鼻中隔穿孔43例手术修补疗效分析及带蒂鼻底黏膜瓣联合硅胶片支撑术式应用

Surgical outcomes of nasal septal perforation repair in 43 cases and application of pedicled nasal floor mucosal flap combined with superior-edge suturing and silicone-sheet support

摘要:

【摘要】目的 总结鼻中隔穿孔患者手术修补的临床疗效，并探讨带蒂鼻底黏膜瓣联合穿孔上缘缝合及硅胶片支撑术式的应用价值。方法 回顾性分析2022年3月至2026年3月于中国人民解放军联勤保障部队第九四〇医院接受鼻中隔穿孔修补术的43例患者临床资料。收集患者年龄、性别、病因、穿孔面积、手术时长、手术方式及术前术后鼻部症状视觉模拟评分（visual analogue scale，VAS）。43例患者根据穿孔大小、部位、病因及局部黏膜条件分别采用带蒂鼻底黏膜瓣联合穿孔上缘缝合及硅胶片支撑修补术、游离植入、软骨/骨板支撑植入及复合移植物修补等术式。所有患者均于术后9个月末次随访时行鼻内镜检查，评估穿孔闭合情况及症状改善情况。结果 43例患者中，男37例、女6例；年龄36.00（28.00，55.50）岁；病因为外伤性23例、医源性8例、不明或其他12例；穿孔面积47.12（19.24，73.05）mm²。手术方式包括带蒂鼻底黏膜瓣联合穿孔上缘缝合及硅胶片支撑修补术8例、游离植入10例、软骨/骨板支撑植入18例、复合移植物修补7例。术后9个月末次随访时，完全闭合34例，完全闭合率为79.1%；修补失败9例，其中部分闭合7例，复发/未闭合2例。8例采用带蒂鼻底黏膜瓣联合穿孔上缘缝合及硅胶片支撑修补术者，完全闭合7例，部分闭合1例，完全闭合率为87.5%。43例患者术后鼻塞、干燥、出血及哨声VAS评分均较术前下降，差异均有统计学意义（均P＜0.05）。结论 手术修补可有效改善症状性鼻中隔穿孔患者的鼻塞、干燥、出血及哨声等症状，并获得较好的穿孔闭合效果。带蒂鼻底黏膜瓣联合穿孔上缘缝合及硅胶片支撑术式可提供带血供黏膜覆盖、边缘减张缝合及术后支撑保护，在较大或局部条件复杂的鼻中隔穿孔修补中具有一定应用价值，但仍需更大样本及长期随访研究进一步验证。

Abstract:

Abstract: Objective To summarize the clinical outcomes of surgical repair for nasal septal perforation and to explore the application value of pedicled nasal floor mucosal flap combined with superior-edge suturing and silicone-sheet support. Methods Clinical data of 43 patients with nasal septal perforation who underwent surgical repair at the 940th Hospital of Joint Logistics Support Force of PLA from March 2022 to March 2026 were retrospectively analyzed. Age, sex, etiology, perforation area, operative time, surgical procedure, and preoperative and postoperative visual analogue scale (VAS) scores for nasal symptoms were collected. According to perforation size, location, etiology, and local mucosal conditions, individualized procedures were performed, including pedicled nasal floor mucosal flap combined with superior-edge suturing and silicone-sheet support, free grafting, cartilage/bony plate support implantation, and composite graft repair. Nasal endoscopy was performed at the last follow-up 9 months after surgery to assess perforation closure and symptom improvement. Results Among the 43 patients, 37 were male and 6 were female. The median age was 36.00 (28.00, 55.50) years, and the median perforation area was 47.12 (19.24, 73.05) mm². Etiologies included trauma in 23 cases, iatrogenic factors in 8 cases, and unknown or other causes in 12 cases. Surgical procedures included pedicled nasal floor mucosal flap combined with superior-edge suturing and silicone-sheet support in 8 cases, free grafting in 10 cases, cartilage/bony plate support implantation in 18 cases, and composite graft repair in 7 cases. At the 9-month follow-up, complete closure was achieved in 34 cases, with an overall complete closure rate of 79.1%. Repair failure occurred in 9 cases, including partial closure in 7 cases and recurrence/non-closure in 2 cases. Among the 8 patients treated with the combined pedicled nasal floor mucosal flap technique, 7 achieved complete closure and 1 had partial closure, yielding a complete closure rate of 87.5%. Postoperative VAS scores for nasal obstruction, dryness, bleeding, and whistling were significantly lower than preoperative scores in the 43 patients (all P<0.05). Conclusion Surgical repair can effectively improve nasal obstruction, dryness, bleeding, and whistling in patients with symptomatic nasal septal perforation and achieve favorable closure outcomes. Pedicled nasal floor mucosal flap combined with superior-edge suturing and silicone-sheet support provides vascularized mucosal coverage, tension-reducing edge approximation, and postoperative support, suggesting potential value for relatively large or locally complex nasal septal perforations. Larger studies with longer follow-up are needed for further validation.