鼻内镜下鼻中隔矫正术中对下鼻甲处理的策略

Strategies on treatment of inferior turbinate during the endoscopic nasal septal construction

目的探讨鼻内镜下鼻中隔矫正术中对下鼻甲处理的临床策略。方法通过62例鼻中隔偏曲合并下鼻甲肥大患者的临床资料,通过视觉模拟量表(visualanalogue scale,VAS)评分对症状进行评分,根据下鼻甲不同特点术中予以不同处理,并分析其手术前后症状改善情况。结果 62例鼻中隔偏曲合并下鼻甲肥大者,根据术前鼻内镜观察及鼻部CT结果确定:下鼻甲黏膜性增生28例,下鼻甲骨性增生的34例;对于28例下鼻甲黏膜性增生者给予低温等离子射频消融术,对于34例下鼻甲骨性增生者行下鼻甲外移术18例,行下鼻甲黏膜下部分切除术者16例,术后随访3～6个月,并定期门诊复查鼻内镜,与术前相比鼻塞症状消失者22例,改善者33例,无效者7例。有效率(症状消失者+改善者)为88.71%,差异有统计学意义(t=12.452,P<0.01)。结论鼻内镜下鼻中隔矫正术中对下鼻甲处理要根据下鼻甲增生的具体情况,做不同的处理,方可有效解决鼻塞症状。

OBJECTIVE To study the strategies on treatments of inferior turbinate during the endoscopic nasal septal construction.METHODS Clinical data of 62 patients with nasal septum deviation and inferior turbinate hypertrophy were analyzed,three kinds of operation were used according to the specific characteristics of different patients,and subjective symptoms were graded,using visual analogue scales（VAS method）before and after operations respectively.RESULTS According to the endoscopy and CT scans,all 64 patients had septum deviation,among which 28 patients were accompanied with mucosal hyperplasia of inferior turbinate and the other 34 patients with bony hyperplasia.The 28 patients with inferior turbinate mucosal hyperplasia accepted lowtemperature radiofrequency ablation.In the patients with bony hyperplasia,eighteen patients accepted inferior turbinate relocation and 16 patients accepted submucosal resection of inferior turbinate.After follow up for 3 to 6 months,symptoms were released in 22 cases,improved in 33 cases,and 7 cases had no effect.The effective rate was 88.71%,and there was a significant difference（t=12.452,P0.01）.CONCLUSION During the endoscopic septoplasty surgery,the treatment of inferior turbinate hyperplasia should be based on the different pathologic changes.