改良中鼻甲部分切除术在功能性鼻内镜手术中的应用

Application of functional endoscopic sinus surgery in the treatment of modified partial turbinectomy

摘要:

目的探讨改良中鼻甲部分切除术在功能性鼻内镜手术中的应用及其对慢性鼻窦炎症状改善和疗效的影响。方法选择中鼻甲垂直部长度≥25mm的慢性鼻窦炎患者60例，随机分为试验组和对照组，各30例。两组患者术前各项观察指标（鼻塞、流涕、头痛、嗅觉VAS评分，鼻内镜检查LundKennedy评分、CT LundMackey评分）差异无统计学意义（P>0.05）。试验组实施经鼻内镜鼻窦、鼻息肉手术并清除中鼻甲本身病变（泡甲、肥厚、息肉样变等）后，根据CT测量结果，以保留中鼻甲垂直部长度约21mm为参考值，切除多余的中鼻甲垂直部游离缘（即切除长度＝CT测量长度-21 mm）；对照组完成鼻窦、鼻息肉手术，按传统理念处理中鼻甲病变和变异，需要时切除中鼻甲前下部1/2~2/3。术后随访10~12个月，观察主观症状（鼻塞、流涕、头面痛及嗅觉障碍）、内镜检查LundKennedy评分、病情控制及疗效。结果两组术后各种症状VAS评分和内镜LundKennedy评分均明显优于术前（P均<0.05）；术后试验组的各项观察指标及总疗效均优于对照组，两组鼻塞及头痛的改善、鼻内镜LundKennedy评分及疗效差异具有统计学意义（P均<0.05）；而流涕、嗅觉改善方面，两组差异无统计学意义（P>0.05）；鼻窦炎伴鼻息肉、鼻窦炎伴中鼻甲病变者，试验组的疗效优于对照组（P<0.05）。结论“改良部分切除”主要针对过长的中鼻甲垂直部，必须是在处理中鼻甲病变（泡甲、肥厚、息肉样变等）、保证中鼻道一定宽度后才予切除，有助于术后鼻部症状的改善和减少术腔粘连，提高鼻内镜手术疗效。

关键词:鼻内镜手术|中鼻甲切除术|鼻窦炎|疗效

Abstract:

ObjectiveTo investigate the application of functional endoscopic sinus surgery (FESS) in the treatment of modified partial turbinectomy and its effect on the improvement of symptoms and curative effect of chronic sinusitis.Methods60 patients with chronic sinusitis whose vertical length of middle turbinate ≥25 mm were selected and randomly divided into 30 cases of experimental group and 30 cases of control group. There was no statistically significant difference between the two groups(P>0.05) in preoperative observation indicators (nasal obstruction, runny nose, headache, olfactory VAS score, LundKennedy endoscopy score and CT Lundmackey score) . In the experimental group, after performing endoscopic surgery on nasal sinuses and nasal polyps and removing the lesions of the middle turbinate itself (vacuole, hypertrophy, polyps, etc.), the redundant free margin of the vertical part of the middle turbinate (i.e., the length of resection = the length of CT measurement21 mm) was removed according to the CT measurement results with the retention of the vertical length of the middle turbinate about 21 mm as the reference value; In the control group, the surgery of sinus and nasal polyp hand were completed, and the lesions and changes of the middle turbinate were treated according to the traditional concept, and the 1/2~2/3 front of anterior and inferior parts of the middle turbinate were removed when necessary. The patients were followed up for 10 to 12 months. Subjective symptoms were observed including nasal obstruction, runny nose, headache and olfactory disturbance), LundKennedy score of endoscopy, disease control and curative effect.ResultsVAS scores and endoscopic LundKennedy scores were significantly better than those before surgery in both groups (P<0.05); the observation indexes and the whole efficacy of the experimental group were better than those of the control group after operation; there were significant differences in nasal obstruction, headache improvement, LundKennedy endoscopy score and curative effect between the two groups (P<0.05); while there were no significant differences in the improvement of runny nose and olfaction between the two groups (P>0.05). The curative effect of the experimental group was better than that of the control group (P<0.05).ConclusionsModified partial resection is mainly for the long vertical part of the middle turbinate, which must be resected after the treatment of the middle turbinate lesions (bullae, hypertrophy, polypoid degeneration, etc.) to ensure a certain width of the middle nasal meatus. It is helpful for the improvement of postoperative nasal symptoms and the reduction of intraoperative cavity adhesion, and the improvement of the curative effect of nasal endoscopic surgery.

Key words:Nasal endoscopic surgery| Middle turbinectomy| Sinusitis| Curative effect