鼻内镜下两种中鼻甲处理模式的对比观察

Clinical effects of two kinds of processing mode with the middle turbinate in and after endoscopic sinus surgery

目的通过寻找更加完善的中鼻甲处理模式,以达到既能有效保留更多中鼻甲黏膜及其功能,又能杜绝术腔粘连等并发症的发生。方法 2000年之前和2010年之后的A、B两组病例采用不同的中鼻甲处理模式,并对其疗效进行对比分析。结果 A组76例(n=144侧)前端粘连12侧,其中重度5侧,轻度3侧,发生于随访中者4侧,经处理并随访6个月以上,仍粘连者4侧。B组80例(n=152侧)仅有前端轻度粘连2侧。结论①以黏骨膜下手术为主体的多元化中鼻甲成形术,可以保留更多的中鼻甲黏膜及其功能;②跳出单一手术模式,将中鼻甲成形术延伸至"手术+填塞+清理"的三步法,以及"鸡尾酒式"的术后填塞与清理,可以解决中鼻甲切除与否的所有相关争议。

Objective To evaluate clinical outcomes of middle turbinate (MT) in and after endoscopic sinus surgery (ESS). Methods Prospective and non-randomized study in cases before the year 2000 (Group A) and after the year 2010 (Group B), the effect of the two groups with different processing pattern of MT were analyzed. The preoperative patients was evaluated using nasal endoscopy, computed tomography. Objective surgical outcomes were assessed 2 years postoperatively based on endoscopic findings. Results The group B had better objective outcomes. Group A (n = 144) had 12 sides anterior nasal cavity adhesion, including 5 sides severe adhesion, 3sides slight adhesion and occurring in follow-up of 4 sides, after treatment were followed up for 6 months, four sides still had nasal cavity adhesion. Group B (n = 152) had 2 sides slight anterior nasal cavity adhesion. Conclusion The submucoperiosteal surgery as the main of the diversification of middle conchoplasty, could retain more middle turbinate mucosa and its function;Out of anoperation mode, the middle conchoplasty extended to the mode of three-steps surgery+packing+cleaning, as well as the cocktail mode of postoperative packing and cleaning, and could be solved with the problem of middle turbinate resection or preservation.