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分析

杨春, 石照辉, 王剑, 等. 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分析[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 723-727. doi: 10.13201/j.issn.2096-7993.2021.08.011
引用本文: 杨春, 石照辉, 王剑, 等. 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分析[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 723-727. doi: 10.13201/j.issn.2096-7993.2021.08.011
YANG Chun, SHI Zhaohui, WANG Jian, et al. Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity[J]. J Clin Otorhinolaryngol Head Neck Surg, 2021, 35(8): 723-727. doi: 10.13201/j.issn.2096-7993.2021.08.011
Citation: YANG Chun, SHI Zhaohui, WANG Jian, et al. Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity[J]. J Clin Otorhinolaryngol Head Neck Surg, 2021, 35(8): 723-727. doi: 10.13201/j.issn.2096-7993.2021.08.011

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分析

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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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  • 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。
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  • 图 1  歪鼻畸形的分类

    图 2  三种类型歪鼻畸形的CT表现

    图 3  倾斜型歪鼻畸形患者手术前(3a、3b、3c)及手术后1个月(3d、3e、3f)外鼻形态的比较

    图 4  歪鼻畸形合并单纯鼻中隔偏曲的鼻内镜表现

    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
    下载: 导出CSV

    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
    下载: 导出CSV
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出版历程
收稿日期:  2021-04-22
刊出日期:  2021-08-05

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