方东升 任彩华

[摘要]目的：探討个体化减张整形矫正术与传统黏膜下切除术治疗鼻中隔偏曲的疗效、并发症以及术后患者生活质量差异。方法：选取笔者医院2015年5月-2020年6月确诊为鼻中隔偏曲的患者40例作为研究对象，将其随机分为观察组（n=20）和对照组（n=20），两组患者均采取全麻进行手术，观察组患者实施个体化减张整形矫正术，对照组实施传统黏膜下切除术。对比两组患者的手术时间、术后疼痛及术后并发症情况;随访12个月，对比两组手术疗效以及患者的生活质量。结果：观察组手术时间长于对照组，差异有统计学意义（P<0.05）。术后3d两组患者疼痛分级均为轻度疼痛，但观察组VAS评分明显低于对照组，差异有统计学意义（P<0.05）。观察组术后并发症发生率明显低于对照组（10.00% vs 35.00%），差异有统计学意义（P<0.05）。随访12个月，观察组的总体疗效略优于对照组（95.00% vs 90.00%），但组间比较差异无统计学意义（P>0.05）;而术后生活质量明显优于对照组，差异有统计学意义（P<0.05）。结论：个体化减张整形矫正术治疗鼻中隔偏曲的效果明显优于传统黏膜下切除术，术后患者疼痛较轻，并发症较少，总体疗效较理想，术后患者生活质量较高，值得临床推广。

[关键词]个体化减张整形矫正术;黏膜下切除术;鼻中隔偏曲;生活质量

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0044-03

Comparison of Individualized Tension Reduction Plastic Surgery and Traditional Submucosal Resection in the Treatment of Nasal Septum Deviation

FANG Dong-sheng，REN Cai-hua

（Department of Otolaryngology，Maanshan Shiqiye Hospital，Maanshan 243000，Anhui，China）

Abstract： Objective  To explore the efficacy， complications and quality of life of patients with nasal septal deviation after individualized tension reduction plastic surgery and traditional submucosal resection. Methods  Forty patients diagnosed as nasal septal deviation from May 2015 to June 2020 in our hospital were selected as the research object， and they were randomly divided into the observation group （n=20） and the control group （n=20）. General anesthesia was used for the operation. The observation group patients performed individualized tension reduction plastic surgery， and the control group performed traditional submucosal resection. The operation time， postoperative pain， and postoperative complications of the two groups of patients were compared and followed up for 12 months. Compare the surgical efficacy and quality of life of the patients in the two groups. Results  The operation time of the observation group was longer than that of the control group， the difference was statistically significant （P<0.05）. The pain grade of the two groups was mild pain three days after operation， but the VAS score of the observation group was significantly lower than that of the control group （P<0.05）. The incidence of postoperative complications in the observation group was significantly lower than that of the control group （10.00% vs 35.00%， P<0.05）. After 12 months of follow-up， the overall efficacy of the observation group was slightly better than the control group （95.00% vs 90.00%）， but there was no significant difference between the two groups（P>0.05）. The quality of life in the observation group was significantly better than that in the control group （P<0.05）. Conclusion  The treatment of nasal septal deflection is better than that of individual subtraction plastic surgery. The postoperative patients have less pain， fewer complications， the overall curative effect is better， and the postoperative patients have a higher quality of life. It is worthy of clinical promotion.

Key words： individualized tension reduction plastic surgery; submucosal resection; septal deflection; quality of life

鼻中隔偏曲是一种鼻部发育异常所致的结构性畸形，外观多表现为鼻梁局部突起并偏向一侧，临床上较为多见。鼻中隔偏曲不仅会影响患者的鼻部外观，还会影响患者的鼻部通气功能，早期可仅表现为鼻腔通气不畅，后期可出现较为严重的鼻塞、流涕、耳鸣等[1-2]。目前临床上主张采用手术方式改善局部结构性异常，传统术式为鼻甲黏膜下切除术，但这种手术方式会一定程度上影响鼻部外观，鼻中隔摆动等情况。几年来随着生物力学研究的逐步深入，有学者提出了三线减张鼻中隔矫正手术，这一手术主要通过对鼻中隔的力学分析找寻鼻中隔偏曲的力学原因，主张从鼻中隔软骨的前方、下方以及后方三个应力方向进行调整，松解局部黏连，纠正“S形”或“C形”鼻中隔偏曲，恢复局部正常组织结构[3]。……