对侧鼻中隔黏膜瓣逆行翻转技术在内镜经鼻扩大入路鞍区肿瘤手术中的临床应用研究

Application of contralateral nasal septal mucosal flap reversal technique in expanded transnasal endoscopic surgery for sellar region tumors

目的探讨对侧鼻中隔黏膜瓣逆行翻转技术在内镜经鼻扩大入路鞍区肿瘤手术中的临床应用。方法回顾性分析2016年1月—2018年9月在我院进行的内镜下经鼻扩大入路颅底手术患者的临床资料,对30例患者使用对侧鼻中隔黏膜瓣翻转与30例未翻转患者进行对比。门诊内镜复查随访2～12周,分析供体部位结痂、鼻塞、肉芽形成、感染、出血及异味感等。结果手术后1～2周的随访检查显示,观察组30例患者的供体部位黏膜完全恢复,而对照组2周内无一例完全恢复,6～12周回访30例完全愈合(100%)。结论逆行翻转黏膜瓣覆盖于裸露的供体部位鼻中隔软骨,黏膜在2周即可完全愈合,减少了鼻中隔结痂、鼻塞、睡眠障碍、肉芽形成、感染、出血及异味等并发症的发病率。

Objective To explore the application of contralateral nasal septal mucosal flap reversal technique in expanded transnasal endoscopic surgery for sellar region tumors.Methods The clinical data of 30 patients who underwent skull base surgery through endoscopic expanded transnasal approach in our hospital from January 2016 to September 2018 were retrospectively analyzed,and 30 patients who used reverse contralateral nasal septum mucosal flap were compared with 30 patients who did not use.Outpatient review and follow-up were conducted for 2~12 weeks to analyze the scab,nasal congestion,nasal obstruction,granulation formation,infection,bleeding,and abnormal odor sensation in the donor site.Results Follow-up and the patients’ examinations in 1~2 weeks after the surgery showed that the mucosa of the donor site completely recovered in 30 patients in the observation group.There was no patient in the control group who completely recovered within 2 weeks,30 cases had complete healing (100%) during 6~12 weeks follow-up.Conclusion Reverse mucosal flap covers in the exposed nasal septum cartilage of the donor site,and mucosa can be completely healed within 2 weeks,and this method can reduce the incidence of septal scab,nasal obstruction,sleep disorders,granulation formation,infection,bleeding,odor and other complications.