Schlüter Anke, Ahmadipour Yahya, Vogelsang Trutz, Kreitschmann-Andermahr Ilonka, Kleist Bernadette, Weller Patrick, Holtmann Laura, Mattheis Stefan, Lang Stephan, Bergmann Christoph, Mueller Oliver
Department of Oto-Rhino-Laryngology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
Eur Arch Otorhinolaryngol. 2016 Dec;273(12):4571-4578. doi: 10.1007/s00405-016-4179-y. Epub 2016 Jun 30.
The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10 days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2 months postoperatively. Patients' subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n = 15; 50 %) than without (n = 16; 84.2 %). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n = 10 vs. n = 2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p = 0.039 and p = 0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9 % of patients without splints, but only 56 % of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.
经鼻内镜手术切除鞍区肿瘤常伴有鼻中隔粘连或鼻通气障碍等鼻腔并发症。在本研究中，我们调查了鼻中隔夹板对避免手术相关合并症的影响。研究对象为2012年至2014年间接受经鼻内镜经蝶窦鞍区肿瘤手术的49例患者。其中30例在手术结束时在鼻中隔两侧应用鼻中隔夹板并留置10天（第1组），19例患者未使用夹板（第2组）。术后平均2个月进行标准化的术后随访调查，包括鼻内镜检查、鼻阻力测量和嗅觉测试。采用一组关于鼻腔问题的标准化自评陈述对随访时患者与鼻子相关的主观不适进行描述性评估。使用鼻中隔夹板时发生粘连的可能性（n = 15；50%）低于未使用夹板时（n = 16；84.2%）。此外，在未使用鼻中隔夹板的组中主要观察到多处粘连（n = 10 vs. n = 2）。鼻阻力测量显示使用夹板时吸气流量-V150得分有所改善（左鼻孔两组间有显著差异：分别为p = 0.039和p = 0.022）。相应地，未使用夹板的患者术后鼻通气障碍的报告频率更高，为76.9%，而使用夹板的患者仅为56%。我们的结果支持在经鼻内镜手术切除鞍区肿瘤时应用鼻中隔夹板，以减少术后粘连并改善鼻通气。
