Rusetsky Yury, Mokoyan Zhanna, Meytel Irina, Spiranskaya Olga, Malyavina Ulyana
Federal State Autonomous Institution "National Medical Research Center of Children Health". Moscow, Lomonosov Avenue, 2, 119991, Russia.
Federal State Autonomous Educational Institution of Higher Education I.M, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Trubetskaya Street, 8, 119048, Russia.
Int J Pediatr Otorhinolaryngol. 2020 Mar;130:109817. doi: 10.1016/j.ijporl.2019.109817. Epub 2019 Dec 13.
Being increasingly faced with the problem of pediatric nasal septal perforations, we have found that the surgical management of nasal septal perforations in children is not widely described in the litrature. The objective of our study was to demonstrate the results of different surgical techniques, including two original endoscopic techniques, in the septal perforation repair in children.
24 children, ranging between 6 and 17 years of age, with nasal septal perforations were operated using different endoscopic techniques from February 2015 to May 2019 at the special tertiary referral clinic. Apart from well-known techniques, such as anterior ethmoidal artery flap, intranasal bipedicled advancement flap, sublabial flap, free temporal fascia graft, we used two original techniques - inverted edges technique and cross-septal returned flap.
The total rate of complete perforation closure was 79% (19 of 24 patients). Regarding the reduction of symptoms, the efficacy of surgery was approaching 100%. The combination of inverted edges technique and anterior ethmoidal artery septal flap demonstrated the best results with no reperforations in all 10 cases. Using cross-septal returned flap, we achieved complete closure of perforation in 5 (83%) of 6 patients. The remaining techniques were performed rare and showed relatively low rates of success. There were 2 cases of complications (oronasal fistula), both developed in patients with sublabial mucosal flap.
Use of endoscopic assistance, vascularized mucoperichondrial flaps and bilateral closure demonstrates high effectiveness in septal perforation surgical repair in children.
由于儿科鼻中隔穿孔问题日益增多，我们发现儿童鼻中隔穿孔的手术治疗在文献中描述并不广泛。本研究的目的是展示不同手术技术的效果，包括两种原创的内镜技术，用于儿童鼻中隔穿孔修复。
2015年2月至2019年5月，在一家特殊的三级转诊诊所，对24例年龄在6至17岁之间的鼻中隔穿孔儿童采用不同的内镜技术进行手术。除了常用的技术，如筛前动脉瓣、鼻内双蒂推进瓣、唇下瓣、游离颞筋膜移植外，我们还采用了两种原创技术——倒置边缘技术和跨鼻中隔回返瓣。
穿孔完全闭合的总率为79%（24例患者中的19例）。在症状减轻方面，手术疗效接近100%。倒置边缘技术和筛前动脉鼻中隔瓣联合应用效果最佳，10例均无再穿孔。使用跨鼻中隔回返瓣，6例患者中有5例（83%）穿孔完全闭合。其余技术应用较少，成功率相对较低。有2例并发症（口鼻瘘），均发生在唇下黏膜瓣患者中。
在内镜辅助下使用带血管蒂的黏软骨膜瓣及双侧闭合术，在儿童鼻中隔穿孔手术修复中显示出高效性。
4级。
