面掀翻及改良半面掀翻联合鼻内镜技术在鼻科手术中的应用

The clinical use of midfacial degloving and modified hemifacial degloving approach associated with nasal endoscopy surgery in nasal surgery

目的：探讨面中部掀翻及改良半面掀翻径路鼻内镜辅助治疗鼻科疾病的方法和疗效。方法：30例患者，采用面中部掀翻术4例，半面掀翻术3例，改良术式23例。改良术式采用以患侧为主的上颌窦根治术切口，不作鼻小柱贯通切口，先完整剥离健侧的鼻中隔皮肤、黏软骨膜和骨膜及鼻底黏骨膜，不作健侧前庭切口，保留健侧鼻腔软组织结构的完整性，再作鼻中隔软骨及患侧皮肤、黏软骨膜切口与鼻前庭弧形切口，掀翻患侧半面中部软组织并联合鼻内镜切除病变。结果：所有创口一期愈合。随访6个月～3年，4例面中部掀翻术后鼻前庭狭窄1例；3例半面掀翻术中鼻中隔穿孔1例；改良术式联合鼻内镜23例无并发鼻前庭狭窄和鼻中隔穿孔等症。结论：面中部掀翻及改良半面掀翻径路联合鼻内镜，术野暴露充分，面部不留瘢痕，手术操作方便、安全；改良术式健侧鼻腔术后不必填塞，无鼻前庭狭窄等并发症发生。

Objective：To explore the method and effect of the midfacial degloving approach and modified hemifacial degloving approach associated with nasal endoscopic surgery in the treatment of the nasal diseases. Method： Thirty patients with nasal diseases were treated with nasal endoscopic surgery by midfacial degloving approach and modified hemifacial degloving approach. Four cases underwent midfacial degloving approach with standard method, three cases were underwent by hemifacial degloving approach and our modified hemifacial degloving approach associated with nasal endoscopic surgery were performed in twenty-three cases. We used Caldwell-Luc＇s approaches which located mainly in affected-side, and modified bilateral intercartilaginous incision,which at first peeled off integralitily healthy- side cutis and mucosa of nasal septum as well as periosteum of basis nasi . With preserving the integrality of the healthy- side nasal cavity parenchyma, the pyriform aperture incisions extending to the healthy-side vestibule wasn＇t been cut. With the incisions of septal cartilage of nasal and disease- side cutis and mucosa of nasal septum as well as the pyriform aperture incisions extending to the affected-side vestibule, the lesion were cleared away completely by modified midfacial degloving approach associated with nasal endoscopic surgery. Result： All cases cuts achieved primary healing. One of four cases with midfacial degloving approach suffered from straitness of nasal vestibule. One of three cases with hemifacial degloving approach was led to perforation of nasal septurn. In 23 cases operated by modified hemifacial degloving approach, no straitness of nasal vestibule and no perforation of nasal septum was happened. Conclusion：The midfacial degloving approach and modified hemifacial degloving associated with endoscopic surgery can achieve the advantages of a widely exposed field for operation ,no facial scar,making tumour resection easier,and also no nasal- stuffed in healthy nasal cavity as well as no straitness of nasal vestibule after modified approach.