三种不同术式治疗慢性肥厚性鼻炎的疗效分析

目的比较下鼻甲部分切除术、半导体激光术和下鼻甲成形术治疗慢性肥厚性鼻炎的效果。方法 650例确诊的慢性肥厚性鼻炎患者,其中男性353例,女性297例,年龄17～62岁,平均年龄41.6岁。随机分为3组,行下鼻甲部分切除术组(A组),行半导体激光术组(B组),行下鼻甲成形术组(C组)。对3组治疗的慢性肥厚性鼻炎患者进行回顾性分析。结果 A组和C组有效率均为100.0%,B组有效率为92.5%;A组和C组与B组比较差异有统计学意义。C组术后鼻塞天数和黏膜修复时间最短,且并发症最少,而A组在3组比较中鼻塞天数和黏膜修复时间最长,并发症最多。结论 3组手术方式均是治疗慢性肥厚性鼻炎的有效方法,但下鼻甲成形术具有术后反应轻、恢复快、并发症少等特点,更符合生理功能。     

两种方法治疗慢性肥厚性鼻炎的临床体会

慢性肥厚性鼻炎是东北地区的常见病,以鼻塞为主,长期可引起分泌性中耳炎、鼻窦炎等。治疗的方法很多,如:硬化法、鼻甲封闭法、烧灼法、鼻甲部分切除术、微波、激光术等。我科自1999年以来对62例患者分别行鼻甲部分切除术和Nd.YAG激光鼻甲粘膜凝固两种方法治疗慢性肥厚性鼻炎,将治疗效果进行比较,借以选择最有效的治疗方法。现报告如下。     

手术联合治疗鼻中隔偏曲合并下鼻甲肥大临床观察

目的：总结分析手术联合治疗在鼻中隔偏曲合并下鼻甲肥大患者治疗中的应用效果。方法选择2010年6月~2012年12月我院收治的60例鼻中隔偏曲合并下鼻甲肥大患者为研究对象，根据治疗方法分为联合手术组和对照组各30例，对照组患者进行鼻中隔矫正术，联合手术组联合进行鼻中隔矫正术与下鼻甲外移术，观察比较两组患者的治疗效果。结果联合手术组治愈率73.33%明显高于对照组33.33%，差异具有统计学意义(P<0.05)；同时联合手术组好转率100.00%明显高于对照组80.00%，差异具有统计学意义(P<0.05)；联合手术治疗组术后3 d 1例鼻中隔局部血肿，并发症发生率为3.33%。对照组患者术后复查2例出现鼻腔局部粘连现象，并发症发生率为6.67%。两组患者术后并发症发生率之间相比不具有统计学意义(P>0.05)。结论对于鼻中隔偏曲合并下鼻甲肥大患者在CT与内镜技术辅助下试试鼻中隔偏曲矫正联合下鼻甲外移术治疗效果较好，且对组织损伤小，手术安全可靠，符合临床上功能性治疗原则，提高临床效果。     

低温等离子射频消融治疗慢性肥厚性鼻炎的护理探讨

目的 探讨低温等离子射频消融治疗慢性肥厚性鼻炎的围手术期护理,减少并发症发生.方法 回顾性分析56例慢性肥厚性鼻炎患者行低温等离子射频消融治疗临床护理资料.结果 术前加强心理护理,完善术前各项检查,术后观察鼻腔渗血情况,指导正确的鼻腔滴药,56例患者均获成功,未出现并发症.结论 配合精心的护理,可减少术后并发症.     

鼻息肉手术中中鼻甲的处理

目的探讨鼻息肉手术中中鼻甲的处理方法,及其对患者术后鼻腔功能恢复的影响。方法回顾分析78例鼻息肉患者的临床资料,分析其术后疗效。结果78例患者共149侧,治愈110侧,好转30侧,无效9侧。结论鼻内镜下鼻息肉手术中,对中鼻甲的处理须根据中鼻甲的病变,彻底清除息肉样变的组织、以保证中鼻道引流通畅,这可减少术后复发,利于患者术后功能恢复。     

等离子射频消融治疗慢性肥厚性鼻炎56例体会

目的探讨等离子低温射频消融对慢性肥厚性鼻炎的临床疗效。方法自2008年3月应用下鼻甲等离子消融治疗治疗慢性肥厚性鼻炎患者56例,回顾性分析总结分析临床疗效。结果术后随访6月,治愈45例（80.5%）,有效9例（16%）,有效率96.5%。无并发症发生。结论等离子低温射频消融是治疗慢性肥厚性鼻炎的一种安全、简便、有效的方法,无不良反应。     

