治疗慢性肥厚性鼻炎三种手术方式疗效观察

The Observation of Curative Effect of Three Surgical Methods to Cure Chronic Hypertrophic Rhinitis

目的:探讨治疗慢性肥厚性鼻炎三种手术方式的疗效。方法:临床确诊为慢性肥厚性鼻炎患者90例,按照随机数字表法分成3组进行治疗。A组30例行下鼻甲去骨及黏膜划痕微创减容术治疗,B组30例行下鼻甲黏膜下低温等离子消融术,C组30例行下鼻甲部分切除术,术后观察6个月临床效果、术后并发症并进行比较分析,以及进行糖精试验,对比术后3、6个月鼻腔黏膜纤毛功能。结果:3种手术方式疗效比较差异均无统计学意义(P>0.05);手术并发症C组明显高于A、B组(P<0.05);A、B组术后3、6个月MTR分别与术前比较无明显变化(P>0.05),而C组分别较术前明显减慢(P<0.01)。与A、B组相比,C组术后3个月、6个月MTR均减慢(P<0.01)。结论:三种手术方式治疗慢性肥厚性鼻炎均效果明显,下鼻甲去骨及黏膜划痕微创减容术、下鼻甲黏膜下低温等离子消融术并发症少,术后保留了鼻黏膜功能,符合临床生理功能,值得推荐。而下鼻甲部分切除术破坏性大,并发症发生率高,鼻腔黏膜功能破坏较大,不符合鼻腔生理功能,应谨慎选择。

Objective：To discuss the curative effect of three surgical methods about cure chronic hypertrophic rhinitis.Method：90 patients with the clinical diagnosis of chronic hypertrophic rhinitis were randomly divided into three groups. Group A of 30 patients accepted the inferior turbinate boning and mucosa scratches minimally invasive volume reduction surgery.Group B of 30 patients accepted the submucosal hypothermia plasma ablation of the inferior turbinate. Group C of 30 patients accepted the operation of partial inferior turbinectomy. For a comparative analysis, they were observed for 6 months for clinical results and postoperative complications after operation. Then the saccharin test was carried out. The nasal mucociliary function at 3 months after operation and 6 months after operation were compared.Result： The difference of the curative effect of three surgical methods was not statistically significant（P〉0.05）.The occurrence rate of operative complication of group C was significantly higher than group A and group B（P〈0.05）.The mucociliary transport rate（MTR） of group A and group B, before the operation and 3 months after operation and 6 months after operation had no obviously changes（P〉0.05）,but the MTR of group C was obviously slower than preoperation（P〈0.01）.Compared to group A and group B respectively, the MTR of group C was slower than 3 months after operation and 6 months after operation（P〈0.01）. Conclusion：The three surgical methods to cure chronic hypertrophic rhinitis are effective. The inferior turbinate boning and mucosa scratches minimally invasive volume reduction surgery and the submucosal hypothermia plasma ablation of the inferior turbinate have fewer complications, which keeps the function of nasal mucosa and is consistent with clinical physiological function, so they are recommended.The occurrence rate of operative complication is high and the damage to the function of nasal mucosa is great, which is not consistent with the physiological function of nasal cavity, so one should choose carefully.