再次鼻中隔矫正术

Revision of submucous resection of nasal septum

目的 探讨鼻中隔矫正术失败而再次手术的技术方法。方法 对1992-2004年鼻中隔矫正术失败的32例患者进行鼻科检查，根据患者鼻中隔偏曲的部位、程度，原有软骨及骨质的残留状况和患者年龄，我们采用3种不同的手术切口（径路）进行矫正：①对5例鼻中隔前端偏曲，1例低位偏曲和14例高位偏曲的患者采用鼻中隔前端“U”形切口；②对8例鼻中隔后端偏曲和2例高位偏曲患者，在偏曲部位的前方作纵向切口，并辅助鼻内镜进行矫正；③对2例鼻中隔前端低位偏曲的青少年患者采用唇龈沟正中横切口，向上揭翻，辅助耳科电钻进行手术。结果 32例患者均获满意矫正，鼻中隔偏曲引起的临床症状消失或明显改善。随访6～36个月，无一例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论 鼻中隔偏曲再次矫正术需针对不同的临床特点选择正确的手术方法，可获满意效果。

Objective To explore the clinical significance and surgical technique for revisionary submucous resection of nasal septum. Methods Thirty-two patients who had undergone nasal septal resection were evaluated rhinologically and the causes of unsuccessful septolasty were analysed . Based on the location and extent of deviation, the status of residual cartilage and bone, and the age of the patients, one of three incisions was choosen during septal surgeries： （1） For 5 cases with anterior , 1 with inferior and 14 with superior deviation, a ＂U＂ shaped incision at the left side of anterior edge of septum cartilage was used. （2）For 8 cases with posterior and 2 with superior deviation, the site of the incision was located just anterior to the deviation, with the aid of endoscope. （3）For 2 cases with anteroinferior deviation, because of their young age, a sublabial incision was made to surge the mucosa of the septum and base of nasal cavity, the otological electronic drill was then used. Results Revision nasal septolasty was successful in all cases. The symptoms resulting from septal deviation disappeared or significantly relieved. Following successful revision surgery, the treatment outcomes of concomitant nasal and/or sinusal diseases also significantly improved. Conclusion Revision nasal septolasty requires different approaches depending on different clinical characteristics. A successful correction of septal deviation can not only relieve the symptoms derived from deviation, but also be of significance for the treatment of concomitant nasal and/or sinusal diseases.