山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (6): 83-88.doi: 10.6040/j.issn.1673-3770.0.2021.227

• • 上一篇    下一篇

鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎的临床对比研究

张旻, 刘永亮, 宋道亮, 韩学锋, 封新荣, 赵允沛   

  1. 淄博市中心医院 耳鼻咽喉科, 山东 淄博 255000
  • 发布日期:2021-12-10
  • 通讯作者: 刘永亮. E-mail:liu_yl@sina.cn
  • 基金资助:
    山东省自然科学基金(ZR2020MC062);淄博市重点研发计划公益类专项(2019gy010003)

A comparative study on the treatment of severe chronic hypertrophic rhinitis by modified inferior turbinate plasty under nasal endoscopy and low-temperature plasma ablation with fracture displacement of the inferior turbinate

ZHANG Min, LIU Yongliang, SONG Daoliang, HAN Xuefeng, FENG Xinrong, ZHAO Yunpei   

  1. Department of Otorhinolaryngology, Zibo Central Hospital, Zibo 255000, Shandong, China
  • Published:2021-12-10

PDF (PC)

398

摘要： 目的 将鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎(下鼻甲黏膜、骨膜及骨质均增生肥大、鼻甲形态异常、VAS评分重度)进行对比研究。 方法 回顾性分析124例重度慢性肥厚性鼻炎患者,按照手术方式分为A(64例)、B(60例)两组,A组采用改良下鼻甲成形术,B组采用下鼻甲低温等离子消融加骨折外移术。术前1周、术后6个月、术后12个月分别用VAS标准评分患者鼻腔症状。糖精试验评价术前1周及术后6个月两组患者鼻腔黏膜纤毛传送功能。术前1周及术后6个月测定鼻阻力,评定鼻塞改善情况。 结果 下鼻甲低温等离子消融加骨折外移术组术中出血、手术时间较改良下鼻甲成形组明显减少,且术后并发症较少;术后6个月两种患者鼻塞均有显著改善;两种手术方式对鼻腔黏膜纤毛功能均无明显影响。A组平均手术时间27.80 min、并发症发生率9.38%,B组平均手术时间19.10 min、并发症发生率6.67%。两组患者术后6个月VAS平均评分差异无统计学意义(P=0.12),术后12个月差异有统计学意义(P=0.03)。 结论 改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎近期效果(6个月内)都良好,但远期效果(1年以上)改良下鼻甲成形术效果更好,因而建议对于重度慢性肥厚性鼻炎患者应因人而异精准诊疗。

关键词: 改良下鼻甲成形术, 低温等离子消融术, 骨折外移术, 鼻内镜, 重度慢性肥厚性鼻炎, 临床效果

Abstract: Objective To compare the clinical effect of modified inferior turbinate plasty under nasal endoscopy and low-temperature plasma ablation with fracture displacement of the inferior turbinate in the treatment of severe chronic hypertrophic rhinitis(hypertrophy of the inferior turbinate mucosa and periosteum, abnormal turbinate morphology, and severe VAS score). Methods A total of 124 patients with severe chronic hypertrophic rhinitis were retrospectively analyzed. Patients were randomly divided into two groups according to the surgical method used: 64 patients in group A were treated with modified inferior turbinate plasty, and 60 patients in group B were treated with low-temperature plasma ablation of the inferior turbinate plus external fracture removal. The VAS standard score was used to evaluate nasal symptoms 1 week before as well as 6 and 12 months after surgery. Saccharin test was used to evaluate the nasal mucociliary transport function of patients in both groups, 1 week before and 6 months after surgery. Nasal resistance was measured 1 week before and 6 months after surgery, and the improvement in nasal obstruction was evaluated. Results Intraoperative hemorrhage was reduced, operative time was shorter, and the complications rate was lower in group B compared with group A. Six months after the surgery, nasal congestion significantly improved in both groups. Nasal mucociliary function was not significantly affected by either surgical methods. The average operation times were 27.80 min and 19.10 min, and the complication rates were 9.38% and 6.67%, in groups A and B, respectively. Comparison of the average VAS score after surgery between the two groups showed no statistically significant difference at 6 months after surgery(P=0.12); however, a statistically significant difference was found at 12 months after surgery(P=0.03) Conclusion Both surgical methods, modified inferior turbinate plasty and low-temperature plasma ablation of the inferior turbinate combined with fracture displacement, had good short-term effects(6 months)in the treatment of severe chronic hypertrophic rhinitis; further, modified inferior turbinate plasty had better long-term effect(>1 year). Therefore, it is suggested that precise diagnosis should be made and treatment should be accordingly performed in different patients with severe chronic hypertrophic rhinitis.

