鼻内镜下阔筋膜修补鼻中隔大穿孔及失败原因分析

Clinical analysis of the causes of defecting repair in repairing of large nasal septal perforation with fascia lata via nasal endoscopic surgery

摘要:

目的  总结鼻内镜下运用阔筋膜修补鼻中隔大穿孔的经验，分析修补失败的原因。方法  回顾性地分析了21例在鼻内镜下用阔筋膜修补鼻中隔大穿孔患者的临床资料。鼻内镜下经鼻中隔进路，分离双侧鼻中隔、鼻腔底黏软骨膜和骨膜，然后植入阔筋膜，并制作一个蒂在一侧鼻中隔后上方的黏膜瓣（黏软骨膜和黏骨膜瓣），将该瓣向前上方转位覆盖穿孔区域的阔筋膜。术后鼻腔充分保湿，观察临床疗效，并分析手术失败的可能原因。结果  随访6个月～8年，15例鼻中隔穿孔修复成功，6例失败。失败者中1例为穿孔部分封闭，3例为筋膜未成活，2例为6个月后再次穿孔。结论  鼻内镜下运用阔筋膜修补鼻中隔大穿孔是一种较好的方法，具有移植物成活能力强、操作术野清晰的优点，但操作空间小，技巧相对复杂，需要慎重地选择患者，术中注意操作细节，术后鼻腔需要良好的护理，才能提高成功率。

Abstract:

【Objectives】 To explore the operational methods of repairing large nasal septal perforation via nasal endoscopic surgery with Fascia Lata, and analyze the causes of defecting repair. 【Methods】 Clinical data of 21 patients with large nasal septal perforation receiving the nasal endoscopic repair was analyzed retrospectively. Intraoperative transnasal septem approach under nasal endoscopy, dissecting mucoperichondrium and mucoperioseptum around the perforation and taking down and out to the floor of nasal cavity to make an inferior extremity pedicle flap. Then, the flap was rotated and sutured onto raw surface of anterior and superior edge of the perforation. After surgery, remaining moisture content of nasal cavities sufficiently, observing the clinical outcomes, and analysis the results of defecting repair. 【Result】 All the patients were followed-up for 6 months ~8 years, 15 cases had their perforation permanently closed, 6 cases were defected ,among them 1 case was partly closed, 3 cases which Fascia Lata were not survival, and 2 cases were reperforation again. 【Conclusion】 Repair of large nasal septal perforation with fascia lata via nasal endoscopic surgery is a good method. While transplants survive easily, and operational scope clearly, the small manipulate space needs more complicated operational skills. So the key for success concludes choosing suitable patients, paying attention to the details of operation, and nursing nasal cavities well.