鼻内镜下阔筋膜修补鼻中隔大穿孔及失败原因分析

发布时间：2018-04-20 02:28

本文选题：鼻中隔穿孔 + 阔筋膜　；参考：《中国内镜杂志》2015年11期

【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]:Objective to summarize the experience of large perforation of nasal septum repaired with fascia lata under nasal endoscope and analyze the causes of failure. Methods the clinical data of 21 patients with large perforation of nasal septum treated with fascia lata under nasal endoscope were analyzed retrospectively. Through nasal septum approach, nasal endoscope was used to separate bilateral nasal septum, nasal floor mucochondral membrane and periosteum, and then implanted fascia lata. A mucosal flap (mucochondral membrane and mucoperiosteal flap) pedicled above the nasal septum was made to cover the fascia lata of perforated area. After operation, the nasal cavity was moisturized, the clinical effect was observed, and the possible causes of failure were analyzed. Results from 6 months to 8 years, 15 cases of nasal septum perforation were successfully repaired and 6 cases failed. One case of failure was perforation, 3 cases were fascia failure, 2 cases were perforation 6 months later. Conclusion the treatment of large perforation of nasal septum with fascia lata under nasal endoscope is a good method. It has the advantages of strong survival ability of graft and clear operation field, but the operation space is small and the technique is relatively complex, so it is necessary to select the patient carefully. In order to improve the success rate, the operation details should be paid attention to and good nursing should be given to the nasal cavity after operation.
【作者单位】：东南大学附属中大医院耳鼻咽喉头颈外科;东南大学附属中大医院整形外科;
【分类号】：R765.9

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