下鼻甲黏膜下海绵体组织部分切除术的临床研究

Clinical research of submucosal partial resection of the inferior turbinate

目的探讨运用下鼻甲黏膜下海绵体组织部分切除术治疗下鼻甲黏膜肥厚的慢性肥厚性鼻炎的优缺点和并发症。方法 选取2013年5月~2015年5月在中山市陈星海医院住院的下鼻甲黏膜肥厚的慢性肥厚性鼻炎患者56例作为研究对象,按随机数字表法将患者分为观察组和对照组。观察组28例行鼻内镜下鼻甲黏膜下海绵体组织部分切除手术治疗,对照组28例行鼻内镜下传统的下鼻甲部分切除术治疗。随访6个月,分别于术前和术后1周、1个月、6个月运用视觉模拟评分（VAS）评价两组术后鼻阻力,并在术前、术后2周、术后1个月进行糖精清除试验,比较糖精清除时间。观察比较两组手术时间、术中出血量及术后并发症的发生率。结果 两组患者术后1周和术后1个月的VAS评分比较差异有统计学意义（P〈0.05）,术后6个月比较差异无统计学意义（P〉0.05）。两组术前糖精清除时间比较,差异无统计学意义（P〉0.05）,术后2周及术后1个月比较差异有高度统计学意义（P〈0.01）。两组手术时间和术中出血量比较差异有高度统计学意义（P〈0.01）。两组并发症发生率比较差异有高度统计学意义（P〈0.01）。结论 下鼻甲黏膜下海绵体组织部分切除术治疗黏膜肥厚的慢性肥厚性鼻炎能更好地保留鼻甲黏膜及纤毛功能,避免形成创面及瘢痕形成,最大程度上保留鼻功能的同时解除鼻阻力,且手术时间短,术中出血量少,并发症少,值得临床推广应用。

Objective To investigate the merits and demerits of submucosal partial resection of the inferior turbinate for turbinate mucosa hypertrophy and the complications. Methods Fifty six chronic hypertrophic rhinitis patients with turbinate mucosa hypertrophy hospitalized in Chen Xinghai Hospital of Zhongshan City from May 2013 to May 2015 were selected as research objects, the patients were divided into observation group and control group by random num- ber table. 28 cases of observation group received endoscopic submucosal partial resection of the inferior turbinate, and 28 cases of control group received conventional endoscopic partial resection of the inferior turbinate. Followed-up for 6 months, the nasal airway resistance of the two groups was evaluated by visual analogue scale （VAS） before operation and after operation for 1 week, 1 month, 6 months, and saccharin clearance test was performed before operation and af- ter operation for 2 weeks, 1 month to contrast saccharin clearing time. The operation time, intraoperative blood loss and the incidence of postoperative complications between two groups were observed and compared. Results The VAS scores for nasal resistance showed significant differences between the two groups after operation for 1 week, 1 month （P 〈 0.05）, but no significant difference was observed after operation for 6 months （P 〉 0.05）. The saccharin clearing time before operation between the two groups showed no statistically significant difference （P 〉 0.05）, the saccharin clearing time after operation for 2 weeks, 1 month between the two groups showed highly statistically significant differences （P 〈 0.01）. The operation time and intraoperative blood loss between the two groups had highly statistically significant differ- ences （P 〈 0.01）, the incidence of postoperative complications between the two groups had highly statistically signifi- cant difference （P 〈 0.01）. Conclusion Submucosal partial resection of the inferior turbinate can better retain turbinate mucosa and cilia functionl avoid formation of wound and scar formation, keep the nasal function in a maximum extend and relieve nasal resistance for chronic hypertrophic rhinitis with mucosal hypertrophy, which has short operation time, less intraoperative blood loss and few complications, thus it is worthy of clinical promotion and application.