鼻内镜下后鼻孔重建术治疗46例先天性后鼻孔闭锁患儿的疗效观察
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摘要
目的:分析后鼻孔闭锁患儿鼻内镜下后鼻孔重建术后的临床资料,探讨新后鼻孔再次闭锁的影响因素。方法:46例因后鼻孔闭锁行鼻内镜下后鼻孔重建术的患儿,按照新后鼻孔是否再次闭锁分为闭锁组19例,未闭锁组27例。对2组临床资料进行比较,探寻影响新后鼻孔再次闭锁的因素。结果:2组的性别、年龄、是否单/双侧闭锁及术后是否放置扩张管均无明显差异,2组术前闭锁的性质及术后肉芽增生情况存在差异。对闭锁性质进一步分析显示术前骨性闭锁患儿再闭锁概率明显高于膜性闭锁患儿。结论:全身麻醉鼻内镜下后鼻孔成形术是先天性后鼻孔闭锁患儿较好的手术方法,但骨性闭锁患儿的新后鼻孔仍然有较高的再闭锁概率。
Objective:The aim of this study is to explore the influencing factors of the posterior nostril re-atresia by analyzing the clinical data of endoscopic posterior nostril reconstruction in the children with posterior nostril atresia.Method:Retrospectively reviewed 46 pediatric patients with congenital choanal atresia who underwent endoscopic posterior nostril reconstruction.Randomly divided the cases into the atresia group(19 cases)and the nonatresia group(27 cases)according to whether the new posterior nostril re-atresia again.Compared the difference of the clinical data between the two groups and observed the influencing factors of the posterior nostril re-atresia.Result:The gender,age,unilateral/bilateral atresia or U-shaped stent had no significant differences between the two groups.However,the nature of the atresia and granulation hyperplasia were significant differences between the two groups.Further analysis of the nature of the atresia revealed osseous atresia had higher rate of re-atresia than membranous atresia.Conclusion:Endoscopic posterior nostril reconstruction was a good method for the treatment of the children with congenital posterior nostril atresia.However,the children with osseous atresia had higher re-atresia rate.
Objective:The aim of this study is to explore the influencing factors of the posterior nostril re-atresia by analyzing the clinical data of endoscopic posterior nostril reconstruction in the children with posterior nostril atresia.Method:Retrospectively reviewed 46 pediatric patients with congenital choanal atresia who underwent endoscopic posterior nostril reconstruction.Randomly divided the cases into the atresia group(19 cases)and the nonatresia group(27 cases)according to whether the new posterior nostril re-atresia again.Compared the difference of the clinical data between the two groups and observed the influencing factors of the posterior nostril re-atresia.Result:The gender,age,unilateral/bilateral atresia or U-shaped stent had no significant differences between the two groups.However,the nature of the atresia and granulation hyperplasia were significant differences between the two groups.Further analysis of the nature of the atresia revealed osseous atresia had higher rate of re-atresia than membranous atresia.Conclusion:Endoscopic posterior nostril reconstruction was a good method for the treatment of the children with congenital posterior nostril atresia.However,the children with osseous atresia had higher re-atresia rate.
引文
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[5]NEMECHEK A J,AMEDEE R G.Choanal atresia[J].J La State Med Soc,1994,146:337-340.
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[8]VERMA R K,LOKESH P,PANDA N K.Congenital bilateral adult choanal atresia undiagnosed until the second decade:How we did it[J].Allergy Rhinol(Providence),2016,7:82-84.
[9]丁吉女,蒋建华,周国文.鼻内镜下钬激光治疗放射性后鼻孔闭锁的疗效观察[J].临床耳鼻咽喉头颈外科杂志,2011,25(23):1100-1101.
[10]GULEN S,BAYSAL E,CELENK F,et al.Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method[J].J Craniofac Surg,2017,28:338-342.
[11]TEISSIER N,KAGUELIDOU F,COULOIGNER V,et al.Predictive factors for success after transnasal endoscopic treatment of choanal atresia[J].Arch Otolaryngol Head Neck Surg,2008,134:57-61.
