鼻内镜下“M”字贯穿缝合技术在鼻中隔偏曲矫正术中的临床应用

Clinical application of “M” penetrating suture technique under nasal endoscope in the correction of nasal septum deviation

目的 评估鼻内镜下“M”字连续贯穿缝合技术在鼻中隔偏曲矫正手术中的临床应用及疗效。方法 选取在我科接受鼻中隔偏曲矫正手术的患者256例,其中对照组128例,术后使用膨胀海绵填塞鼻腔;观察组128例,术后应用5-0圆针可吸收缝线“M”字连续贯穿缝合鼻中隔黏膜。比较2组患者术后主观不适感的视觉模拟量表(VAS)评分均值及术后鼻出血、鼻中隔血肿、鼻中隔穿孔、鼻腔粘连等并发症的发生情况。结果 观察组患者在术后12、48、72 h的鼻部疼痛、鼻塞、流泪、头痛、口干、睡眠质量等VAS评分均明显低于对照组;术后72 h行鼻腔换药时引起的疼痛评分明显低于对照组,差异均具有统计学意义(P值均<0.05)。2组患者术后72 h行鼻腔换药时鼻出血情况、术后96 h的各症状VAS评分、术后第7天行鼻腔清理引起的疼痛及出血、术后7 d内出现鼻出血、鼻中隔血肿、鼻中隔穿孔、鼻腔粘连等并发症的发生率,差异均无统计学意义(P值均> 0.05)。观察组患者术后24 h出现鼻塞的VAS评分与术后12、48、72、96 h比较,差异具有统计学意义(P <0.05);在出现鼻中隔血肿的患者中,黏膜完好者出现的概率(87.7%)高于黏膜破裂者(14.3%),且多出现在棘突、嵴突型的黏膜凸出处。结论 鼻中隔偏曲矫正术后患者行“M”字贯穿缝合能明显改善患者围手术期鼻部疼痛、头痛、鼻塞、流泪、口干等症状,提高患者术后生活质量;同时不增加术后鼻出血、鼻中隔血肿、鼻腔粘连等并发症的发生,值得临床应用和推广。

Objective To evaluate the clinical application and curative effect of “M” continuous penetrating suture technique under nasal endoscopy in the correction of nasal septal deviation. Methods Two hundred and fifty-six patients who underwent nasal septal deviation correction surgery in our department were devided into the control group(n=128, the nasal cavity was filled with swelling sponge after the operation) and the observation group(n=128, the mucosa of the nasal septum was sutured by using “M” penetrating suture technique with 5-0 round needle absorbable suture after the operation. The average visual analogue scale(VAS) scores of postoperative subjective discomfort in the two groups were compared, and the incidence of postoperative complications such as epistaxis, nasal septal hematoma, perforation, and nasal adhesions were compared. Results In the observation group, the VAS scores of nasal pain, nasal congestion, tearing, headache,dry mouth and sleep quality at 12 h, 48 h and 72 h after surgery were significantly lower than those of the control group;at 72 h after surgery, the pain score caused by nasal dressing change was significantly lower than that of the control group, and the differences were all statistically significant(P<0.05). Statistical analysis of the two groups of patients’ epistaxis during nasal dressing at 72 h after the operation, VAS score at 96 h after the operation, pain and bleeding caused by nasal cavity cleaning on the 7 th day after the operation, complications such as epistaxis, septal hematoma, perforation and nasal adhesion occurred within 7 days after the operation,showed that the differences were all not statistically significant(P>0.05). The VAS scores of patients with nasal congestion 24 h after the operation in the observation group was higher than at 12 h, 48 h, 72 h and 96 h after the surgery, and the differences were statistically significant(P<0.05);the incidence of hematoma in patients with intact nasal septum mucosa(87.7%) was higher than that in patients with mucosal rupture(14.3%), and most of the hematoma appeared in the mucosal protrusions of spinous and ridge-type. Conclusions The continuous suture of “M” after nasal septum correction can significantly improve the patients’ symptoms such as perioperative nasal pain, headache, nasal congestion, tearing and dry mouth, and improve the patients’ postoperative quality of life with similar postoperative complications such as epistaxis, septal hematoma and nasal adhesion, which is worthy of clinical application and promotion.