鼻中隔双向粘骨膜瓣应用于成人难治性后鼻孔闭锁的手术治疗

发布时间：2018-03-30 02:02

本文选题：后鼻孔闭锁　切入点：鼻咽癌放疗　出处：《浙江大学》2010年硕士论文

【摘要】： [摘要]目的探讨鼻中隔双向粘骨膜瓣治疗成人难治性后鼻孔闭锁的效果。方法我科2006年7月至2009年6月手术的9例后鼻孔闭锁的患者,男性4例,女性5例,单侧闭锁2例,双侧闭锁7例,先天性闭锁2例,7例后天性闭锁均为鼻咽癌放疗后患者。先天性和后天性中各有1例为第一次手术后复发患者。所有患者均接受了经鼻腔鼻内镜下后鼻孔成形术,术中使用鼻中隔双向粘骨膜瓣,术后未放置硅胶扩张管。观察患者术后的症状改善程度及是否发生后鼻孔再狭窄或闭锁。结果9例患者中术后鼻塞、张口呼吸等症状明显改善。在平均19.3个月的随访时间内,鼻内镜复查见新成形后鼻孔及鼻咽部通畅,粘膜瓣无移位及坏死,无后鼻孔再狭窄或闭锁发生。2例患者出现鼻腔粘连,1例出现后鼻孔边缘肉芽组织增生,均为鼻咽癌放疗后闭锁患者。鼻腔粘连、肉芽组织增生者经鼻内镜下修正后无复发。结论经鼻腔鼻内镜下后鼻孔成形术可作为鼻咽癌放疗引起的后鼻孔闭锁选择的手术方式,术后复发患者仍可经鼻腔鼻内镜下手术,粘骨膜瓣的应用及术后定期的鼻内镜复查可降低再狭窄或闭锁的发生率,术后可不用放置硅胶扩张管。
[Abstract]:Objective to investigate the effect of bidirectional mucoperiosteal flap of nasal septum on the treatment of intractable posterior nostril atresia in adults. Methods from July 2006 to June 2009, 9 patients with posterior nostril atresia were treated, including 4 males, 5 females and 2 unilateral atresia. Bilateral atresia was found in 7 cases. Two cases of congenital atresia and 7 cases of acquired atresia were all patients with nasopharyngeal carcinoma after radiotherapy. 1 case of congenital atresia and 1 case of acquired atresia were relapsed after the first operation. All the patients were treated with transnasal endoscopic posterior nasoplasty. The bidirectional mucoperiosteal flap of nasal septum was used during operation, and no silicone dilatation tube was placed after operation. The degree of improvement of symptoms and the occurrence of restenosis or atresia of posterior nostril were observed. During the mean follow-up period of 19.3 months, the nasal endoscopy showed that the nasolus and nasopharynx were unobstructed, and there was no displacement and necrosis of the mucosal flap. There was no restenosis or atresia of the posterior nostril. 2 cases had nasal adhesions and 1 case had hyperplasia of granulation tissue at the edge of the posterior nostril, all of them were atresia patients after radiotherapy of nasopharyngeal carcinoma. Conclusion transnasal endoscopic retronasoplasty can be used as a choice for posterior nostril atresia caused by radiotherapy for nasopharyngeal carcinoma, and recurrent patients can still be treated by nasal endoscope. The rate of restenosis or atresia can be reduced by the application of mucoperiosteal flap and regular endoscopy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765

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