- 期刊
以部分鼻孔封閉法治療萎縮性鼻炎
Partial Closure of the Nostrils for Atrophic Rhinitis
摘要
背景;Fraenkel 自 1876 年首先提出萎縮性鼻炎，此病症及困擾著病患及耳鼻喉科醫師，因其不但治癒率低且復發性高。當病患乎吸帶有惡臭、鼻黏膜萎縮與膿痂塊成行，且病人亦可能有鼻塞、鼻仞、嗅覺喪失與頭痛症狀時，即為典型的萎縮性鼻炎。內科療法包括改善起居飲食、給予維生素A、改善貧血、給予鹽水沖洗鼻腔等，但大多效果不彰貨復發性高，我們嘗試將鼻孔部分封閉，縮小鼻孔面積改變其流引起鼻黏膜充血以改善萎縮的黏膜，又部會組隊鼻呼吸來治療此症。 方法;我們將門診診對為萎縮性鼻炎的患者，在口服藥物貨內科治療無效後，施行手術，將病患兩側鼻孔部分縫合後，不在予以打開；述前述後以問卷調查方式來紀律病人狀況，並以門診醫師紀錄臨床發現的結果。 結果; 自 1987年 1月 起至1997 年6月止，共有20名病患接受鼻孔部分封閉法。述後追蹤超過1年並有問卷調查者有14名，全部均為女性，平均年齡35.2 歲。手術後1年病患滿意程度為100%，症狀平均改善率80%。致病菌種有Klebsiella ozaenae 、Proteus Staphylococcus aureus。 結論；萎縮性鼻炎不論是先天性抑是醫源性造成，其治療方法式仍是對耳鼻喉科醫師的一大挑戰，作者嘗試以各種手術方式來治療此疾病,發現鼻孔部分封閉手術來治療的結果，雖無法完全治療，但病患之自覺滿意度高，以目前而言也算是最佳的選擇了。(中耳醫誌 200; 35; 230-235)
並列摘要
BACKGROUND; Atrophic rhinitis is a chronic progressive nasal disease characterized by mucosal atrophy, thick crusts and distinct, fetid odor. Various therapeutic regimens have been tried for atrophic rhinitis, but none have proven to be wholly successful. We attempted nasal cavity narrowing to produce a secondary vasodilator effect, with the hope of curing the atrophic rhinitis. METHODS; patients, who had unsuccessfully tried medical treatment for atrophic rhini-tis, were included in the study. All patients underwent partial closure of the nostril with a 3-5 mm hole made below the suture line. Later reversal of the partial closures was not anticipated. Patients were followed up for at least a tear, undergomig endonasoscopic examination and answering questionnaires addressing symptoms and signs RESULTS;Between January 1987 and June 1997, fourteen patients with atrophic rhinitis were enrolled in the study. All patients were female, aged between 19 and 45 years, with an average age of 35.2 vears. At the end of follow-up, many of the patients’ symptoms had improved(80%). No crusting or very little crusting was found after the operation and all patients reported a subiective improvement CONCLSIONS; chronic atrophic chinitis is a non-cura disease. Sinec the main under-lying mechanism of atrophic rhinitis is a wide nasal cavity, no conservative treatment can cure the disease if, the nasal cavity remains uncorrected. After ten years experience, we have concluded that partial closure of the nostril significantly improves the symptoms and signs of atrophic rhinitis.