鼻內鏡下手術與傳統手術治療鼻中隔偏曲的療效比較

藍啟先

[摘要] 目的 探討鼻內鏡下與傳統手術治療鼻中隔偏曲的臨床療效。 方法 選擇整群2007年3月—2013年10月在該院行鼻內鏡下鼻中隔偏曲矯正術的57例患者作為內鏡組，另選取同期行傳統鼻中隔矯正術的55例患者作為傳統組，比較兩組手術時間、術中失血量、術后住院時間、術后24 h 患者疼痛情況、手術相關并發癥及術前和術后鼻塞癥狀VAS評分。 結果 與傳統組相比較，內鏡組患者手術時間和術后住院時間均明顯縮短，術中失血量明顯減少（P<0.05）；內鏡組患者術后24 h疼痛程度明顯輕于傳統組（P<0.05）；經手術后，兩組患者鼻塞癥狀VAS評分均較術前有了顯著改善（P<0.05）；但與傳統組相比較，內鏡組改善程度更為明顯（P<0.05）；兩組總有效率比較差異無統計學意義（P>0.05），但內鏡組治愈率明顯高于傳統組（P<0.05）；內鏡組不良反應發生率為3.51%，明顯低于傳統組的14.55%（P<0.05）。 結論 鼻內鏡手術與傳統手術均能有效治療鼻中隔偏曲，但鼻內鏡手術耗時更短、創傷更小、術后恢復更快、疼痛更輕，且并發癥少，值得臨床推廣應用。

[關鍵詞] 鼻中隔偏曲；鼻內鏡手術；傳統手術；臨床療效

[中圖分類號] R765.3 [文獻標識碼] A [文章編號] 1674-0742（2015）04（c）-0032-03

[Abstract] Objective To explore the clinical curative effect of nasal septum deviation and traditional surgery under nasal endoscope. Methods Selected 57 cases from March 2007 to October 2013 in our hospital endoscopic nasal septum surgery patients as the endoscopic group， the other 55 cases selected underwent traditional nasal septum surgery patients as the traditional group， operation time， intraoperative blood loss， compared with two groups of postoperative hospital stay， postoperative pain 24 h patients， complications related to operation and preoperative and postoperative VAS scores of nasal obstruction symptoms. Results Compared with the traditional group， the endoscopic group of patients， operation time and postoperative hospital stay were significantly shortened， the blood loss in operation were significantly reduced（P<0.05）； endoscopic groups of patients with 24 h pain were significantly lighter than the conventional group（P<0.05）； after the operation， two groups of nasal symptoms in patients with VAS scores compared with the preoperative have significantly improved（P<0.05）； compared with the traditional group， the endoscopic group improved more obviously（P<0.05）； two group there were no statistically significant differences in efficiency comparison（P>0.05）， but the endoscopic group the cure rate significantly higher than the traditional group（P<0.05）； endoscopic group the incidence of adverse reaction was 3.51%， significantly lower than that of the traditional group 14.55%（P<0.05）. Conclusion Endoscopic surgery and conventional surgery was effective in the treatment of deviation of nasal septum， nasal endoscopic surgery but consumes less time， less trauma， faster postoperative recovery， lighter pain， and less complications， which is worthy of clinical application.

[Key words] Deviation of nasal septum； Nasal endoscopic surgery； Traditional operation； Clinical effect

鼻中隔偏曲是指鼻中隔偏離中線在形態上向一側或雙側偏斜，或局部形成明顯突起而引起鼻腔功能異常，是耳鼻喉科常見疾病之一，發病后可不同程度影響鼻腔通氣功能，也是誘發鼻竇炎、鼻息肉等疾病的高危因素[1]。通過手術來糾正鼻腔與鼻竇結構結構和生理功能異常是治療鼻中隔偏曲的主要方法，傳統的手術方式術野不清、創傷大，而且常需分次手術治療，容易導致手術并發癥的增多，而且增加患者痛苦和經濟負擔。目前鼻內鏡手術應用日趨廣泛，通過內鏡深入鼻腔中、后部及鼻咽部，并清晰的顯示鼻腔內周圍結構，其用于鼻中隔偏曲矯正的效果正逐漸獲得認可[2]。該研究2007年3月—2013年10月間中通過觀察鼻內鏡下鼻中隔偏曲矯正術與傳統手術的治療效果，來探討鼻內鏡在鼻中隔偏曲矯正術中的應用價值，現報道如下。……