下鼻甲外移术与鼻通气功能改善的相关性研究

Relationship between inferior turbinate outfracture and the improvement of nasal ventilatory function

目的探讨下鼻甲外移术后鼻腔结构的变化与鼻通气功能改善的相关性。方法采用前瞻性研究设计，选取50例主诉为鼻塞，鼻内镜及CT检查表现为下鼻甲肥大的慢性肥厚性鼻炎患者，行下鼻甲外移术。分别对患者术前术后行鼻内镜检查测得下鼻甲前缘黏膜至鼻中隔之间距离（简称DTNS）。CT检查测量冠状位筛漏斗中心层面双侧下鼻甲软组织内侧缘之间最小距离（简称MDTF）及双侧下鼻甲骨之间最小距离（简称MDTB）；轴位鼻阈处下鼻甲黏膜之间最小距离（简称NLDT）以及下鼻甲厚度（简称11Tr），以评价手术前后鼻腔结构的变化。采用鼻声反射及鼻阻力对鼻腔通气功能进行客观评价。用视觉模拟量表（visualanaloguescale，VAS）对鼻塞进行评价。检查数据进行配对t检验、用Spearman秩相关评价手术前后患者双侧VAS评分与鼻吸气相有效阻力（简称IER）、鼻呼气相有效阻力（简称EER）及DTNS的关系；分析鼻吸气相总阻力、鼻呼气相总阻力与MDTY、MDTB之间的相关性。以SPSS20．0软件进行统计学分析。结果术前右侧DTNS、左侧DTNS、MDTr平均（X±S，下同）分别为（0．12±0．07）、（0．10±0．07）、（0．70±0．13）cm，术后分别为（0．47±0．27）、（0．43±0．15）、（1．05±0．15）cm，差异有统计学意义（t值分别为一8．827、一8．590、一17．525，P值均〈0．05）；MDTB、NLDT、右侧ITT、左侧ITT、IER、EER、0～5cm鼻腔容积、鼻腔最小截面积、右侧及左侧VAS手术前后比较，差异有统计学意义（t值分别为一23．562、一8．374、8．693、6．684、12．021、14．510、一6．074、一2．285、14．042、9．925，P值均〈0．05）；患者双侧VAS评分与IER、EER呈正相关趋势（左侧r值分别为0．541、0．660；右侧r值分别为0．940、0．688，P值均〈0．05），患者VAS评分与DTNS呈负相关（r=一0．861，P〈0．05）；鼻吸气相总阻力与MDTr、MDTB呈负相关趋势（r值分别为一0．565、一0．546，P值均〈0．05）；鼻呼气相总阻力与MDTr、MDTB呈负相关趋势（r值分别为一0．562、一0．546，P值均〈0．05）。结论下鼻甲外移术是拓宽鼻腔，改善鼻通气功能的有效手术方式。

Objective To discuss the relationship between structural change in nasal cavity and the change of nasal ventilatory function after ouffracture of the inferior turbinate. Methods The inferior turbinate outfracture surgery was performed on 50 chronic hypertrophic rhinitis patients who suffered inferior turbinate hypertrophy according to endoscopy and CT scan. Preoperative and postoperative nasal endoscopy was carried out on all patients, by which the distance from the inferior turbinate front mucous membrane to nasal septum （DTNS） was measured. In addition, CT was used to measure the minimal distance between the inside edges of the bilateral inferior turbinate soft tissue （MDTT） and the minimal distance between the bilateral inferior turbinate bones （MDTB） at the central layer of coronal sectional infundibulum; the minimal distance between the inferior turbinate at asial nasal limen （NLDT） ; inferior turbinate thickness （ITT）. In this way, the change in the structure of nasal cavity was evaluated. Acoustic rhinomctry and rhinomanometry were utilized to evaluate the ventilatory function of the nasal cavity objectively. Visual analogue scale （VAS） was applied to evaluate the severity of preoperative and postoperative nasal obstruction subiectively. The testdata were used to perform match t-test; Spearman rank correlation was adopted to evaluate the relationship between patients＇ bilateral VAS and nasal inspiratory effective resistance （IER）, nasal expiratory effective resistance （EER） and DTNS. The relationship between the total resistance of nasal inspiratory phase as well as the total resistance of nasal expiratory phase and MDT？ and MDTB was analyzed. SPSS 20. 0 software was used to analyze the data. Results The preoperative data showed that rightward DTNS was （0. 12 ± 0. 07） cm, leftward DTNS was （0. 10±0. 07） em and MDTr was （0. 70 ± 0. 13） cm, and postoperative data showed that rightward DTNS was （0.47 ± 0. 27 ） cm, leftward DTNS was （0.43±0. 15 ） cm, and MDTT was （ 1.05± 0. 15 ） cm. Significant differences existed in rightward DTNS, leftward DTNS and MDTT between pre-and post operative data （t values were - 8. 827, - 8. 590, - 17. 525, all P 〈 0. 05 ）. According to the preoperative and postoperative comparison, the difference in MDTB, NLDT, rightward ITT, leftward ITT, IER, EER, 0 -5 cm nasal cavity volume （0 -5 cm NCV） , nasal minimal cross-sectional area （NMCA）, rightward VAS and leftward VAS had statistical significance （t values were -23. 562, - 8. 374, 8. 693, 6. 684, 12. 021, 14. 510, - 6. 074, - 2. 285, 14. 042 and 9. 925, respectively, all P 〈 0. 05）. Patients＇ bilateral VAS grades had a positive relationship with IER and EER （left side： r values were 0. 541 and 0. 660, respectively, right side： r values were 0. 940 and 0. 688, respectively, all P 〈 0. 05）. Additionally,patients＇ VAS had a negative relationship with DTNS （r value was -0. 861, P 〈 0. 05）. Besides,the total resistance of nasal inspiratory phase had a negative relationship with both MDTT and MDTB （ r values were - 0. 565 and - 0. 546, respectively, all P 〈 0. 05 ）. The total resistance of nasal expiratory phase had a negative relationship with both MDTF and MDTB （ r values were - 0. 562 and - 0. 546, all P 〈 0. 05 ）. Conclusion The inferior turbinate ouffracture surgery was an ideal surgical method by which nasal cavity could be broadened and nasal ventilatory function improved.