U型瓣翻转加局部扩张治疗后天性鼻咽闭锁(修后).docVIP

双U形粘膜瓣修复加局部扩张术治疗鼻咽闭锁 张炳辉1 史余明2 刘鸣1 1哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科 哈尔滨150086 2黑龙江省省医院耳鼻咽喉头颈外科 哈尔滨150010 摘要 目的：探讨双U形粘膜瓣修复加局部扩张术治疗鼻咽闭锁的方法和效果。方法：对9例后天性鼻咽闭锁患者采用双U形粘膜瓣修复咽后壁和软腭创面，再置入扩张管，观察疗效。结果：半年后取出硅胶管，鼻咽腔缩小到左右径约2.0～2.5厘米，前后径约1.0厘米的间隙。鼻腔通畅，均有腭咽闭合不全、食物鼻腔反流。术后2年随访，患者鼻腔均通畅，睡眠、饮食均正常。1例仍有食物鼻腔反流。结论: U形粘膜瓣修复加局部扩张术是治疗鼻咽闭锁行之有效的方法。 关键词 粘膜瓣 局部扩张 修复术 鼻咽闭锁 Pairs of U-shaped mucosal flap and local dilation treatment of nasopharyngeal atresia Zhang Bing-hui1 Shi Yu-ming2 Liu Ming1 (1 Second Affiliated Hospital of Harbin Medical University, Otolaryngology Head and Neck Surgery Harbin 150086 2 Hospital of Heilongjiang Province, Otolaryngology Head and Neck Surgery Harbin 150010) ?Abstract Objective: To investigate the double U-shaped mucosal flap surgery plus local expansion method and effect of nasopharyngeal atresia. Methods: 9 cases of acquired nasopharyngeal closure in patients with dual U-shaped flap pharyngeal mucosa and soft palate wound, then placed in the expansion tube effects were observed. Results: After six months, removed silicone tube, the nasopharynx down to about 2.0 to about 2.5 cm in diameter, about 1.0 cm in diameter before and after the gap. Nasal patency, had velopharyngeal insufficiency, nasal regurgitation of food. After 2 years of follow-up, all patients with nasal patency, sleeping, eating normal. One case of nasal regurgitation of food there. Conclusion: U-shaped mucosal flap and Local dilatation is an effective method of treatment of nasopharyngeal atresia. Keyword： Mucosal flap Local expansion Prosthesis Atresia of nasopharynx 鼻咽闭锁在临床上比较少见，先天性鼻咽闭锁大多原因不明，后天性鼻咽闭锁大多由外伤和感染所致。手术是治疗鼻咽闭锁的有效方法，尽管治疗方法很多，但术后再次闭锁仍是治疗的难题。我们于1997年～2007年间，利用U形粘膜瓣修复加局部扩张术治疗鼻咽闭锁9例，取得了满意的治疗效果。现报道如下。 1资料和方法 1．1临床资料 9例患者中，男4例；女5例。年龄22～46岁，平均31.2岁。腭咽成形术后鼻咽闭锁2例；咽扁桃体切除术后1例；结核感染2例；外伤1例；不明原因3例。2例有1次手术史，1例有3次手术史。 检查：口咽、鼻咽通道瘢痕粘连闭锁或仅有约直径2毫米大小裂隙。悬雍垂均缺失，5例扁桃体缺失或瘢痕化，4例扁桃体已萎缩或1°大。鼻咽镜检查，双侧后鼻孔通畅。CT检查鼻咽部软组织闭锁。 1.2手术方法 9例均在口腔插管全麻下进行。置入开口器，将钢丝气管插管压于开口器之下。先在粘连平面上方1.5厘米处的软腭上做倒U形切口，在粘膜下分离到粘连平面下，形成基底在下方的倒U形粘膜瓣即A瓣（图