Zhang Qing-xiang, Zhou Wei-guo, Zhang Hai-dong, Ke Yong-fang, Wang Qiu-ping
Department of Otorhinolaryngology, Nanjing University, Nanjing, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 May;48(5):422-5.
To discuss the relationship between structural change in nasal cavity and the change of nasal ventilatory function after outfracture of the inferior turbinate.
The inferior turbinate outfracture surgery was performed on 50 chronic hypertrophic rhinitis patients who suffered inferior turbinate hypertrophy according to endoscopy and CT scan. Preoperative and postoperative nasal endoscopy was carried out on all patients, by which the distance from the inferior turbinate front mucous membrane to nasal septum (DTNS) was measured. In addition, CT was used to measure the minimal distance between the inside edges of the bilateral inferior turbinate soft tissue (MDTT) and the minimal distance between the bilateral inferior turbinate bones (MDTB) at the central layer of coronal sectional infundibulum; the minimal distance between the inferior turbinate at asial nasal limen (NLDT); inferior turbinate thickness (ITT). In this way, the change in the structure of nasal cavity was evaluated. Acoustic rhinometry and rhinomanometry were utilized to evaluate the ventilatory function of the nasal cavity objectively. Visual analogue scale (VAS) was applied to evaluate the severity of preoperative and postoperative nasal obstruction subjectively. The test data were used to perform match t-test; Spearman rank correlation was adopted to evaluate the relationship between patients' bilateral VAS and nasal inspiratory effective resistance (IER),nasal expiratory effective resistance (EER) and DTNS. The relationship between the total resistance of nasal inspiratory phase as well as the total resistance of nasal expiratory phase and MDTT and MDTB was analyzed. SPSS 20.0 software was used to analyze the data.
The preoperative data showed that rightward DTNS was (0.12 ± 0.07) cm, leftward DTNS was (0.10 ± 0.07) cm and MDTT was (0.70 ± 0.13) cm, and postoperative data showed that rightward DTNS was (0.47 ± 0.27) cm, leftward DTNS was (0.43 ± 0.15) cm, and MDTT was (1.05 ± 0.15) cm. Significant differences existed in rightward DTNS, leftward DTNS and MDTT between pre-and post operative data (t values were -8.827, -8.590, -17.525, all P < 0.05). According to the preoperative and postoperative comparison, the difference in MDTB, NLDT, rightward ITT, leftward ITT, IER, EER, 0-5 cm nasal cavity volume (0-5 cm NCV), nasal minimal cross-sectional area (NMCA), rightward VAS and leftward VAS had statistical significance (t values were -23.562, -8.374, 8.693, 6.684, 12.021, 14.510, -6.074, -2.285, 14.042 and 9.925, respectively, all P < 0.05). Patients' bilateral VAS grades had a positive relationship with IER and EER (left side: r values were 0.541 and 0.660, respectively,right side: r values were 0.940 and 0.688, respectively, all P < 0.05). Additionally, patients' VAS had a negative relationship with DTNS (r value was -0.861, P < 0.05). Besides,the total resistance of nasal inspiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.565 and -0.546,respectively, all P < 0.05). The total resistance of nasal expiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.562 and -0.546, all P <0.05).
The inferior turbinate outfracture surgery was an ideal surgical method by which nasal cavity could be broadened and nasal ventilatory function improved.
探讨下鼻甲外折术后鼻腔结构变化与鼻腔通气功能改变之间的关系。
对50例经鼻内镜及CT扫描确诊为下鼻甲肥大的慢性肥厚性鼻炎患者行下鼻甲外折术。所有患者术前行鼻内镜检查，测量下鼻甲前端黏膜至鼻中隔的距离（DTNS）。此外，利用CT测量冠状位扫描漏斗部中心层面双侧下鼻甲软组织内缘之间的最小距离（MDTT）及双侧下鼻甲骨质之间的最小距离（MDTB）；鼻阈处下鼻甲最小距离（NLDT）；下鼻甲厚度（ITT）。以此评估鼻腔结构的变化。采用鼻声反射和鼻阻力测定客观评估鼻腔通气功能。应用视觉模拟评分法（VAS）主观评估术前、术后鼻阻塞的严重程度。对测试数据进行配对t检验；采用Spearman等级相关分析评估患者双侧VAS与鼻吸气有效阻力（IER）、鼻呼气有效阻力（EER）及DTNS之间的关系。分析鼻吸气相总阻力、鼻呼气相总阻力与MDTT、MDTB之间的关系。采用SPSS 20.0软件进行数据分析。
术前数据显示，右侧DTNS为（0.12±0.07）cm，左侧DTNS为（0.10±0.07）cm，MDTT为（0.70±0.13）cm；术后数据显示，右侧DTNS为（0.47±0.27）cm，左侧DTNS为（0.43±0.15）cm，MDTT为（1.05±0.15）cm。术前、术后右侧DTNS、左侧DTNS及MDTT比较差异有统计学意义（t值分别为-8.827、-8.590、-17.525,均P<0.05）。术前、术后比较，MDTB、NLDT、右侧ITT、左侧ITT、IER、EER、0～5cm鼻腔容积（0～5cm NCV）、鼻腔最小横截面积（NMCA）、右侧VAS及左侧VAS差异有统计学意义（t值分别为-23.562、-8.374、8.693、6.684、12.021、14.510、-6.074、-2.285、14.042及9.925,均P<0.05）。患者双侧VAS分级与IER、EER呈正相关（左侧：r值分别为0.541、0.660；右侧：r值分别为0.940、0.688,均P<0.05）。此外，患者VAS与DTNS呈负相关（r值为-0.861,P<0.05）。此外，鼻吸气相总阻力与MDTT、MDTB均呈负相关（r值分别为-0.565、-0.546,均P<0.05）。鼻呼气相总阻力与MDTT、MDTB均呈负相关（r值分别为-0.562、-0.546,均P<0.05）。
下鼻甲外折术是一种理想的手术方法，可扩大鼻腔并改善鼻腔通气功能。
