Wong S, Raghavan U
Department of Otorhinolaryngology, Doncaster Royal Infirmary, UK.
J Laryngol Otol. 2010 Aug;124(8):868-74. doi: 10.1017/S0022215110000745. Epub 2010 May 20.
To assess success rates and symptom control after surgical treatment of nasal septal perforation.
A prospective study was undertaken of 28 consecutive patients with symptomatic nasal septal perforation treated surgically by one surgeon between 2005 and 2007. All patients underwent an open rhinoplasty approach with bilateral superior and inferior nasal mucosal advancement flaps and acellular porcine collagen placed in between. Symptom severity was assessed pre- and post-operatively using a validated visual analogue score. The nasal valve angle was assessed pre- and post-operatively by two independent assessors.
Patients comprised 12 women and 16 men, with a mean age of 45 years (range: 21-76). The mean follow up was 16 months (range: 6-24). The mean vertical and horizontal diameters of the perforations were 22 mm (range: 10-35) and 27 mm (range: 10-37), respectively. Twenty-seven (96 per cent) patients had complete closure of nasal septal perforation. There were statistically significant differences between the pre- and post-operative mean visual analogue scale scores for epistaxis (p < 0.001), crusting (p < 0.001), whistling (p < 0.001) and nasal obstruction (p < 0.001). Epistaxis, crusting and whistling resolved in all patients, and 92 per cent reported improvement in nasal blockage.
Closure of nasal septal perforation using an open rhinoplasty approach with nasal mucosal advancement flaps and a porcine collagen sandwich is a pertinent and reliable technique for the management of nasal septal perforation.
评估鼻中隔穿孔手术治疗后的成功率及症状控制情况。
对2005年至2007年间由一名外科医生手术治疗的28例有症状的鼻中隔穿孔患者进行前瞻性研究。所有患者均采用开放式鼻整形术，使用双侧鼻黏膜上下推进皮瓣，并在其间放置脱细胞猪胶原蛋白。术前和术后使用经过验证的视觉模拟评分评估症状严重程度。术前和术后由两名独立评估者评估鼻瓣角度。
患者包括12名女性和16名男性，平均年龄45岁（范围：21 - 76岁）。平均随访时间为16个月（范围：6 - 24个月）。穿孔的平均垂直直径和水平直径分别为22毫米（范围：10 - 35毫米）和27毫米（范围：10 - 37毫米）。27例（96%）患者鼻中隔穿孔完全闭合。鼻出血（p < 0.001）、结痂（p < 0.0）、 whistling（p < 0.001）和鼻塞（p < 0.001）的术前和术后平均视觉模拟量表评分之间存在统计学显著差异。所有患者鼻出血、结痂和whistling症状均消失，92%的患者报告鼻塞症状有所改善。
采用开放式鼻整形术、鼻黏膜推进皮瓣和猪胶原蛋白夹层闭合鼻中隔穿孔是治疗鼻中隔穿孔的一种相关且可靠的技术。
