下鼻甲序贯手术在慢性肥厚性鼻炎中的应用

doi:10.6040/j.issn.1673-3770.0.2016.295

摘要/Abstract

摘要： 目的探讨下鼻甲序贯手术治疗慢性肥厚性鼻炎患者的应用价值,为临床提供一种优化的下鼻甲手术方案。方法随机纳入的109例肥厚性鼻炎患者,随机分为2组:序贯手术组54例、单纯等离子治疗组55例。分別于治疗后第2周、第2个月、第6个月记录患者的鼻塞、闷胀、鼻痒、流涕、鼻腔干燥、疼痛、鼻不适感的病情严重程度视觉模拟量表(VAS)积分及Lund-Kennedy内镜评分标准积分,观察治疗6个月。结果序贯手术组、单纯等离子治疗2个月、6个月后,2组的Lund-Kennedy内镜评分无统计学意义(P>0.05);2组在治疗第2周后Lund-Kennedy内镜评分的积分有统计学意义(P<0.05);序贯手术组Lund-Kennedy内镜评分的积分低于单纯等离子治疗组。2组在病情严重程度视觉模拟量表鼻塞、闷胀、鼻痒、流涕积分疗效的比较上存在统计学意义(P<0.05);2组在病情严重程度视觉模拟量表鼻腔干燥、疼痛、鼻不适感积分疗效的比较上存在统计学意义(P<0.05),序贯手术组鼻塞模拟视觉量表的积分低于单纯等离子治疗组。结论序贯手术组、单纯等离子治疗组在治疗肥厚性鼻炎上均取得了满意的疗效。2组患者经客观的Lund-Kennedy内镜评价,疗效无统计学意义。经主观视觉模拟量表评价,序贯手术组均优于单纯等离子治疗组。下鼻甲序贯手术对慢性肥厚性鼻炎有良好的疗效,对于保护下鼻甲生理功能、避免术后患者主观不适有明显的优越性。

关键词: 等离子射频消融, 序贯疗法, 慢性肥厚性鼻炎, 下鼻甲

Abstract: Objective To explore the application value of inferior nasal concha sequential surgery in the treatment of chronic hypertrophic rhinitis, so as to provide a optimized inferior nasal concha surgical protocol for clinical treatment. Methods A total of 109 patients with hypertrophic rhinitis were randomly enrolled and divided into sequential surgery group(n=54)and single plasma treatment group(n=55). The severity degree of rhinobyon, nasal stuffy, rhinocnesmus, mycteroxerosis, nasal pain, and nasal discomfort, visual analogue scale(VAS)score and Lund-Kennedy endoscope scores were recorded 2 weeks, 2 months and 6 months after the treatment. Results There was no significant difference between two groups in Lund-Kennedy endoscope score after treatment for 2 and 6 months respectively(P>0.05), but the difference was significant after 2-week treatment(P<0.05). Sequential surgery group was markedly lower in the total Lund-Kennedy endoscope score than single plasma treatment group. There were significant differences between the two groups in the severity scores of VAS like rhinobyon, nasal stuffy, rhinocnesmus and running nose(P<0.05), and the differences in the severity scores of VAS like mycteroxerosis, nasal pain, and nasal discomfort were also significant(P<0.05). Sequential surgery group was markedly lower in the total VAS score than single plasma treatment group. Conclusion Both groups have obtained satisfactory efficacy in the treatment of hypertrophic rhinitis. There is no significant difference between the two groups in objective Lund-Kennedy endoscope evaluation score. According to subjective VAS evaluation, sequential surgery group is evidently better than single plasma treatment group in clinical efficacy. Inferior nasal concha sequential surgery has excellent clinical efficacy in the treatment of chronic hypertrophic rhinitis, and also has significant advantages in protecting the physical function of inferior nasal concha and avoiding patients’ postoperative subjective discomfort.

Key words: Inferior turbinate, Sequential surgery, Chronic hypertrophic rhinitis, Plasma radiofrequency ablation

中图分类号:

R765.4

李宇,郑天其,李晋,李重,郭朝先. 下鼻甲序贯手术在慢性肥厚性鼻炎中的应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 62-66.

