Department of Oto-rhino-laryngology, Lovisenberg Diakonale Hospital, Oslo, Norway.
Rhinology. 2011 Oct;49(4):486-91. doi: 10.4193/Rhino10.081.
Results of surgical treatment of nasal septal perforation are usually evaluated using closure of the perforation as criterion of success. Patients, however, may still have symptoms.
To assess the long-term results of surgical treatment of nasal septal perforation with bilateral, posterior based mucoperichondrial septal flaps using a four-point symptom score to ultimately improve treatment and selection criteria.
Patients were seen 6 months postoperatively. Questionnaires were sent to 116 surviving patients in 2008-2009. The response was 104. Patients reporting moderate or severe symptoms were seen as outpatients.
Between 1987 and 2004, 126 patients were surgically treated using posterior based bilateral mucoperichondrial septal flaps. Sixteen patients had a reperforation during the first 3 months, and another 3 several years later. There was no correlation between early outcome and diagnosis, preoperative size of the perforation, gender or severity of preoperative crusting. There was an increased rate of reperforation with increasing age. Complications seen at the 6 months` follow-up of patients with closed perforations were lachrymal duct stenosis, partial vestibular stenosis, hypoesthesia, crusting and septal deviation, most of which were treatable. Long-term observation mean 10 years) of the same patients showed the following moderate or severe symptoms: crusting, obstruction and bleeding, mainly in men. Obstruction was often due to various forms of perennial rhinitis, sometimes to crusting and more rarely to septal deviation. Crusting was the only independent symptom. There was no correlation between crusting and diagnosis, preoperative size of the perforation, age or severity of preoperative crusting.
Results of the surgical technique using posterior based bilateral mucoperichondrial septal flaps for treatment of nasal septal perforations were good, but depend on surgical expertise and age of the patient. Long-term results from other studies will be a guide to choose the proper surgical procedure to minimize the number of late symptoms. Prosthetic treatment cans be an alternative. Patients with return of symptoms should seek further advice.
鼻中隔穿孔的手术治疗结果通常以穿孔闭合作为成功的标准来评估。然而，患者可能仍有症状。
使用双侧、后部基底部黏软骨鼻中隔瓣评估鼻中隔穿孔手术治疗的长期结果，采用四点症状评分最终改善治疗和选择标准。
患者在术后 6 个月接受检查。2008-2009 年向 116 名存活患者发送了问卷，有 104 名患者做出了回应。报告有中度或重度症状的患者作为门诊患者进行了检查。
1987 年至 2004 年间，126 例患者接受了后部基底部双侧黏软骨鼻中隔瓣手术治疗。16 例患者在术后 3 个月内出现再穿孔，另有 3 例患者在数年后出现再穿孔。早期结果与诊断、术前穿孔大小、性别或术前结痂严重程度之间无相关性。再穿孔发生率随年龄增长而增加。闭合穿孔患者在术后 6 个月随访时出现的并发症有泪道狭窄、部分前庭狭窄、感觉减退、结痂和鼻中隔偏曲，其中大部分是可治疗的。对同一患者进行的长期观察（平均 10 年）显示出以下中度或重度症状：结痂、阻塞和出血，主要见于男性。阻塞通常是由于各种形式的常年性鼻炎引起的，有时是结痂引起的，更少见的是鼻中隔偏曲引起的。结痂是唯一的独立症状。结痂与诊断、术前穿孔大小、年龄或术前结痂严重程度之间无相关性。
使用后部基底部双侧黏软骨鼻中隔瓣治疗鼻中隔穿孔的手术技术效果良好，但取决于手术技术和患者年龄。来自其他研究的长期结果将指导选择适当的手术程序，以最大限度地减少晚期症状的数量。假体治疗是一种替代方法。有症状复发的患者应寻求进一步的建议。
