耳屏软骨联合带蒂鼻腔黏骨膜瓣在修补鼻中隔大穿孔中的应用

Application of tragus cartilage combined with pedicled nasal mucoperiosteal flap in repairing large perforation of nasal septum

目的探讨耳屏软骨联合带蒂鼻腔黏骨膜瓣修补鼻中隔大穿孔的方法及疗效。方法选取联勤保障部队第九四〇医院18例鼻中隔大穿孔(直径≥15 mm)患者,鼻内镜下采用耳屏软骨联合带蒂鼻腔黏骨膜瓣行鼻中隔穿孔修补术,间断缝合,明胶海绵贴敷固定,术后观察修补物的存活情况。结果 18例患者术后全部随诊6个月至1年,17例完全修补成功,术后半年复查移植物全部成活;1例在术后半年复查时残留有小穿孔(直径为2 mm),门诊在局麻鼻内镜下重新创建新鲜创面后对位缝合,换药2个月后完全愈合。结论鼻内镜下采用耳屏软骨联合带蒂鼻腔黏骨膜瓣修补鼻中隔大穿孔,是行之有效的治疗方法,可以临床推广应用。

Objective To explore the method of repairing large perforation of nasal septum with auricular cartilage combined with pedicled nasal mucoperiosteal flap.Methods Eighteen patients with large nasal septum perforation(diameter ≥15 mm)in the 940 th Hospital of the Joint Logistics Support Force were selected, who were repaired with auricular cartilage combined with pedicled nasal mucoperiosteal flap under nasal endoscope, interrupted suture and gelatin sponge application. The survival of the repair was observed after operation.Results All the 18 patients were followed up for half a year to one year after the operation, and the graft repair was successful in 17 patients.All the grafts were survived after the reexamination half a year after the operation. One patient had a small residual perforation(diameter of 2 mm) at the time of reexamination half a year after surgery. The fresh wound was sutured again under nasal endoscope in outpatient department, and the wound healed completely after 2 months of dressing change.Conclusion using tragus cartilage combined with pedicled nasal mucoperiosteal flap to repair large perforation of nasal septum under nasal endoscope is an effective method, which can be popularized in clinical practice.