動力旋轉刀輔助鼻中隔鼻道成形合併鼻甲外折手術

Microdebrider-Assisted Septomeatoplasty with Turbinate Lateralization

林彩勤(Tsai-Chin Lin) ； 林煌斌(Huang-Pin Lin) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chung-Han Hsin)

《台灣耳鼻喉頭頸外科雜誌》 49卷2期 (2014/06) Pp. 81-87

https://doi.org/10.6286/2014.49.2.81

摘要

背景：鼻中隔鼻道成形手術是耳鼻喉科最常施行的手術之一。傳統上這類鼻部手術會放置鼻內填塞，然而鼻內填塞會使病患承受術後疼痛與不適，另外因鼻填塞而增長住院天數，一方面增加醫療支出，一方面也延緩病患回到工作或日常生活的時間。本研究的目的是評估病患接受動力旋轉刀輔助鼻中隔鼻道成形合併鼻甲外折手術後，僅以鼻中隔縫合加上簡易下鼻甲傷口填塞，觀察病患術後併發症發生的機會，並評估縮短術後住院天數與減少回診次數的可行性。方法：本研究採回溯性病例回顧，收集自2010年7月至2011年6月間，於中山醫學大學附設醫院接受動力旋轉刀輔助鼻中隔鼻道成形合併鼻甲外折手術與傳統鼻中隔鼻道成形手術的病患。手術適應症為病患長期鼻塞，診斷為鼻中隔彎曲及下鼻甲肥厚，且經藥物治療無效。統計並比較兩組病患止痛藥的使用、出血、鼻中隔血腫、傷口感染、傷口沾黏、鼻中隔穿孔、住院天數及門診追蹤次數。結果：共計納入112名患者，Group 1為動力旋轉刀輔助鼻中隔鼻道成形合併鼻甲外折手術，術後合併以鼻中隔縫合加上簡易下鼻甲傷口填塞， 共計70名；Group 2為傳統鼻中隔鼻道成形手術合併使用凡士林紗布做填塞，共計42名。在併發症方面，兩組沒有統計上差異；Group 1相較Group 2在止痛藥的使用（p＜0.05）、住院天數（p＜0.05）及門診追蹤次數（p＜0.05）都較少。結論：以動力旋轉刀輔助鼻中隔鼻道成形合併鼻甲外折手術，因為黏膜傷口小，即使僅以簡易下鼻甲傷口填塞，仍可有效控制術後出血，在術後併發症部分，沒有顯著增加的情形；更重要的是動力旋轉刀手術方式讓病患不必接受傳統鼻填塞，減少術後鼻腔不適，也可縮短住院天數與回診次數。

關鍵字

鼻中隔鼻道成形手術 ； 鼻中隔縫合 ； 動力旋轉刀 ； 鼻填塞 ； 併發症

並列摘要

BACKGROUND: Septomeatoplasty remains one of the most common surgeries in the practice of otolaryngology. In general, nasal packing is applied routinely at the conclusion of this procedure. The use of nasal packing, however, may cause various complications and discomforts. Besides, it increases unnecessary medical costs and postpones the return of patients to normal life. The aim of this study was to investigate the occurrence of surgical complications, admission duration and follow-up in patients undergoing microdebrider-assisted septomeatoplasty with lateralization combined with septal suturing and minimal nasal packing. METHODS: A retrospective study was conducted to review the medical records of patients undergoing microdebrider-assisted septomeatoplasty with lateralization and traditional septomeatoplasty in Chung Shan Medical University Hospital between July 2010 and June 2011. The surgical indication included failed medical treatments in patients with nasal septum deviation and hypertrophic rhinitis. Post-operative bleeding, septal hematoma, septal abscess, wound adhesion, septal perforation, pain-killer use, admission days and times of follow-up were analyzed and compared between 2 groups. RESULTS: One hundred and twelve patients were enrolled in the study. Seventy patients underwent microdebrider-assisted septomeatoplasty with lateralization combined with nasal septal suturing and minimal nasal packing, and were classified in Group 1. Forty two patients underwent traditional septomeatoplasty combined with vaseline gauze packing, and were classified in Group 2. Regarding complications, no significant difference was noted between the two groups. Those patients in Group 1 had fewer medicines for pain (p＜0.05), fewer admission days (p＜0.05), and fewer times of follow-up (p＜0.05). CONCLUSIONS: Microdebrider-assisted septomeatoplasty with lateralization has a smaller incision wound and therefore hemostasis can be achieved with minimal nasal packing, without increasing surgical complications. More importantly, the surgery can reduce patients’ discomfort and decrease the time of hospital stay and the number of post-operative visits.

並列關鍵字

septomeatoplasty ； nasal septal suturing ； microdebrider ； nasal packing ； complications