[12]张欣然,张庆丰,佘翠萍.鼻内镜下低温等离子射频技术治疗先天性后鼻孔闭锁的初步观察[J].临床耳鼻咽喉头颈外科杂志,2011,25(2):90-91.
[13]GUJRATHI C S,DANIEL S J,JAMES A L,et al.Management of bilateral choanal atresia in the neonate:an institutional review[J].Int J Pediatr Otorhinolaryngol,2004,68:399-407.
[14]TATAR E,CAL B,DOGAN E,et al.Stentless endoscopic repair of congenital choanal atresia:is it enough for maintaining choanalpatency?[J].Eur Arch Otorhinolaryngol,2017,274:3673-3678.
[15]STRYCHOWSKY J E,KAWAI K,MORITZ E,et al.To stent or not to stent?A meta-analysis of endonasal congenital bilateral choanal atresia repair[J].Laryngoscope,2016,126:218-227.
[16]NEWMAN J R,HARMON P,SHIRLEY W P,et al.Operative management of choanal atresia:a 15-year experience[J].JAMA Otolaryngol Head Neck Surg,2013,139:71-75.
[2]KWONG K M.Current Updates on Choanal Atresia[J].Front Pediatr,2015,3:52-52.
[3]BRENNER KE,OCA M J,DONN S M.Congenital choanal atresia in siblings[J].J Perinatol,2000,20:443-444.
[4]KANCHERLA V,ROMITTI P A,SUN L,et al.Descriptive and risk factor analysis for choanal atresia:The National Birth Defects Prevention Study,1997-2007[J].Eur J Med Genet,2014,57:220-229.
[5]NEMECHEK A J,AMEDEE R G.Choanal atresia[J].J La State Med Soc,1994,146:337-340.
[6]BROWN O E,POWNELL P,MANNING S C.Choanal atresia:a new anatomic classification and clinical management applications[J].Laryngoscope,1996,106(1Pt 1):97-101.
[7]黄选兆,汪吉宝.实用耳鼻咽喉科学[M].北京:人民卫生出版社,2006:25-26.
[8]VERMA R K,LOKESH P,PANDA N K.Congenital bilateral adult choanal atresia undiagnosed until the second decade:How we did it[J].Allergy Rhinol(Providence),2016,7:82-84.
[9]丁吉女,蒋建华,周国文.鼻内镜下钬激光治疗放射性后鼻孔闭锁的疗效观察[J].临床耳鼻咽喉头颈外科杂志,2011,25(23):1100-1101.
[10]GULEN S,BAYSAL E,CELENK F,et al.Treatment of Congenital Choanal Atresia via Transnasal Endoscopic Method[J].J Craniofac Surg,2017,28:338-342.
[11]TEISSIER N,KAGUELIDOU F,COULOIGNER V,et al.Predictive factors for success after transnasal endoscopic treatment of choanal atresia[J].Arch Otolaryngol Head Neck Surg,2008,134:57-61.
[12]张欣然,张庆丰,佘翠萍.鼻内镜下低温等离子射频技术治疗先天性后鼻孔闭锁的初步观察[J].临床耳鼻咽喉头颈外科杂志,2011,25(2):90-91.
[13]GUJRATHI C S,DANIEL S J,JAMES A L,et al.Management of bilateral choanal atresia in the neonate:an institutional review[J].Int J Pediatr Otorhinolaryngol,2004,68:399-407.
[14]TATAR E,CAL B,DOGAN E,et al.Stentless endoscopic repair of congenital choanal atresia:is it enough for maintaining choanalpatency?[J].Eur Arch Otorhinolaryngol,2017,274:3673-3678.
[15]STRYCHOWSKY J E,KAWAI K,MORITZ E,et al.To stent or not to stent?A meta-analysis of endonasal congenital bilateral choanal atresia repair[J].Laryngoscope,2016,126:218-227.
[16]NEWMAN J R,HARMON P,SHIRLEY W P,et al.Operative management of choanal atresia:a 15-year experience[J].JAMA Otolaryngol Head Neck Surg,2013,139:71-75.