等离子射频消融治疗慢性肥厚性鼻炎56例体会

目的 探讨等离子低温射频消融对慢性肥厚性鼻炎的临床疗效.方法 自2008年3月应用下鼻甲等离子消融治疗治疗慢性肥厚性鼻炎患者56例,回顾性分析总结分析临床疗效.结果 术后随访6月,治愈45(80.5%),有效9例(16%),有效率96.5%.无并发症发生.结论 等离子低温射频消融是治疗慢性肥厚性鼻炙的一种安全、简便、有效的方法,无不良反应.     

鼻内镜下中鼻甲修整治疗泡状中鼻甲致鼻源性头痛

目的：探讨泡状中鼻甲引发头痛的诊断与手术治疗。方法对29例经鼻内试验及鼻窦CT检查明确为泡状中鼻甲者行鼻内镜下中鼻甲修整术。结果头痛症状完全消失,随访6个月无复发视为痊愈。头痛明显减轻6月以上视为显著疗效,24例痊愈,5例显著疗效。结论治疗的要点是矫正鼻腔局部解剖变异,解除鼻粘膜相抵触的状态,使鼻腔接触性头痛的病因得以解除。     

鼻内镜中鼻甲手术的应用解剖

目的:为鼻内镜中鼻甲手术提供相关解剖学资料。方法:对60具完整成年尸头标本中鼻甲的矢状位和冠状位进行解剖学观察,观察中鼻甲有无被筛窦气化、中鼻甲弯曲形态;以鼻前棘为标志点,测量鼻前棘与中鼻甲前缘顶点、与中鼻甲前缘与中鼻甲下缘移行处及与中鼻甲基板中点间距离,并以鼻腔底部为水平面测量其与上述三条测量线所成的夹角。结果:中鼻甲被筛窦气房气化率为34.1%,中鼻甲反向弯曲率为19.2%。鼻前棘至中鼻甲前端顶部距离为48 mm,两点连线与鼻腔底部成角75°;鼻前棘至中鼻甲前缘与中鼻甲下缘移行处的距离为35 mm,两点连线与鼻腔底部成角60°;鼻前棘至中鼻甲基板中部距离43 mm,两点连线与鼻腔底部成角55°。结论:中鼻甲是鼻内镜手术的重要标志,熟练掌握中鼻甲的应用解剖可以有效预防鼻内镜手术颅内及眶内并发症的发生。     

鼻内镜下鼻甲重塑术63例分析

目的：探索治疗下鼻甲结构异常的合理方式。方法：对63例（88侧）下鼻甲结构异常患者，根据异常类型采用不同的重塑方式，并同期处理影响结构异常的其它因素；术后定期随访观察，记录术后切缘愈合、下鼻甲的位置和形态、鼻塞改善情况。结果：术后随访半年，治愈75侧（85．2％），有效13侧（14．8％），全部患者下鼻甲的形态、结构、功能均基本恢复正常，未有鼻腔粘连、干燥等现象发生。结论：鼻内镜下鼻甲重塑术并同期处理影响其结构改变的其它因素，临床疗效好，并发症少，符合鼻腔微创原则，是治疗下鼻甲结构异常的理想途径。     

Submucous turbinectomy decreases not only nasal stiffness but also sneezing and rhinorrhea in patients with perennial allergic rhinitis

