中鼻甲的处理在鼻内窦镜手术中的应用分析

The application analysis of middle turbinates processing for intranasal sinus arthroscopic surgery

目的探讨鼻内窥镜手术中的中鼻甲处理技巧和意义。方法对两组共计80例慢性鼻窦炎、鼻息肉病例予以前瞻性和回顾性调查分析，分为观察组（32例39侧）和对照组（42例54侧），观察组强调中鼻甲的处理上尽可能保障中鼻甲空间结构和形态上的相对正常。对照组采用传统的Messerklinger术或wigand术式。对比术后6月以后中鼻甲稳定性，中鼻道狭窄或粘连的发生情况以及按lund-Kennedy内镜粘膜形态评分系统进行评价。结果两组患者的术前lund—Kennedy内镜粘膜形态评分差异无统计学意义（t=1．659，P〉0．05），观察组术后6月Lund—Kennedy评分（x±s，以下同）为（1．89±1．31）分，低于对照组的（2．48±1．42）分，差异有统计学意义（t=8．1，P〈O．01）。术后观察组中鼻甲结构良好稳定，中鼻甲轻度外移、中鼻道狭窄、中鼻甲与鼻腔外侧壁粘连三种情况的发生率分别为21．1％、4．1％、6．7％，对照组的发生率分别为44．9％、21．6％、10．3％，2组差异有统计学意义（x2=10．77，P〈0．01）。结论保障中鼻甲相对正常形态和空间结构有助于提高鼻内窥镜手术疗效，减少术后不良并发症。

Objective To investigate the skill and significance of middle turbinates processing for intranasal sinus arthroscopic surgery. Methods 80 cases of chronic sinusitis and nasal polyp patients received prospective and retrospective survey and analysis. They were divided into observation group （32 cases,39 sides） and control group（42 cases, 54 sides）o The patients in the observation group enchanced to protect the spatial structure and morphology of middle turbinate as much as possible during the middle turbinate processing, while the patients in control group received traditional Messerklinger or Wigand surgery. The stability of the middle turbinate, the stenosis or adhension occurrence of middle meatus,and the Lund-Kennedy endoscopic mucosal morphology scoring system evaluation between the two groups was compared after 6 months of the surgery. Results The Lund-Kennedy endoscopic mucosal morphology score between the two groups was not statistically significant（t： 1. 659, P^0.05） before the surgery. However, the Lund-Kennedy endoscopic mucosal morphology score of the observation group after 6 months oI the surgery was（1.89 ± 1.31）, which was much less than（2. 48± 1.42） of the control group. The diffrence between the two groups was statistically significant （t=8.1, P〈0.01）. The middle turbinate structure was stable of the observation group after the surgery. The occurrence of slight relocation, the middle meatus stenosis and adhension in the observation group were 21. 1%, 4. 1% and 6. 7% respectively, while the occurrence in the control group were 44.9% ,21.6% and 10.3% respectively. The diffrence between the two groups was statistically siginificant （x2= 10. 77, P 〈 0. 01 ）. Conclusion To retain the relatively normal morphology and spatial structure is helpful to miprove the clinical efficacy of the endoscopic sinus surgery, and decrease the postoperative complications after the surgery.