鼻内镜下鼻中隔矫正术后鼻中隔血肿的预防

摘要

Objective To investigate the method and strategy of preventing hematoma of the nasal septum af-ter re-correction of nasal septum under nasoscope. Methods The data of 120 patients who had undergone re-correction of nasal septum in Department of Otorhinolaryngology of Meizhou Municipal People's Hospital from January 2012 to October 2016 were retrospectively analyzed, which included 30 patients with local resection of nasal septum crest and 90 patients with re-correction of nasal septum under nasoscope (10 patients with intraoperative unilateral mucosa dam-age of nasal septum, 80 patients with integrity of bilateral nasal septum mucosa). Among the 80 paitents with integrity of bilateral nasal septum mucosa, an incision in the unilateral septum mucosa was made in 40 patients, and no incision in the unilateral mucosa in the other 40 patients. The inflation sponge tamponade was applied in both groups after sur-gery. Results No septal hematoma occurred in the patients with local resection of nasal septum crest, intraoperative unilateral mucosa damage of the nasal septum, an incision in unilateral integrated nasal septum mucosa after nasal sep-tum re-correction. Septal hematoma occurred in 6 patients with integrity of bilateral nasal septum mucosa who didn't re-ceive unilateral incision. All the cases showed no nasal septum perforation. Moreover, the incidence of septal hematoma in the group underoing an incision in unilateral septum mucosa was remarkably lower than that in the group without re-ceiving incision in unilateral mucosa (0 vs 15.0%, P<0.05). Conclusion Incision in unilateral septum mucosa in the pa-tients with integrity of bilateral nasal septum mucosa after re-correction of nasal septum can effectively prevent hemato-ma of the nasal septum after recorrection of nasal septum.%目的 探讨预防鼻内镜下鼻中隔矫正术后鼻中隔血肿的方法及策略.方法 回顾性分析我科2012年1月至2016年10月收治的行鼻中隔矫正术的120例患者资料,其中行鼻中隔嵴突局部切除术30例,鼻内镜下鼻中隔黏膜下矫正术90例(术中鼻中隔一侧黏膜破损10例,鼻中隔黏膜完整80例).对80例鼻中隔黏膜完整患者,鼻中隔矫正后行一侧中隔黏膜切开40例,未行一侧黏膜切开40例,术后均予膨胀海绵填塞.结果 行鼻中隔嵴突局部切除、术中鼻中隔一侧黏膜破损、鼻中隔黏膜完整鼻中隔矫正后一侧中隔黏膜切开的患者均未出现鼻中隔血肿.鼻中隔黏膜完整而未行一侧黏膜切开的患者中,出现鼻中隔血肿6例,所有病例均无鼻中隔穿孔.行一侧中隔黏膜切开组鼻中隔血肿发生率明显低于未行一侧黏膜切开组(0 vs 15.0%),差异有统计学意义(P<0.05).结论 对于术后两侧鼻中隔黏膜完整的患者,鼻中隔矫正后行一侧中隔黏膜切开能有效预防鼻中隔术后鼻中隔血肿.