鼻内镜下鼻中隔后缘前移在放射性后鼻孔闭锁成形术中的应用

Application of Endoscopic Posterior Edge of Nasal Septum Antedisplacement in Radiotherapeatical Choanal Atresia

目的探讨后鼻孔成形术的手术治疗方法,减少再闭锁及狭窄的形成。方法对11例放射性后鼻孔闭锁患者在鼻内镜下行后鼻孔成形术,术中行鼻中隔后缘前移,粘膜瓣修复创面,止血纱块及膨胀海绵后鼻孔填塞。结果术后粘膜瓣生长良好,创面光整,随访两年,11例患者均鼻腔通气良好,无鼻塞流涕症状,鼻内镜检查患者见后鼻孔光整,无粘连及再狭窄。结论鼻中隔后缘前移在后鼻孔成形中扩大了闭锁的后鼻孔空间,使后鼻孔外侧壁与鼻中隔后缘不在同一矢状面,增加了创缘间距,减少了再粘连的形成;同时闭锁组织切除后,创面用粘膜瓣覆盖,减少创面间瘢痕的形成及粘连。

Objective To discuss the surgical approaches of choanal angioplasty, decrease formation of narrow and re-atresia. Methods 11 cases of radiotherapeatical choanal atresia patients received the choanal angioplasty under nasal endoscopy. Posterior edge of nasal septum antedisplacement, wounds repaired with mucosal disc, hemostatic gauze and packing choana with merocel were taken in the operation. Results After surgery, mucosal disc grew well, with skinpassed wound surface. With the follow-up for two years, all of the patients had good ventilation with no narrow, sear hyperplasia or adhesion. Conclusions The method enlarges the space of the eatresia choanal, decreases adhesion; the use of mucosa flap decreases the scar hyperplasia and adhesion.