鼻中隔偏曲与慢性鼻—鼻窦炎关系的临床研究

发布时间：2018-05-20 19:54

本文选题：鼻中隔偏曲 + 慢性鼻-鼻窦炎　；参考：《广西医科大学》2011年硕士论文

【摘要】：目的:探讨鼻中隔偏曲与慢性鼻-鼻窦炎发生的关系以及改良切口的鼻中隔成形术对其临床疗效的影响。方法:收集由鼻内窥镜检查,鼻窦CT扫描证实的鼻中隔偏曲伴慢性鼻-鼻窦炎病变患者共33例,分为2组,其中A组患者15例,同期行改良切口鼻中隔偏曲成形术和内窥镜鼻窦手术;B组患者18例,单纯行内窥镜鼻窦手术。根据偏曲位置将鼻中隔偏曲分为高位偏曲和低位偏曲,偏曲部位位于中鼻甲游离缘水平以上为高位偏曲,偏曲部位位于中鼻甲游离缘水平以下为低位偏曲;所有患者均行内窥镜鼻窦手术A组患者同时联合行鼻中隔手术,鼻中隔偏曲采用改良切口的鼻中隔成形术,手术方法为取右侧鼻中隔软骨尾端切口,即在鼻小柱后方、鼻中隔尾端前方作一“┚”形切口,上自鼻中隔软骨尾端顶部,向下延至鼻底部,手术保留鼻中隔软骨支架。所有患者随访6个月,临床疗效的评估方法参照慢性鼻-鼻窦炎诊断和治疗指南(2008年,南昌)标准,比较同期行改良切口的鼻中隔成形术和内窥镜鼻窦手术与单纯行内窥镜鼻窦手术的患者症状和体征改变的差异。结果:高位鼻中隔偏曲慢性鼻-鼻窦炎发生率大于低位鼻中隔偏曲慢性鼻-鼻窦炎发生率(P0.05);高位鼻中隔偏曲多引起额窦炎为主,其次为筛窦炎,低位鼻中隔偏曲多引起上颌窦炎其次为筛窦炎。改良切口的鼻中隔成形术在治疗鼻中隔偏曲并发慢性鼻窦炎疾病中有积极意义,主观和客观治愈率(P 0.05)。结论:鼻中隔偏曲与慢性鼻-鼻窦炎的发生有关,其中高位偏曲主要与额窦炎发生有关,低位偏曲主要与上颌窦炎发生有关;同期行改良切口的鼻中隔成形术和内窥镜鼻窦手术可以明显改善鼻中隔偏曲并慢性鼻-鼻窦炎患者的症状和体征;鼻中隔偏曲并慢性鼻-鼻窦炎患者在临床手术治疗过程中在行内窥镜鼻窦手术同时行鼻中隔偏曲手术其对鼻中隔偏曲并慢性鼻-鼻窦炎的治疗有积极意义。
[Abstract]:Objective: to investigate the relationship between deviation of nasal septum and the occurrence of chronic rhinosinusitis and the effect of modified incision nasoplasty. Methods: a total of 33 patients with nasal septum deviation and chronic rhinosinusitis confirmed by nasal endoscopy and CT scan were divided into two groups: group A (n = 15). At the same time, 18 patients in group B were treated with modified incision and endoscopic sinus surgery. Only endoscopic sinus surgery was performed. According to the position of deviation, the nasal septum deviation was divided into high deviation and low deviation, which were located above the level of the free edge of the middle turbinate and below the level of the free edge of the middle turbinate, and the position of the deviation was lower than the level of the free edge of the middle turbinate. All patients were treated with endoscopic sinus surgery (group A) and nasal septum surgery was performed simultaneously. Nasal septum deviation was performed with modified incision of nasal septum plasty. The method of operation was to take the right end of nasal septum cartilage caudal incision, that is, behind the column of nasal septum. In front of the nasal septum, an incision was made, which was made from the top of the tail end of the nasal septum cartilage and down to the bottom of the nose. The nasal septal cartilage scaffold was preserved. All patients were followed up for 6 months. The clinical efficacy was evaluated according to the guidelines for the diagnosis and treatment of chronic rhinosinusitis (Nanchang, 2008). To compare the changes of symptoms and signs between the patients undergoing nasal septoplasty and endoscopic sinus surgery at the same time and the patients undergoing endoscopic sinus surgery alone. Results: the incidence of chronic rhinosinusitis of high nasal septum deviation was higher than that of low nasal septum deviation chronic rhinosinusitis (P 0.05), and that of high nasal septum deviation was mainly caused by frontal sinusitis, followed by ethmoid sinusitis. Lower nasal septum deviation caused maxillary sinusitis, followed by ethmoid sinusitis. The modified incision septoplasty has positive significance in the treatment of nasal septal deviation complicated with chronic sinusitis. The subjective and objective cure rate is P 0.05. Conclusion: the deviation of nasal septum is related to the occurrence of chronic rhinosinusitis, the high deviation is mainly related to the occurrence of frontal sinusitis, and the low deviation is mainly related to the occurrence of maxillary sinusitis. Nasal septal angioplasty and endoscopic sinus surgery at the same time can significantly improve the symptoms and signs of patients with nasal septum deviation and chronic rhinosinusitis. The patients with nasal septum deviation and chronic rhinosinusitis were treated with endoscopic sinus surgery and nasal septum deviation surgery, which has positive significance for the treatment of nasal septum deviation and chronic rhinosinusitis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R765

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