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FESS或鼻中隔成形术失败原因及修正性鼻功能重建手术的疗效
卫来,彭凤兰,王立志,王志强
0
(大连大学附属中山医院耳鼻咽喉科)
摘要:
【摘要】 目的 探讨功能性内窥镜鼻窦手术(FESS)和(或)鼻中隔成形术失败的原因及修正性鼻功能重建手术的临床疗效。 方法 收集大连大学附属中山医院2013年1月~2017年12月因慢性鼻鼻窦炎(CRS)伴或不伴鼻中隔偏曲患者,行功能性内窥镜鼻窦手术和(或)鼻中隔成形术疗效不佳而行修正性鼻功能重建手术的患者40例,对临床资料进行回顾性分析。分别采用鼻窦CT、症状视觉模拟量表评分法(VAS)、Lund-Kennedy评分法评估功能性内镜鼻窦手术和(或) 鼻中隔成形术失败患者的症状和原因,针对病因制定手术方案,分别行修正性鼻功能重建手术,包括:鼻小叶成形术、鼻小柱成形术、歪鼻矫正术、鼻瓣区成形术、修正性鼻中隔成形术、修正性功能性内窥镜鼻窦手术等,以Lund-Kennedy评分法、VAS评估修正性鼻功能重建手术的临床疗效。 结果 功能性鼻内镜鼻窦手术失败的原因包括: 额隐窝区狭窄38例(95%),前组筛窦气房残留34例(85%),后组筛窦气房残留31例(77.5%),上颌窦窦口狭窄37例(92.5%),蝶窦口狭窄26例(54.2%),钩突残留34例(85%),中鼻甲畸形34例(85%),下鼻甲肥大34例(85%),鼻瓣区狭窄:鼻中隔尾端脱位11例(27.5%);鼻中隔偏曲矫正术失败的原因包括:鼻中隔软骨偏曲20例(50%)、筛骨垂直板偏曲18例(45%)、腭骨鼻棘偏曲10例(25%)、犁骨偏曲14例(35%)。外鼻畸形未矫正手术失败的原因:软骨鼻锥畸形2例(5%),骨鼻锥畸形2例(5%)、鼻小柱畸形1例(2.5%)、鼻小叶畸形2例(5%)。术后随访6个月,术前VAS评分和Lund-Kennedy评分与术后相比差异有统计学意义(P<0.05)。病情完全控制39例,部分控制1例,未控制0例,总有效率975%。 结论 窦口鼻道复合体、额隐窝和鼻中隔尾端异常解剖结构的残留是鼻鼻窦炎患者行功能性内窥镜和(或)鼻中隔成形术失败的主要原因;修正行鼻功能重建手术可有效治疗慢性鼻鼻窦炎伴或不伴鼻中隔偏曲手术失败的患者。
关键词:  慢性鼻-鼻窦炎  再手术  内窥镜鼻窦手术  鼻中隔成形术  修正性鼻功能重建手术  鼻中隔
DOI:
基金项目:
Reasons for failure of FESS or septoplasty and the effect of modified rhinoplasty
WEI Lai,PENG Fenglan,WANG Lizhi,WANG Zhiqiang
(Department of Otolaryngology, The Affiliated Zhongshan Hospital of Dalian University)
Abstract:
【Abstract】 Objective To explore the causes of failure of functional endoscopic sinus surgery (FESS) and/or septoplasty, and the clinical effect of modified functional rhinoplasty. Methods From January 2013 to December 2017, 40 patients with chronic rhinosinusitis (CRS) with or without deviation of the nasal septum who underwent functional endoscopic sinus surgery and / or septoplasty were collected. The clinical data were analyzed retrospectively. The symptoms and causes of failure of functional endoscopic sinus surgery and / or septoplasty were evaluated by CT, VAS and Lund Kennedy score, respectively. According to the cause of the disease, the modified reconstruction of nasal function was performed, including lobular rhinoplasty, columella rhinoplasty, crooked nose correction, flap area rhinoplasty, modified septum rhinoplasty, and modified functional endoscopic sinus surgery. Lund Kennedy score and VAS were used to evaluate the clinical effect of modified rhinoplasty. Results The reasons for failure of functional endoscopic sinus surgery include: 38 cases (95%) of frontal recess stenosis, 34 cases (85%) of air chamber residue of ethmoid sinus in anterior group, 31 cases (77.5%) of air chamber residue of ethmoid sinus in posterior group, 37 cases (92.5%) of maxillary sinus stenosis, 26 cases (54.2%) of sphenoid sinus stenosis, 34 cases (85%) of uncinate process residual, 34 cases (85%) of middle turbinate deformity and 11 cases (27.5%) of dislocation of nasal septum. The reasons for the failure of correction of deviation of nasal septum include: 20 cases (50%) of deviation of cartilage of nasal septum, 18 cases (45%) of deviation of vertical plate of ethmoid bone, 10 cases (25%) of deviation of nasal spine of palatine bone and 14 cases (35%) of deviation of vomer bone. The reasons for the failure of the operation were as follows: 2 cases (5%) of cartilaginous rhinoconus, 2 cases (5%) of bony rhinoconus, 1 case (2.5%) of columella and 2 cases (5%) of lobular deformity. After 6 months of followup, there were significant differences in VAS score and Lund Kennedy score (P<0.05). There were 39 cases of complete control, 1 case of partial control and 0 case of no control. The total effective rate was 975%. Conclusion The main reason for the failure of functional endoscopy and / or septoplasty in patients with nasosinusitis is the residual of the abnormal anatomical structure of the complex of the sinus, the frontal recess and the caudal end of the nasal septum. The modified reconstruction of nasal function can effectively treat the patients with chronic nasosinusitis with or without septal deviation.
Key words:  Chronic rhinosinusitics  Reoperation  Endoscopy surgery  Nasal septum plasty  Corrective nasal function reconstruction surgery

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