Treatment of congenital bilateral choanal atresia by low temperature plasma ablation and fully degradable sinus drug stent: a case report
-
摘要: 探讨低温等离子消融术配合全降解鼻窦药物支架系统在膜性闭锁为主的先天性后鼻孔闭锁治疗中的应用。分析2023年4月收治的1例膜性双侧后鼻孔闭锁患儿，采用鼻内镜下低温等离子射频消融术的手术方式切除闭锁板，术后放置全降解鼻窦药物支架。患儿术后鼻通气明显改善，后鼻孔成形良好，未见手术并发症，随访8个月，成形的后鼻孔未见再狭窄或闭锁，术中放置的药物支架已完全降解消失。低温等离子消融术治疗膜性闭锁为主的先天性后鼻孔闭锁具有减少手术创伤、保护正常组织结构、避免手术并发症的优势，同时合并全降解鼻窦药物支架的应用，可减轻术区黏膜水肿，减少肉芽组织增生，加快术后创面黏膜化，从而有效降低鼻腔粘连、后鼻孔再狭窄，甚至闭锁的发生率，可获得较为满意的疗效。Abstract: To investigate the application of low temperature plasma ablation combined with fullly degradable sinus stent system in the treatment of congenital choanal atresia mainly menbranous atresia. A child with membranous bilateral choanal atresia admitted in April 2023 was analyzed. This case underwent endoscopic ablative posterior nostriplasty and placed a fully degradable drug stent in bilateral operative cavities. The case's nasal ventilation was effectively improved after operation and the profile of postnaris was well formed. No restenosis oratresia was found under electronic nasopharyngoscope and the drug stent was completely degraded after 8 months follow-up. Low temperature plasma ablation has the advantages of reducing surgical trauma, protecting normal tissue and avoiding complications in the treatment of congenital choanal atresia. At the same time, combined with the application of the fully degradable sinus drug stent, it can achieve remarkable efficacy by alleviating mucosal edema, reducing granulation tissue hyperplasia, accelerating wound mucosification, and effectively reducing the incidence of nasal adhesion, restenosis or even atresia.
-
-
[1] Marston AP, Patel T, Nguyen SA, et al. Short-term risk factor profile of pediatric choanal atresia repair using ACS-NSQIP national database[J]. Ann Otol Rhinol Laryngol, 2019, 128(9): 855-861. doi: 10.1177/0003489419848457
[2] van Schaik CGR, Paasch S, Albrecht T, et al. Treatment of choanal atresia in a cohort of 29 patients: Determinants for success or failure[J]. Int J Pediatr Otorhinolaryngol, 2022, 160: 111240. doi: 10.1016/j.ijporl.2022.111240
[3] ebová I, Vyrvová I, Barkociová J. Nasal cavity CT imaging contribution to the diagnosis and treatment of choanal atresia[J]. Medicina(Kaunas), 2021, 57(2): 93.
[4] 倪道凤, 陶泽章, 张秋航, 等. 译. 耳鼻咽喉头颈外科手术学[M]. 2版. 天津: 天津翻译出版公司, 2017: 27-32.
[5] Al-juboori AN, Al Hail A, Emam SS. Congenital bilateral adult choanal atresia: Transnasal endoscopic coblation assisted correction[J]. Otolaryngol Case Rep, 2022, 25: 100489. doi: 10.1016/j.xocr.2022.100489
[6] Wilcox LJ, Smith MM, de Alarcon A, et al. Use of steroid-eluting stents after endoscopic repair of choanal atresia: a case series with review[J]. Ann Otol Rhinol Laryngol, 2020, 129(10): 1003-1010. doi: 10.1177/0003489420928374
[7] 谢利生, 黄正华, 李琦, 等. 鼻内镜下后鼻孔重建术治疗46例先天性后鼻孔闭锁患儿的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(8): 742-745. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2019.08.014
[8] 娄凡, 明澄, 马静, 等. 低温等离子射频消融术治疗膜性闭锁为主的先天性后鼻孔闭锁临床分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(10): 595-597. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202010014.htm
[9] Hauser LJ, Turner JH, Chandra RK. Trends in the use of stents and drug-eluting stents in sinus surgery[J]. Otolaryngol Clin North Am, 2017, 50(3): 565-571. doi: 10.1016/j.otc.2017.01.007
[10] 娄凡, 明澄, 马静, 等. 全降解药物支架治疗先天性后鼻孔闭锁的疗效观察[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 27(2): 146-150. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY202102005.htm
[11] Moreddu E, Rizzi M, Adil E, et al. International Pediatric Otolaryngology Group(IPOG)consensus recommendations: Diagnosis, pre-operative, operative and post-operative pediatric choanal atresia care[J]. Int J Pediatr Otorhinolaryngol, 2019, 123: 151-155. doi: 10.1016/j.ijporl.2019.05.010
[12] 卫静娟, 马静, 娄凡, 等. 先天性后鼻孔闭锁的研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 27(1): 119-122. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY202101027.htm
-
下载:
计量
- 文章访问数: 176
- 施引文献: 0