鼻内镜下动力系统鼻前庭囊肿揭盖术治疗鼻前庭囊肿的疗效观察

江晓东 舒继红

[摘要]目的：研究鼻内镜下动力系统鼻前庭囊肿揭盖术治疗鼻前庭囊肿（Nasal vestibular cyst，NVC）的疗效。方法：根据不同术式将笔者医院2018年9月-2020年2月笔者医院收治的59例NVC患者分为观察组（鼻内镜下动力系统鼻前庭囊肿揭盖术）27例与对照组（唇齿沟径路鼻前庭囊肿切除术）32例。比较两组手术疗效、不同时间点视觉模拟评分（Visual analogue score，VAS）及创伤指标。结果：观察组手术时长、切口愈合时间和住院时间均短于对照组，术中出血量少于对照组，差异有统计学意义（P<0.05）。观察组无切口感染发生，面部肿胀和麻木各1例，对照组对应5例、4例、7例，组间比较差异无统计学意义（P>0.05）。觀察组术后第1天、第3天、第5天VAS评分均低于对照组，差异有统计学意义（P<0.05）。与术前比较，两组术毕即刻血清C反应蛋白（CRP）、P物质（SP）、前列腺素E2（PGE2）、肿瘤坏死因子-α（TNF-α）水平均明显上升，但观察组低于对照组，差异有统计学意义（P<0.05）。观察组随访半年无复发，对照组复发3例，组间比较差异无统计学意义（P>0.05）。结论：鼻内镜下动力系统鼻前庭囊肿揭盖术治疗NVC具有创伤小、术后疼痛轻、并发症少、复发风险低等特点。

[关键词]鼻前庭囊肿;鼻动力系统;揭盖术;唇齿沟径路;并发症;复发;VAS评分

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）05-0021-03

Observation on the Curative Effect of Nasal Vestibular Cyst Uncovering with Dynamic System under Nasal Endoscope

JIANG Xiao-dong，SHU Ji-hong

（Department of ENT & HN Surgery，the First Affiliated Hospital of Bengbu Medical College，Bengbu 233000，Anhui，China）

Abstract： Objective  To study the efficacy of nasal vestibular cyst （NVC） uncovering with dynamic system under nasal endoscopy. Methods  According to different surgical methods， 59 patients with NVC admitted to the hospital from September 2018 to February 2020 were divided into the observation group （nasal vestibular cyst uncovering with dynamic system under nasal endoscopy） with 27 cases and the control group （nasal vestibular cyst by labiodental sulcus path resection） with 32 cases. The surgical efficacy， visual analogue scale （VAS） and trauma indicators at different time points were compared between the two groups. Results  The operation time， incision healing time and hospitalization time in the observation group were shorter than those in the control group， and intraoperative blood loss was less than that in the control group， the differences were statistically significant （P<0.05）. There were no incision infection， one case of facial swelling and one case of numbness in the observation group， while there were 5 cases， 4 cases and 7 cases in the control group respectively， there were no significant difference between the two groups （P>0.05）. The VAS scores of the observation group on the 1st， 3rd， and 5th day after operation were lower than those of the control group （P<0.05）. Compared with those before the operation， serum C-reactive protein （CRP）， substance P （SP）， prostaglandin E2 （PGE2）， and tumor necrosis factor-α （TNF-α） levels in the two groups increased significantly after the operation， but the comparison between the observation group and the control group was significantly lower， the differences were statistically significant （P<0.05）. There was no recurrence in the observation group and 3 cases in the control group， there was no significant difference between the two groups （P>0.05）. Conclusion  Nasal vestibular cyst uncovering with dynamic system under nasal endoscopy in the treatment of NVC has the characteristics of less trauma， less postoperative pain， less complications， and low risk of recurrence.

Key words： nasal vestibular cyst; nasal dynamic system; uncovering technique; labial sulcus approach; complication; recurrence; VAS score

鼻前庭囊肿（Nasal vestibular cyst，NVC）是发生在鼻前庭底部和下鼻甲、上颌骨牙槽突及外下壁间、以中青年女性居多的囊性肿瘤[1]，其发病与先天不足、腺体潴留有关[2-3]。NVC生长不快，早期症状不典型，待其慢慢增大时患者会有胀痛感，且继发感染会加重疼痛，隨之增快囊肿生长进程。唇齿沟径路切除术（Labiodental sulcus path resection，LSPR）为NVC治疗常见术式，但其手术耗时长，创伤大，易出现牙龈瘘等并发症，不利于患者恢复，且易复发。近年来鼻前庭囊肿揭盖术（以下简称“揭盖术”）因其微创、恢复快、复发率低等特点在NVC治疗中应用较多[4]。本研究对笔者医院2018年9月-2020年2月接受LSPR、鼻内镜下动力系统揭盖术治疗的59例NVC患者临床相关资料进行回顾性分析，报道如下。……