusion The nasal endoscope-assisted nasal columella approach and the correction of nasal septum deviation and crooked nose deformity can solve the nasal deformity and nasal ventilation function at the same time, realize the unity of cosmetology and function, and reduce the frequency and cost of surgical treatment at the same time. The effect is good, and the patients benefit greatly.
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表 1 手术前后症状VAS评分
M(IQR) 术前 术后 Z P 鼻塞 6(4，8) 0(0，2) -4.646 0.000 流涕 0(0，3) 0(0，1) -2.555 0.011 嗅觉减退 0(0，0) 0(0，0) -1.000 0.317 面部疼痛或压迫感 0(0，0) 0(0，0) 0.000 1.000 总体症状 5(0，6) 0(0，1) -4.308 0.000 
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表 2 手术前后SNOT-20评分
M(IQR) 术前 术后 Z P 需要擤鼻 0(0，1) 0(0，0.5) -2.392 0.017 喷嚏 0(0，0.5) 0(0，0) -1.414 0.157 流鼻涕 0(0，1) 0(0，0.5) -2.232 0.026 咳嗽 0(0，0) 0(0，0) 0.000 1 鼻后滴流 0(0，0) 0(0，0) -1.000 0.317 浊涕 0(0，0) 0(0，0) -1.000 0.317 耳闷胀感 0(0，0) 0(0，0) 0.000 1.000 眩晕 0(0，0) 0(0，0) 0.000 1.000 耳痛 0(0，0) 0(0，0) 0.000 1.000 颜面部疼痛/胀满感 0(0，0) 0(0，0) 0.000 1.000 入睡困难 0(0，0) 0(0，0) 0.000 1.000 夜间易醒 0(0，0) 0(0，0) 0.000 1.000 睡眠质量差 0(0，0) 0(0，0) 0.000 1.000 醒来时疲倦 0(0，0) 0(0，0) 0.000 1.000 疲劳 0(0，0) 0(0，0) 0.000 1.000 工作能力下降 0(0，0) 0(0，0) 0.000 1.000 注意力下降 0(0，0) 0(0，0) 0.000 1.000 失落感/坐立不安/易怒 0(0，0) 0(0，0) 0.000 1.000 情绪低落 0(0，0) 0(0，0) 0.000 1.000 窘迫感 0(0，0) 0(0，0) 0.000 1.000
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