鼻中隔穿孔57例临床分析

Clinical analysis of nasal septal perforation

目的分析鼻中隔穿孔的原因、部位和大小。方法收集57例鼻中隔穿孔患者的临床资料。以四方软骨与筛骨垂直板的交界线将鼻中隔分为前部和后部。根据穿孔大小将鼻中隔穿孔分为大(>2 cm)、中(1～2 cm)、小穿孔(<1 cm)。结果 57例鼻中隔穿孔患者中,因传统鼻中隔偏曲矫正术引起33例,其中前部穿孔30例,后部穿孔3例;小穿孔8例,中等穿孔15例,大穿孔10例。原发性因素(未知因素)引起7例,均为前部穿孔,其中小穿孔1例,中等穿孔4例,大穿孔2例。创伤引起5例,其中前部穿孔3例,后部穿孔2例;中等穿孔3例,大穿孔2例。化疗引起5例,其中前部穿孔2例,后部穿孔3例;小穿孔1例,中等穿孔3例,大穿孔1例。感染引起5例,均为前部穿孔;其中小穿孔2例,中等穿孔2例,大穿孔1例。肿瘤侵犯引起2例,均为后部穿孔及中等穿孔。结论传统鼻中隔偏曲矫正术是鼻中隔穿孔的主要原因,其部位以前部多见,大多为中等穿孔。

Objective To briefly review the clinical characteristics including the causes, positions, and sizes of nasal septal perforations. Methods Clinical data of 57 patients with nasal septal perforation was analyzed retrospectively. Nasal septum was divided into anterior portion and posterior portion by the border line between the quadrilateral cartilage and the perpendicular plate of the ethmoid. According to their maximal diameters, the perforations were classified into small （ 〈 1 cm ） , moderate （ 1 - 2 cm ） and large （ 〉 2 cm ） perforations. Results Ofall the 57 cases, perforations were induced by conventional nasal septoplasty in 33 cases including 30 of anterior portion and 3 of posterior. As for the size of perforation, the case number of small, moderate, and large type was 8, 15, and 10 respectively. Idiopathic factors （ unknown factors ） caused perforation of anterior portion in 7 cases with the case number of 1 , 4 and 2 of small, moderate and large type. Trauma induced perforation in 5 cases including 3 of anterior portion and 2 of the posterior, the case number of moderate and large type was 3 and 2. Chemotherapy induced perforation in 5 cases, the perforation located at anterior portion in 2 cases and at posterior in 3 with the case number of small, moderate, and large type of 1 , 3 , and 1. Perforations were induced by infection in 5 cases, all at anterior portion, and the case number of small, moderate and large type was 2, 2 and 1 respectively. Tumor invasion induced perforation in 2 cases, both located at posterior portion and were moderate type. Conclusions Surgical trauma during septoplasty is the major risk factor of nasal septal perforation featuring as moderate perforation at anterior portion of nasal septum.