Department of Otorhinolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, 56 Nan Li Shi Road Xi Cheng District, Beijing, 100045, People's Republic of China.
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing, 100045, People's Republic of China.
J Otolaryngol Head Neck Surg. 2021 Aug 12;50(1):51. doi: 10.1186/s40463-021-00535-9.
Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants.
Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra‑low‑dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years.
The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.001), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases.
The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.
已经提出了多种手术方法来修复先天性后鼻孔闭锁。然而，对于最佳手术技术仍没有普遍共识。本研究旨在描述和评估经鼻内镜鼻中隔黏膜瓣联合可吸收类固醇洗脱支架治疗新生儿和婴儿先天性后鼻孔闭锁的结果。
回顾性分析了 2018 年 1 月至 2020 年 7 月期间接受经鼻内镜下瓣技术手术的 37 例先天性后鼻孔闭锁新生儿和婴儿的临床资料。所有患者均在术前进行超低剂量鼻窦 CT 成像，以确认诊断并制定手术计划。对于双侧闭锁的患者采用镜像 L 形瓣技术，对于单侧闭锁的患者采用交叉 L 形瓣技术。术后 22 例患者使用了硅胶支架，15 例患者使用了可吸收类固醇洗脱支架。术后 1 个月在二次全身麻醉下取出硅胶支架，而可吸收类固醇洗脱支架无需麻醉即可取出。术后随访时间为 10 个月至 3 年。
所有患者均采用鼻中隔黏膜瓣技术。与硅胶支架组相比，可吸收类固醇洗脱支架组的平均手术时间和住院时间缩短[（97.46±15.37）min 比（83.49±19.16）min，t=13.733，P<0.001]，[（12.8±3.22）d 比（7.67±3.91）d，t=15.082，P<0.001]，手术次数减少[（2.04±0.64）次比（1.00±0.001）次，t=82.689，P<0.001]，差异均有统计学意义。可吸收类固醇洗脱支架组无术后再狭窄和并发症报道，所有患者随访内镜检查均显示通畅和稳定的鼻道。
经鼻内镜鼻中隔黏膜瓣技术可有效暴露和扩大后鼻孔骨性结构，用于修复新生儿和婴儿的先天性后鼻孔闭锁。该技术联合可吸收类固醇洗脱支架可有助于防止需要再次手术，并避免支架相关损伤。
Zotero 插件