Key words: Modified inferior turbinate plasty, Low temperature plasma ablation, Displacement of fracture, Nasal endoscopy, Severe chronic hypertrophic rhinitis, Clinical effect

中图分类号: 

  • R765.21
[1] 田勇泉.耳鼻咽喉头颈外科学[M]. 6版.北京: 人民卫生出版社, 2010: 58-61.
[2] 黄选兆, 汪吉宝. 实用耳鼻咽喉科学[M]. 北京: 人民卫生出版社, 2007: 109-112.
[3] Asai K, Haruna S, Otori N, et al. Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery[J]. Laryngoscope, 2000, 110(1): 117-122. doi:10.1097/00005537-200001000-00021.
[4] Boatsman JE, Calhoun KH, Ryan MW. Relationship between rhinosinusitis symptoms and mucociliary clearance time[J]. Otolaryngol Head Neck Surg, 2006, 134(3): 491-493. doi:10.1016/j.otohns.2005.10.045.
[5] Cmejrek RC, Gutman MT, Torres AJ, et al. The effect of injection immunotherapy on mucociliary clearance in allergic patients[J]. Otolaryngol Head Neck Surg, 2005, 133(1): 9-15. doi:10.1016/j.otohns.2005.03.062.
[6] Lin HC, Lin PW, Su CY, et al. Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy[J]. Laryngoscope, 2003, 113(4): 673-678. doi:10.1097/00005537-200304000-00017.
[7] 袁晓培, 马有祥, 邢志敏, 等. 鼻内镜下鼻腔成形术治疗结构性鼻炎[J]. 临床耳鼻咽喉头颈外科杂志, 2007,21(17): 782-785. doi: 10.3969/j.issn.1001-1781.2007.17.006. YUAN Xiaopei, MA Youxiang, XING Zhimin, et al. Endoscopic rhinoplasty of nasal cavity for treatment of structural rhinitis[J]. J Clin Otorhinolaryngol Head Neck Surg, 2007,21(17): 782-785. doi: 10.3969/j.issn.1001-1781.2007.17.006.
[8] 钱克坚. 鼻内镜下鼻甲黏膜下切除治疗慢性肥厚性鼻炎172例[J]. 中国耳鼻咽喉颅底外科杂志, 2011,17(3): 229,231. doi: CNKI:SUN:ZEBY.0.2011-03-024.
[9] Lenders H, Pirsig W. Diagnostic value of acoustic rhinometry: patients with allergic and vasomotor rhinitis compared with normal controls[J]. Rhinology, 1990, 28(1): 5-16. PMID: 2336526.
[10] 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. doi:10.3969/j.issn.1672-7002.2003.04.001. HAN Demin. The construction, function and symptom of inferior turbinate[J]. Chin Arch Otolaryngol-Head Neck Surg, 2003, 10(4): 195-196. doi:10.3969/j.issn.1672-7002.2003.04.001.
[11] 许庚, 杨钦泰, 徐睿, 等. 对下鼻甲手术的评价[J]. 耳鼻咽喉头颈外科, 2003, 10(4): 197-198. doi:10.3969/j.issn.1672-7002.2003.04.002. XU Geng, YANG Qintai, XU Rui, et al. Comment of inferior turbinate surgery[J]. Chin Arch Otolaryngol- Head Neck Surg, 2003, 10(4): 197-198. doi:10.3969/j.issn.1672-7002.2003.04.002.
[12] Churchill SE, Shackelford LL, Georgi JN, et al. Morphological variation and airflow dynamics in the human nose[J]. Am J Hum Biol, 2004, 16(6): 625-638. doi:10.1002/ajhb.20074.
[13] Damm M, Eckel HE, Jungehülsing M, et al. Olfactory changes at threshold and suprathreshold levels following septoplasty with partial inferior turbinectomy[J]. Ann Otol Rhinol Laryngol, 2003, 112(1): 91-97. doi:10.1177/000348940311200117.
[14] 王琪, 付维. 下鼻甲肥大的诊断和治疗[J]. 中国医学文摘·耳鼻咽喉科学, 2006, 21(3): 163-166. doi:10.19617/j.issn1001-1307.2006.03.011.
[15] 葛文彤. 下鼻甲手术历史和现状[J]. 耳鼻咽喉头颈外科, 2003, 10(4): 203-207. doi:10.3969/j.issn.1672-7002.2003.04.005.
[16] 史广涛, 王梅英, 孙慧远. 不同方式下鼻甲手术治疗慢性鼻炎的疗效观察[J]. 中国耳鼻咽喉头颈外科, 2021,28(2): 116-117. doi:10.16066/j.1672-7002.2021.02.013.
[17] 宋西成, 陈秀梅. 功能性鼻内镜手术中下鼻甲的处理及应用[J]. 山东大学耳鼻喉眼学报, 2011,25(5): 41-45.
