Nasal Valve Surgery: How I do it?

One of the reasons for patients attending ENT clinic with a persistent feeling of Nasal obstruction is the presence of a narrow nasal valve. Currently, there are many surgical methods for widening narrow nasal valves. Yet, most of these methods are difficult to perform and with unpredictable results. The main purpose of this study is to describe and evalu- ate our technique of minimally invasive nasal valve surgery. Thirty three patients, who attended our clinic complaining from of nasal obstruction, were evaluated for indication for nasal valve surgery, complications, and postoperative re- sults. Thirty one out of the 33 patients (94%) who underwent the surgery reported subjective improvement. Visual ana- logue score (VAS score) was used to estimate the degree of pre and postoperative nasal obstruction, the mean preopera- tive score was 8.891 and the mean postoperative was 3.241 and the improvement was statistically significant (P = 3.174). In conclusion, it can be said that the technique of Minimal Invasive Nasal Valve Surgery was found to be safe and extremely effective for most patients having narrow nasal valve.

鼻瓣区狭窄的射频消融治疗

鼻塞是鼻部疾病的常见症状,临床往往重点关注是否存在固有鼻腔阻塞性疾病,而常常忽略可能存在鼻瓣区狭窄,以至于鼻腔手术后仍然达不到理想的通气效果。总结2004年6月～2005年7月我科诊治的鼻塞患者中因鼻瓣区狭窄者58例，经射频消融治疗后通气改善良好，现报道如下。

鼻阀功能不良的诊治进展

鼻阀又称鼻瓣区(nasal valve),是鼻腔内最狭窄的区域,维持鼻阀功能的正常在鼻整形术及修正鼻腔功能手术中非常重要。鼻阀功能不良诊断缺乏金标准,主要依赖Cottle试验、影像学辅助检查,并排除其他相关疾病,其治疗方式多样。本文旨在回顾鼻阀的相关定义、解剖、生理及鼻阀功能不良的病因、诊断和手术治疗的研究进展,以提高对鼻阀功能不良的认识。

带储气囊无重复呼吸面罩在COPD患者脱机后的应用

目的探讨带储气囊无重复呼吸面罩、普通面罩及经鼻吸氧在慢性阻塞性肺病(COPD)脱机后的优缺点。方法选取2010年6月至2013年1月郧县人民医院收治的须行气管插管机械通气的COPD急性发作并发重度呼吸衰竭患者66例,依据随机数字表法分为三组:第1组(22例)脱机后应用带储气囊无重复呼吸面罩吸氧,第2组(22例)应用普通面罩进行吸氧,第3组(22例)应用鼻导管进行吸氧。比较三组3 d内再次应用呼吸机人次、脱机后24、48、72 h血气分析中pH、二氧化碳分压、氧合指数。结果再次应用呼吸机患者会在第1、2、3组分别为2、6、8人次,再次上呼吸机率分别为9%、27%、36%。脱机后24、48、72 h,三组患者的二氧化碳分压、氧分压、pH比较差异均有统计学意义(P<0.05)。结论带储气囊无重复呼吸面罩应用于COPD可有效提高氧分压,无明显加重二氧化碳蓄积的不良反应。

Pediatric nasolacrimal duct obstruction-benefit of a combined therapeutic approach

Background:Pediatric nasolacrimal duct obstruction (PNDO) requires therapeutic intervention after conservative procedures failed.As resilient treatment guidelines for the treatment are missing,the aim of this study was to evaluate the advantages of two different intervention techniques in children with PNDO.Methods:Between January,2006 and June,2014,233 children (0-208 months) were treated either with conventional probing by ophthalmologists only (Group I) or with endonasal endoscopic interdisciplinary approach (Group Ⅱ).The clinical outcome was analyzed.Results:The overall success rate of Group Ⅰ was 93.4% compared to 98.4% of Group Ⅱ (P<0.05).50% of all interventions (n=62) of Group Ⅱ required further surgical procedures in addition to probing/irrigation,particularly with regard to children <6 and >24 months.Conclusions:Endoscopic control in treatment of PNDO allows exact identification of the stenosis and appropriate surgical intervention with an improved clinical outcome.Endonasai endoscopic surgical techniques should be the standard PNDO treatment.

等离子射频消融辅助手术治疗鼻瓣区多部位狭窄47例

目的探讨等离子射频消融配合传统手术综合治疗鼻瓣区多部位狭窄的临床效果。方法回顾分析我科47例鼻瓣区多部位狭窄患者应用等离子射频消融配合传统手术综合治疗的临床资料。结果术后随访1.5~3年,患者鼻阻塞症状均消失,鼻腔通气改善良好,无1例出现鼻外观变形、鼻中隔穿孔。结论等离子射频消融配合传统手术多元化、个体化综合治疗鼻瓣区多部位狭窄疗效显著,技术简单,值得临床应用及推广。

半导体激光辅助下手术治疗鼻瓣区狭窄

目的探讨半导体激光辅助下手术治疗鼻瓣区狭窄的临床效果。方法回顾性分析鼻瓣区狭窄48例(62侧)的临床资料。根据形成狭窄的主要突起(或塌陷)部位,分成A型:内侧突起(26侧),B型:外、上侧凸起(包括夹角过小、鼻翼塌陷)(22侧)和C型:底部突起(14侧)。所有患者行半导体激光辅助下鼻瓣区扩大手术。术后随访1年。术前和术后1年,分别采用10 cm视觉模拟评分法(visual analog scale,VAS)评价手术结果。结果三种类型患者VAS评分术后1年较术前均有下降,差异有极显著统计学意义(P<0.001)。其中A型总有效率85%,B型总有效率72%,C型总有效率93%。术后未发现鼻塞症状加重者。结论用传统手术器械行鼻瓣区手术时会有很多困难。激光在分离目标组织时合理、灵活,可轻易去除突起组织,扩大鼻瓣区,术后较少形成瘢痕,手术安全,疗效明确、持久。

软骨扩展移植物治疗鼻阀功能不良

目的探讨软骨扩展移植物在鼻阀功能不良治疗中的作用。方法回顾性分析使用软骨扩展移植物治疗的两例鼻阀功能不良患者的临床资料,并复习文献,简述该疾病的进展。结果两例患者均以鼻塞为主要症状,术前平静呼吸时鼻侧壁塌陷,采用软骨扩展移植物治疗后,鼻塞症状完全消失,用力吸气时,鼻侧壁塌陷消失。结论软骨扩展移植物是治疗鼻侧壁软骨塌陷导致鼻阀功能不良的有效手段,其长期有效性值得期待。