BACKGROUND: Turbinate surgery, in which mucous epithelium is resected, has often been used for patients with perennial allergic rhinitis, since the mucous epithelium is the principal site for immunoglobulin (Ig)E-mediated allergic reactions and chronic inflammation. OBJECTIVE: To assess the effect of submucous turbinectomy on allergic rhinitis. METHODS: Sixty patients with severe perennial allergic rhinitis underwent submucous turbinectomy and were followed-up for 1 year. Nasal symptoms were evaluated with a standard symptom score. Rhinometry was used to evaluate nasal congestion, and nasal provocation tests in vivo were performed to evaluate allergic reactions. In 16 cases, biopsies from the nose were also available for immunohistochemical analysis. These examinations were performed before and after submucous turbinectomy. RESULTS: The mean total nasal symptom score (7.2 +/- 1.7, mean +/- SD before surgery) was significantly reduced after surgery (1.2 +/- 1.4, P < 0.0001), and the effect of the surgery on nasal symptoms continued for at least 12 months (1.9 +/- 1.8, P < 0.0001). Submucous turbinectomy reduced both nasal discharge and sneezing, as well as nasal stiffness. Histopathological examination following surgery revealed that the lamina propria was occupied by fibrous tissues, and that the number of vessels, nasal glands, eosinophils and infiltrating IgE+ cells decreased in the turbinate. There were no significant differences in the levels of either house dust mite-specific or non-specific IgE in the serum between before and after surgery. CONCLUSION: Submucous turbinectomy preserving the ciliary epithelium is a powerful strategy for improving nasal symptoms induced by allergic reaction via the reduction in the number of allergy-related cells in the nose.     

Effects of single-sided inferior turbinectomy on nasal function and airflow characteristics

Knowledge of airflow characteristics in the nasal cavity is essential to understanding the physiologic and pathologic aspects of nasal breathing. Airflows inside post-surgery models were investigated both experimentally and numerically to simulate the inferior turbinectomy. The left cavities of all three models are normal and right cavity is modified by (1) excision of the head of the inferior turbinate, (2) resection of the lower fifth of the inferior turbinate, and (3) resection of almost the entire inferior turbinate. Thin-slice CT (computed tomography) data (0.6mm deep) and meticulous refinement of the model surface by over a decade-long collaboration between engineers and an experienced ENT doctor resulted in the creation of sophisticated nasal cavity models. After numerical experiments and validation by comparison with the PIV results, the CFD code using the Reynolds stress turbulent model and variable temperature boundary condition on the mucosal wall was chosen as the proper numerical framework. Both global quantities (pressure drop, flow rate ratio, total wall heat transfer) and local changes (velocity, temperature, humidity, pressure gradient, and wall shear stress) were numerically investigated. The turbinectomy obviously altered the main stream direction. The flow rate in the upper airway near the olfactory slit decreased in models (1) and (3). This may weaken the olfactory function of the nose. Fluid and thermal properties that are believed to be related with physiology and prognosis are dependent on turbinate resection volume, position, and manner. Widening of the inferior airway does not always result in decreased flow resistance or wall heat transfer. The gains and losses of inferior turbinectomy were considered by analysis of the post-surgery model results. Nasal resistance was increased in model (1) due to sudden airway expansion. Nasal resistance increased and the wall heat transfer decreased in model (3) due to sudden airway expansion and excessive reduction of the mucosal wall surface area. Local shear stress and pressure gradient levels were increased in models (1) and (3).     

Surgical treatment of the inferior turbinate for allergic rhinitis: clinical evaluation and therapeutic mechanisms of the different techniques

Many different surgical procedures have been described to alleviate nasal obstruction due to turbinate hypertrophy in patients with allergic rhinitis (AR) who continuously have chronic nasal congestion. The goal of surgical procedures should be 'optimal reduction of volume and secretion with preservation of function'. For a period of about 25 years, laser surgery of the inferior turbinate has been considered a simple and effective surgical treatment with a low complication rate that has been in widespread use by many ENT surgeons. Various trials have demonstrated the clinical effectiveness of a series of different laser systems including carbon dioxide, Nd:YAG, potassium-titanyl-phosphate, and diode laser. Laser surgery generally induces significant increases of the total volume of the nasal cavity. Several studies have provided evidence that the expression degree of local inflammatory cytokines and chemical mediators can be attenuated by the treatment. The mucociliary function of the inferior turbinate seems to be preserved after CO₂ laser intervention. A breakthrough in the surgical procedures available for allergic patients who severely suffer from both intractable hypertrophic inferior turbinates and unregulated nasal secretion was introduced in Japan. Posterior nasal neurectomy is a novel alternative method in which neural bundles are selectively cut or cauterized from the sphenopalatine foramen. Resection of the posterior nasal nerve at this point enables surgeons to inhibit the parasympathetic nerve function of the nasal mucosa with no troublesome complications such as decrease of lacrimal secretion. The procedure simultaneously provides interruption of the somatic afferent innervation to the turbinate mucosa. Herein we assess the clinical effectiveness of this surgical procedure based on objective and measurable monitoring parameters and discuss the underlying therapeutic mechanisms.     