[18] 牛善利, 柴茂文, 李振秀. 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16-18. doi:10.3969/j.issn.1673-3770.2006.01.005. NIU Shanli, CHAI Maowen, LI Zhenxiu. Endoscopic rhinoplasty of inferior turbinate in 60 patients with chronic hypertrophic rhinitis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2006, 20(1): 16-18. doi:10.3969/j.issn.1673-3770.2006.01.005.
[19] 肖水芳, 张俊波. 进一步规范化推广等离子射频技术在耳鼻咽喉头颈外科中的应用[J]. 山东大学耳鼻喉眼学报, 2021,35(2): 1-8. doi: 10.6040/j.issn.1673-3770.1. XIAO Shuifang, ZHANG Junbo. Further standardized promotion of the application of radiofrequency coblation in otorhinolaryngology, head and neck surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2021,35(2): 1-8. doi: 10.6040/j.issn.1673-3770.1.
[20] Elwany S, Gaimaee R, Fattah HA. Radiofrequency bipolar submucosal diathermy of the inferior turbinates[J]. Am J Rhinol, 1999, 13(2): 145-149. doi:10.2500/105065899782106715.
[21] Berger G, Ophir D, Pitaro K, et al. Histopathological changes after coblation inferior turbinate reduction[J]. Arch Otolaryngol Head Neck Surg, 2008, 134(8): 819-823. doi:10.1001/archotol.134.8.819.
[22] 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): 137-139,205. doi:10.14166/j.issn.1671-2420.2011.03.008. 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): 137-139,205. doi:10.14166/j.issn.1671-2420.2011.03.008.
[23] Bäck LJ, Hytönen ML, Malmberg HO, et al. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment[J]. Laryngoscope, 2002, 112(10): 1806-1812. doi:10.1097/00005537-200210000-00019.
[24] Larrabee YC, Kacker A. Which inferior turbinate reduction technique best decreases nasal obstruction?[J]. Laryngoscope, 2014, 124(4): 814-815. doi:10.1002/lary.24182.
[1] 李帅,黄春燕,常明章. 鼻内镜下鼻中隔软骨尾端偏曲矫正术的临床效果分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 65-70.
[2] 王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.
[3] 姜知临,朱瑞楷,邱前辉. 基于影像学对咽旁颈内动脉走行的观察与分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 69-76.
[4] 郭荣昌,刘晴航,王洪增,孙树军. 巨大鼻眼贯通、颅底嵌顿异物损伤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 135-141.
[5] 李晓宇,王彬晨,徐大朋,王艳华,杜平功,张庆泉. 三维建模配准分析经口与经鼻开窗治疗上颌骨囊肿三维形态变化[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 72-78.
[6] 郭振平,李雪冰. 慢性主观性耳鸣患者心理特征、睡眠质量调查及与临床效果相关性[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 1-7.
[7] 孙乐,张云云,刘浩,叶京英,吴彦桥. 鼻内镜辅助下经口鼻联合入路腭部巨大多形性腺瘤切除术1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 117-122.
[8] 石忠刚,蔡晓岚,李学忠,张立强,冯昕. 上颌骨囊肿并内翻性乳头状瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 123-129.
[9] 侯静,房高丽,周兵. 功能性鼻内镜手术后鼻黏膜囊泡的形成机制及囊液成分分析:一项组织生化学研究[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 1-5.
[10] 郑露,程杰,欧阳虹,池花明,杜敬东. A型血友病致难治性鼻出血1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 86-90.
[11] 李美辰,陈海玲,李阳,马登殿. 下鼻甲黏液囊肿1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 91-94.
[12] 后婕,刘丁丁,王涵东,徐峥嵘,钱晓云,高下,俞晨杰. 鼻内镜下经泪前隐窝-翼突入路上咽旁间隙病变手术[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 28-35.
[13] 陈兴雪,张广玲,武天义,王卫卫,孙占伟,李世超,王广科. 抗IL-4Rα单克隆抗体与鼻内镜手术治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的疗效分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 43-54.
[14] 袁玥,庞文会,陈敏,付圣尧,于龙刚,孙钰博,李玲玲. 毛霉菌性鼻窦炎25例临床特征分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 102-107.
[15] 李红金,王剑,来育斌,许敏,薛涛,陈福权,查定军,陈晓栋. 不同术式治疗上颌骨囊肿的疗效评价[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 33-37.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发