鼻—鼻咽部放疗后鼻腔鼻窦粘连的内镜下手术疗效分析

Endoscopic surgery for nasal and paranasal sinus adhesion after nasopharyngeal radiotherapy

目的当前鼻-鼻咽部放疗后导致的鼻腔鼻窦粘连尚不可避免。文中旨在探讨放疗后鼻腔鼻窦粘连的内镜下手术处理方法,分析手术运用特点及疗效。方法回顾性分析2016年9月至2021年11月南京鼓楼医院耳鼻咽喉头颈外科收治的11例鼻-鼻咽恶性肿瘤放疗后鼻腔粘连患者临床资料。手术操作均结合粘连带临床特征,运用内镜下冷器械钝性分离结合微型电针局部精准消融。粘连组织标本通过HE染色观察。所有患者术后定期鼻内镜随访观察,鼻塞症状以VAS评分评估,并记录其他症状。结果患者术后随访结果显示鼻腔-鼻道通畅,术后愈合良好,均未见明显再粘连。所有患者鼻塞情况明显缓解,VAS评分示术前平均为(9.45±0.82),术后平均为(1.36±1.75),术后鼻塞症状较术前明显好转(P<0.01)。8例(72.7%)患者术后鼻腔无脓性分泌物,夜间打鼾憋气或张口呼吸明显改善。结论内镜下手术可有效解除鼻-鼻咽部放疗后的鼻腔粘连,冷器械钝性分离具有保护鼻腔鼻道生理结构和功能的优势。

Objective At present, adhesion of nasal cavity and paranasal sinuses after nasopharyngeal radiotherapy is inevitable. This article aims to discuss the endoscopic surgical management of nasal and paranasal sinonasal adhesion after radiotherapy, and analyze the operation characteristics and efficacy. Methods The clinical data of 11 patients with nasal adhesion after radiotherapy for nasopharyngeal malignant tumors admitted to the Department of Otorhinolaryngology Head and Neck Surgery of Nanjing Drum Tower Hospital from September 2016 to November 2021 were retrospectively analyzed. The surgical procedures were combined with the clinical characteristics of adhesions, and local precise ablation was performed using endoscopic cold instrument blunt separation combined with micro electroacupuncture. The adhesions were observed by HE staining. All patients were followed up by nasal endoscopy regularly after operation. Nasal congestion was assessed by VAS score, and other symptoms were recorded. Results The postoperative follow-up results showed that the nasal and nasal passages were unobstructed and healed well, and no obvious readhesion was observed. The mean VAS score was(9.45±0.82) before operation and(1.36±1.75) after operation. The nasal congestion symptoms were significantly improved after operation(P<0.01). There was no purulent discharge in nasal cavity in 8 patients(72.7%), snoring and breath-holding at night or open-mouth breathing were significantly improved. Conclusion Endoscopic surgery can effectively relieve nasal adhesion after nasopharyngeal radiotherapy, and blunt separation of cold instruments has the advantage of protecting the physiological structure and function of nasal passages.