参考文献

[1] Wrobel BB, Bien AG, Holbrook EH, et al. Decreased nasal mucosal sensitivity in older subjects[J]. Am J Rhinol, 2006, 20(3):364-368.
[2] Lund VJ, Kennedy DW. Quantification for staging sinusitis. The staging and therapy group[J]. Ann Otol Rhinol Laryngol Suppl, 1995, 167:17-21.
[3] Nakayama T, Asaka D, Okushi T, et al. Endoscopic medial maxillectomy with preservation of inferior turbinate and nasolacrimal duct[J]. Am J Rhinol Allergy, 2012, 26(5):405-408.
[4] Gindros G, Kantas I. Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction[J]. Eur Arch Otorhinolaryngol, 2009, 266(9):1409-1416.
[5] 韩德民. 下鼻甲的结构、功能与症状[J]. 耳鼻咽喉-头颈外科, 2003, 10(4):195-196. HAN Demin. The construction, function and symptom of inferior turbinate[J]. Chin Arch Otolaryngolo Head Neck Surg, 2003, 10(4):195-196.
[6] 张松志, 王平, 宋瑾. 下鼻甲手术的循证研究[J]. 新乡医学院学报, 2012, 29(5):372-374, 377. ZHANG Songzhi, WANG Ping, SONG Jin. Evidence-based medicine of inferior turbinate surgery[J]. J Xinxiang Med Coll, 2012, 29(5):372-374, 377.
[7] 李宇. 下鼻甲骨折外移术与下鼻甲黏膜下部分切除术的比较[J]. 四川医学, 2010, 31(12):1835-1836.
[8] 董晶, 杨军, 徐永昌, 等. 慢性肥厚性鼻炎4种术式特点及下鼻甲黏膜的超微结构观察[J]. 临床耳鼻咽喉头颈外科杂志, 2006, 20(14):630-633. DONG Jing, YANG Jun, XU Yongchang, et al. The features of four types of operation for treating chronic hypertrophy rhinitis and ultrastructure observation of the inferior turbinate mucosa[J]. J Clin Otorhinolaryngol, 2006, 20(14):630-633.
[9] Passali D, Lauriello M, Anselmi M, et al. Treatment of hypertrophy of the inferior turbinate: long-termresults in 382 patients randomly assigned to therapy[J]. Ann Otol Rhinol Laryngol, 1999, 108(6):569-575.
[10] 胡洁, 邹坚定, 胡志孟, 等. 下鼻甲等离子消融的能量释放对鼻黏膜纤毛功能及组织病理改变的影响[J]. 中国眼耳鼻喉科杂志, 2011, 11(3):137-139. HU Jie, ZOU Jianding, HU Zhimeng, et al. Effect of coblation inferior turbinate reduction on nasal mucosa[J]. Chin J Ophthalmol Otorhinolaryngol, 2011, 11(3):137-139.
[11] 李云秋, 肖旭平, 谭志强, 等. 低温等离子消融术联合下鼻甲骨折外移治疗下鼻甲肥大的远期疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(23):1095-1097.
[12] 田昊, 马有祥, 丁秀勇, 等. 慢性鼻-鼻窦炎患者鼻内镜手术前心理学特征初步分析[J].中华耳鼻咽喉头颈外科杂志, 2015,50(3):210-214. TIAN Hao, MA Youxiang, DING Xiuyong, et al. Prevalence and psychopathological characteristics of anxiety and depression in patients with chronic rhinosinusitis before endoscopic sinus surgery[J]. Chin J Otorhinolaryngol Head Neck Surg, 2015, 50(3):210-214.
[13] Forkmann T, Norra C, Wirtz M, et al. Prevalence and psychopathological characteristics of depression in consecutive otorhinolaryngologic inpatients[J]. BMC Ear Nose Throat Disord, 2011, 11:7.
[14] Passali D, Passali FM, Damiani V, et al. Treatment of inferior turbinate hypertrophy: a randomized clinical trial[J]. Ann Otol Rhinol Laryngol, 2003, 112(8):683-688.

相关文章 15

[1]	王桂香, 张杰, 赵靖, 唐力行, 倪鑫. 婴幼儿舌根囊肿的诊断及围手术期治疗要点[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 62-64.
[2]	周毅波，颜永毅. 鼻内镜下改良下鼻甲成形术临床观察[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 31-33.
[3]	梁飞，林庆强，刘俊平. 低温等离子射频消融治疗常年性变应性鼻炎合并支气管哮喘的疗效及安全性评价[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 20-22.
[4]	徐文雅，刘婷婷，姜晓丹，党志红，娄帅帅,张念凯. 低温等离子消融术与下鼻甲成形术治疗慢性鼻炎的对比研究[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 27-30.
[5]	谭国杰，颜永毅，林颖. 两种术式处理慢性肥厚性鼻炎疗效分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(3): 30-32.
[6]	张浩亮,于锋,龚辉成,张群慧. 保留下鼻甲海绵状组织的鼻腔扩容术治疗OSAHS[J]. 山东大学耳鼻喉眼学报, 2013, 27(3): 42-44.
[7]	侯森1，杨海珍2. 低温等离子射频消融术治疗慢性肥厚性鼻炎有效率的Meta分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(1): 51-53.
[8]	王丽娟1，左敏2，高国凤1，曾少明1，张伟1，刘明1. 神经生长因子及其受体在鼻息肉中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 49-.
[9]	刘继远，佘志强，龙增勇，陆灵娟. 等离子射频消融辅助手术治疗鼻瓣区多部位狭窄47例[J]. 山东大学耳鼻喉眼学报, 2011, 25(3): 63-65.
[10]	刘杰1，陈珊1，孙伯锋1，田兴德2 . 等离子低温射频消融联合下鼻甲骨折外移术治疗慢性肥厚性鼻炎的疗效观察[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 66-67.
[11]	甘卫刚1，洪育明2. 鼻中隔矫正术治疗变应性鼻炎的临床观察[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 48-50.
[12]	郭涛,孙敬武, 胡燕明,汪银风. 黏膜下下鼻甲骨部分切除联合骨折外移术的临床疗效[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 44-46.
[13]	何本超,郑志刚,李健勇 . 内镜下吸引切割器及反向咬钳下鼻甲成形治疗肥厚性鼻炎[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 155-156 .
[14]	张庆泉,宋西成,张华,孙岩,王强,王永福 . 鼻部手术联合其他平面手术治疗OSAHS疗效分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 102-104 .
[15]	蔡克敏,程雷 . 鼻内镜下应用微型切割器行下鼻甲减容术[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 83-84 .

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed