鼻内镜微创手术治疗鼻中隔穿孔的临床效果分析

Clinical analysis of minimally invasive endoscopic surgery for nasal septum perforation

目的比较传统手术和鼻内窥镜辅助下双旋转鼻中隔黏膜瓣修补术治疗鼻中隔穿孔患者的临床疗效及安全性。方法将天津市宁河区中医医院2018年1月-2022年6月期间收治的鼻中隔穿孔患者84例作为研究对象。采用随机数字表法将患者随机分为观察组和对照组,每组各42例。采用传统手术对对照组进行治疗,采用鼻内窥镜辅助下双旋转鼻中隔黏膜瓣修补术对观察组进行治疗,术后随访6个月。比较两组患者损伤黏膜范围、术后黏膜修复时间、术中出血量、手术时间、修复成功率、I期愈合率、鼻腔通气恢复正常率、术后疼痛、鼻腔通气功能及并发症发生率。结果术后观察组损伤黏膜范围、术后黏膜修复时间、术中出血量、手术时间分别为(9.53±2.14)mm^(2)、(15.73±2.61)d、(4.33±0.87)mL、(27.71±3.61)min,均明显低于对照组的(17.56±4.42)mm^(2)、(31.12±5.56)d、(14.49±2.56)mL、(44.18±3.75)min,差异均有统计学意义(均P<0.05)。术后观察组I期愈合率、鼻腔通气恢复正常率、修复成功率分别为95.24%、97.62%、90.48%,均明显高于对照组的73.81%、78.57%、69.05%,差异均有统计学意义(均P<0.05)。术后观察组VAS评分为(2.89±0.97)分,明显低于对照组的(4.89±1.12)分,差异有统计学意义(P<0.05),术前两组呼气和吸气总阻力均无明显差异(均P>0.05),术后两组呼气和吸气总阻力均明显降低,且观察组低于对照组,差异均有统计学意义(均P<0.05)。术后6个月内观察组并发症发生率为9.52%,明显低于对照组的33.33%,差异有统计学意义(χ^(2)=6.272,P<0.05)。结论鼻中隔穿孔患者采用双旋转鼻中隔黏膜瓣修补术进行治疗后可提高手术效果,提高手术成功率,减轻创伤,促进患者早日康复和鼻腔功能恢复,减少并发症发生,减轻患者痛苦,提高舒适度。

Objective To compare the clinical efficacy and safety of traditional surgery and endoscopic assisted double rotating nasal septum mucosal flap repair in the treatment of nasal septum perforation.Methods 84 patients with nasal septum perforation admitted in our hospital from January 2018 to June 2022 were taken as the research objects.The patients were randomly divided into an observation group and a control group using a random number table method,with 42 cases in each group.The control group was treated with traditional surgery,and the observation group was treated with double rotating nasal septum mucosal flap repair assisted by nasal endoscope.The patients were followed up for 6 months.Compare the extent of mucosal injury,postoperative mucosal repair time,intraoperative bleeding.surgical time,repair success rate,Phase I healing rate,nasal ventilation recovery rate,postoperative pain,nasal ventilation function,and incidence of complications between two groups of patients.Results The range of mucosal damage,postoperative mucosal repair time,intraoperative bleeding volume,and surgical time in the observation group were(9.53±2.14)mm^(2),(15.73±2.61)d,(4.33±0.87)mL,and(27.71±3.61)min,respectively,which were significantly lower than the control group's(17.56±4.42)mm^(2),(31.12±5.56)d,(14.49±2.56)mL,and(44.18±3.75)min,with statistical significance(all P<0.05).The postoperative healing rate,nasal ventilation recovery rate,and repair success rate of the observation group were 95.24%,97.62%,and 90.48%,respectively,which were significantly higher than the control group's 73.81%,78.57%,and 69.05%,with statistical significance(all P<0.05).The postoperative VAS score of the observation group was(2.89±0.97)points,significantly lower than the control group's(4.89±1.12)points,with a statistically significant difference(P<0.05).There was no significant difference in total expiratory and inspiratory resistance between the two groups before surgery(all P>0.05).After surgery,the total expiratory and inspiratory resistance of the two groups decreased significantly,and the observation group was lower than the control group,with a statistically significant difference(all P<0.05).The incidence of complications in the observation group within 6 months after surgery was 9.52%,significantly lower than 33.33%in the control group,with a statistically significant difference(x*=6.272,P<0.05).Conclusion After the treatment of nasal septum perforation patients with double rotating nasal septum mucosal flap repair,it can improve the surgical effect,improve the success rate of the operation,reduce trauma,promote the early recovery of patients and nasal function recovery,reduce complications,alleviate patients'pain,and improve comfort.