先天性后鼻孔闭锁的治疗进展

Advances in the treatment of congenital choanal atresia

先天性后鼻孔闭锁是指后鼻孔解剖学上的闭合,临床上表现为无鼻腔呼吸气流,CT的典型表现为犁骨、翼突内侧板骨质增生以及后鼻孔骨性、混合性或膜性闭锁。根据病变范围,可以分为双侧或单侧闭锁,前者往往需要及时治疗。首选治疗方式为经鼻内镜下手术治疗,其安全性及有效性在过去的十余年间得到认证。然而术后狭窄仍然是最主要的并发症,传统支架与丝裂霉素的应用是否有利于避免术后狭窄一直存在争议。目前,一些预防术后狭窄的新方法(糠酸莫米松药物洗脱支架、球囊扩张、羧甲基纤维素钠盐凝胶的局部应用)还在不断出现,可能为后鼻孔闭锁的治疗带来良好的前景。

Congenital choanal atresia(CCA) refers to the anatomical closure of the posterior nostril, which is clinically characterized by no nasal respiratory airflow. The typical manifestations of CT are thickening of the bone of the posterior vomer, pterygoid plate, and closure of the choana with bony/and or membranous plate. According to the extent of the lesion, it can be divided into bilateral atresia and unilateral atresia, and the former often needs timely treatment. Transnasal endoscopic surgery is the first choice of surgery, and its safety and effectiveness have been certified in the past decade. However, postoperative stenosis is still the most important complication. It has been controversial whether the application of traditional stent and mitomycin C is beneficial to avoid postoperative stenosis. At present, some new methods to prevent postoperative stenosis(steroid-eluting stent, and balloon dilatation, and local application of the carboxymethyl cellulose gel-sodium salt) are still emerging, Which may offer promising prospects for the treatment of choanal atresia.