Release of high-molecular-weight neutrophil chemotactic activity from resected human nasal turbinate after antigen challenge

Eleven patients with allergic rhinitis were studied. All subjects were sensitive to house dust mite documented by skin test, RAST score, and nasal provocation test. The patients needed lower turbinectomy because of chronic hypertrophic rhinitis. Tissues of the lower turbinate were obtained at the time of surgery, fragmented, and subsequently challenged with house dust mite in vitro. Diffusates were collected for measurement of neutrophil chemotactic activity (NCA) and histamine. NCA and histamine were released in a dose-dependent manner, and the time course of release of these mediators was identical. Release of NCA and histamine correlated significantly (p less than 0.001). The prior administration of the antiallergic drugs, disodium cromoglycate or tranilast, significantly blocked the release of NCA and histamine from antigen-challenged tissues. NCA released from nasal tissues eluted as a single peak with estimated molecular size of between 669 kd and 440 kd in three subjects and as two or three peaks in two patients. These results provide evidence that NCA might be involved in the pathogenesis of allergic rhinitis.     

Clinical effectiveness of coblation-assisted inferior turbinoplasty

Background: Laser-assisted inferior turbinoplasty has become accepted as a common treatment for patients displaying allergic rhinitis with severe nasal obstruction. Coblation-assisted inferior turbinoplasty has recently been reported. The aim of this study was to evaluate the effectiveness of coblation-assisted inferior turbinoplasty, compared with laser surgery. Methods: Between November 2004 and May 2007, a total of 29 patients were treated with coblation-assisted inferior turbinoplasty. We evaluated symptom scores at 1 month, 1 year and 2 years after surgery, compared with the results of Nd: YAG laser surgery. Results: At 1 month after surgery, improvement rates of symptom scores were good and similar between coblation- and laser-assisted surgery. At 1 year after surgery, improvement rates of laser surgery had significantly decreased. However, improvement rates of coblation surgery had not changed at 1 and 2 years (sneeze, 64%; nasal discharge, 71%; nasal obstruction, 79%) after surgery. Conclusion: Coblation-assisted inferior turbinoplasty appears effective for the treatment of patients with allergic rhinitis and nasal obstruction.     

Ethmoid sinus mycology of chronic rhinosinusitis

This goal of this study was to demonstrate whether fungi were present in the ethmoid sinus in patients with chronic rhinosinusitis. Before surgery, swab specimens were collected from the middle meatus for conventional fungal cultures, and lavaged fluid was collected from the nasal cavity for fungal cultures by Ponikau’s method. During surgery, tissue specimens were taken from the inferior turbinate and the anterior ethmoid sinus for conventional fungal cultures and detection of fungal DNA by polymerase chain reaction. The ethmoid sinus mucosa with coating mucus was also collected for fungal cultures by Ponikau’s method. Among 53 specimens, three middle meatal specimens and 27 lavaged specimens (50.9%) grew fungi. Inferior turbinal mucosa did not grow fungi, but three ethmoid sinus specimens grew fungi by the conventional fungal culture method and by Ponikau’s method. Alternaria DNA was detected in 42 inferior turbinal specimens (79.3%) and in 39 ethmoid sinus specimens (73.6%). Our study showed that although fungi were rarely cultured from the ethmoid sinus Alternaria DNA was detected in most of the ethmoid sinus mucosa.     

鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的疗效分析

探讨鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的疗效。方法 选取81例就诊于我科的变应性鼻炎伴鼻中隔偏曲患者,随机分为对照组40例和治疗组41例。对照组采用鼻中隔矫正术治疗,治疗组采用鼻中隔矫正联合射频消融治疗。观察两组治疗后3个月、6个月和1年的临床疗效以及并发症情况。结果 两组患者术后3个月治疗总有效率比较,差异无统计学意义（P＞0.05）;治疗组患者术后6个月和术后1年的治疗总有效率分别为85.00%和82.50%,均高于对照组的63.41%和58.54%,差异具有统计学意义（P＜0.05）。手术病例均未见鼻中隔穿孔、鼻腔粘连、下鼻甲萎缩等严重并发症。结论 相对于单纯鼻中隔矫正术,鼻中隔矫正联合筛前神经射频消融治疗变应性鼻炎伴鼻中隔偏曲的远期疗效明显,安全性较高。