鼻内镜术后鼻腔粘连的处理——附42临床分析

Nasal Endoscopy of Postoperative Nasal Cavity Adhesion Treatment——42 Cases Clinical Analysis

目的探讨鼻内镜术后鼻腔粘连发生的原因及相应的治疗处理方法，从而进一步降低鼻内镜手术带来的副作用。方法对2009年4月～2012年2月收治的鼻内镜手术患者316例（527侧），术中、术后处理进行比较，回顾性分析鼻腔粘连的原因并对处理方法进行比较。结果术后1个月门诊复诊时发现鼻腔粘连47侧，鼻内镜下检查示鼻窦炎患者筛窦腔粘膜粘连16侧，中鼻甲与鼻腔外侧壁粘连13侧，中鼻甲与鼻中隔粘连6侧，合并鼻中隔矫正患者下鼻甲与鼻中隔粘连12侧。进行相应处理后3个月、6个月后复诊，仍有鼻腔粘连6侧，其中筛窦腔粘膜粘连3侧，中鼻甲与鼻腔外侧壁粘连2侧，下鼻甲与鼻中隔粘连1侧。结论术前抗炎治疗效果、术中鼻腔异常结构处理、术后鼻腔换药及冲洗不及时和粘连后处理方法不当，是造成鼻腔粘连的主要原因。针对病因采取预防及有效治疗是减少鼻内镜术后鼻腔粘连的解决办法。

Objective To analyze cause and treatment of nasal adhesion after nasal endoscope surgery, then decrease side effects of endoscope surgery. Methods A retrospective analysis was applied to summarize causes of nasal adhesion and compare effect of different treatments in 316 patients （527 sides） undergoing nasal endoscope surgery from April, 2009 to February, 2012 before and after surgery. Results 1 month after surgery, 47 sides were found with nasal adhe- sion, including 16 sides in ethmoid mucosa, 13 sides in middle turbinate and lateral nasal -wall, 6sides in middle turbi- nate and nasal septum, 12 sides in inferior turbinate and nasal septum after endoscopic nasal septal reconstruction. 3 months or 6 months after treatment, nasal adhesion was located in in ethmoid mucosa in 2 sides, middle turbinate and nasal septum in 6 sides and inferior turbinate and nasal septum in 1 sides. Conclusions Inefficient preoperative anti - inflammatory therapy, intraoperative nasal anatomy reconstruction, postoperative dressing and unappropriate treatment after nasal adhesion were major causes for nasal adhesion. Avoiding causes and effective treatments could reduce the incidence of nasal adhesion.