内镜下鼻中隔方形软骨再次成形术的临床观察

Endoscopic revision septoplasty to correct the deviation of caudal quadrangular cartilage

目的 探讨鼻中隔尾端方形软骨残留偏曲行内镜下再次软骨成形术的适应证和手术方法。方法 回顾性分析2015年1月至2019年3月19例因鼻中隔方形软骨尾端残余偏曲于首都医科大学附属北京友谊医院行鼻内镜下再次软骨成形术患者的临床资料,统计方形软骨尾端偏曲发生率、手术方法和随访结果。结果 19例患者中单一方形软骨尾端偏曲8例(42.11%),合并多处残留偏曲者11例(57.89%)。18例接受内镜下再次软骨成形术,1例因鼻小柱偏曲及外鼻畸形接受开放式外鼻-鼻中隔成形术。内镜下再次软骨成形术采用鼻中隔偏曲凹面侧半贯穿切口,分离黏软骨膜,完全暴露方形软骨尾端,软骨凹面侧行网格状软骨切开减张。首次鼻中隔手术距再次手术时间为(15.12±11.68)年,所有患者再次手术前均有持续鼻塞症状,术后随访(24.47±13.08)个月,全部患者鼻塞症状均缓解。结论 方形软骨尾端是鼻中隔手术后最常见的偏曲残留部位之一,内镜下软骨切开成形术可用于矫正鼻中隔方形软骨尾端残留偏曲,但不适用于伴鼻小柱偏曲和外鼻畸形的患者。

Objective To describe the indication and our technique in the revision septoplasty of caudal quadrangular cartilage deviation. Method A retrospective analysis was made of the clinical data of 19 patients who underwent endoscopic re-chondroplasty due to residual deviation of the tail end of the square cartilage of nasal septum from January 2015 to March 2019. The incidence, surgical methods and follow-up results of the deviation of the tail end of the square cartilage were analyzed. Result Among the 19 cases, 8 cases (42.11%) had single square cartilage tail deviation and 11 cases (57.89%) had multiple residual deviation. 18 cases received endoscopic septoplasty, and 1 case received open septoplasty because of the columella deviation and a twisted nose. The hemi-transfixion incision was made at the concave side of septum to expose the concave side of septal cartilage completely, then full thickness latticed incisions were made on the concave side of cartilage to correct the deviation. The interval between the revision septoplasty and the primary septal surgery is (15.12±11.68)years. All patients complained about the persisted nasal obstruction after the primary operations and had subjective symptom improvement after the revision operations. No recurrence and nasal deformity were observed during the follow-up of (24.47±13.08) months. Conclusion Caudal quadrangular cartilage deviation is one of the most common sites in revision septoplasty. Endoscopic revision cartilaginous septoplasty can effectively correct the residential caudal quadrangular cartilage deviation without columella deviation and aesthetic requirements.