Name: endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation
Uploaded: 2018-06-20T13:30:00
Description: Watch this Scientific Journal Video about Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation at JoVE.com

这项工作由中国国家自然科学基金 (81300810 号)、上海市青年医生培训计划 (20141057 号)、上海自然科学基金 (16ZR1405100) 和上海市资助。卫生和计划生育委员会 (201740187 号)。我们感谢 LetPub (www.letpub.com) 在编写本手稿期间提供语言援助。

这一程序涉及人类的主题, 是由中国复旦大学眼科和耳鼻喉科医院的机构审查委员会批准的。所有登记的病人都提供书面知情同意。
1. 手术准备
<ol><li>手术前, 检查病人的鼻腔与前 rhinoscopy, 内窥镜, 和计算机断层扫描 (CT), 以确认和定位的偏差和确定的迹象15。</li>
	<li>让病人评估整个鼻子的通畅性, 并在手术前用视觉模拟量表 (VAS) 表示这一点。 注: 总长度...

<ol>
	<li>Chung, B. J., Batra, P. S., Citardi, M. J., Lanza, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+revisitation+of+the+technique,+indications,+and+outcomes.">Endoscopic septoplasty: revisitation of the technique, indications, and outcomes.</a> The American Journal of Rhinology. 21 (3), 307-311 (2007).</li><li>Hwang, P. H., McLaughlin, R. B., Lanza, D. C., Kennedy, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+indications,+technique,+and+results.">Endoscopic septoplasty: indications, technique, and results.</a> Otolaryngology-Head and Neck Surgery. 120 (5), 678-682 (1999).</li><li>Fettman, N., Sanford, T., Sindwani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+the+deviated+septum:+techniques+in+septoplasty.">Surgical management of the deviated septum: techniques in septoplasty.</a> Otolaryngologic Clinics of North America. 42 (2), 241-252 (2009).</li><li>Killian, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+submucous+window+resection+of+the+nasal+septum.">The submucous window resection of the nasal septum.</a> Annals of Otology, Rhinology &amp; Laryngology. 14, 363-393 (1905).</li><li>Freer, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+correction+of+deflections+of+the+nasal+septum+with+a+minimum+of+traumatism.">The correction of deflections of the nasal septum with a minimum of traumatism.</a> The Journal of The American Medical Association. 38, 636-642 (1902).</li><li>Aaronson, N. L., Vining, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+the+deviated+septum:+from+ancient+Egypt+to+the+endoscopic+era.">Correction of the deviated septum: from ancient Egypt to the endoscopic era.</a> International Forum of Allergy &amp; Rhinology. 4 (11), 931-936 (2014).</li><li>Bloom, J. D., Kaplan, S. E., Bleier, B. S., Goldstein, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Septoplasty+complications:+avoidance+and+management.">Septoplasty complications: avoidance and management.</a> Otolaryngologic Clinics of North America. 42 (3), 463-481 (2009).</li><li>Rettinger, G., Kirsche, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+in+septoplasty.">Complications in septoplasty.</a> Facial Plastic Surgery. 22 (4), 289-297 (2006).</li><li>Cottle, M. H., Loring, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Newer+concepts+of+septum+surgery;+present+status.">Newer concepts of septum surgery; present status.</a> Eye, Ear, Nose &amp; Throat Monthly. 27 (9), 403-406 (1948).</li><li>Gibson, T., Davis, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+distortion+of+autogenous+cartilage+grafts:+Its+causes+and+prevention.">The distortion of autogenous cartilage grafts: Its causes and prevention.</a> British Journal of Plastic Surgery. 10, 257-274 (1958).</li><li>Kenedi, R. M., Gibson, T., Abrahams, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+characteristics+of+skin+and+cartilage.">Mechanical characteristics of skin and cartilage.</a> Human Factors. 5, 525-529 (1963).</li><li>Stenstroem, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+&amp;#34;natural&amp;#34;+technique+for+correction+of+congenitally+prominent+ears.">A &amp;#34;natural&amp;#34; technique for correction of congenitally prominent ears.</a> Plastic and Reconstructive Surgery. 32, 509-518 (1963).</li><li>Fry, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interlocked+stresses+in+human+nasal+septal+cartilage.">Interlocked stresses in human nasal septal cartilage.</a> British Journal of Plastic Surgery. 19 (3), 276-278 (1966).</li><li>Wang, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+septoplasty+with+three+high+tension+lines+resection.">A modified septoplasty with three high tension lines resection.</a> Acta Oto-Laryngologica. 130 (5), 593-599 (2010).</li><li>Trimarchi, M., Bellini, C., Toma, S., Bussi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Back-and-forth+endoscopic+septoplasty:+analysis+of+the+technique+and+outcomes.">Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes.</a> International Forum of Allergy &amp; Rhinology. 2 (1), 40-44 (2012).</li><li>Kilicaslan, A., Acar, G. O., Tekin, M., Ozdamar, O. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+the+long-term+effects+of+septoplasty+surgery+on+olfactory+function.">Assessment the long-term effects of septoplasty surgery on olfactory function.</a> Acta Oto-Laryngologica. 136 (10), 1079-1084 (2016).</li><li>Meeuwis, J., Verwoerd-Verhoef, H. L., Verwoerd, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+and+abnormal+nasal+growth+after+partial+submucous+resection+of+the+cartilaginous+septum.">Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum.</a> Acta Oto-Laryngologica. 113 (3), 379-382 (1993).</li><li>Lopatin, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Do+laws+of+biomechanics+work+in+reconstruction+of+the+cartilaginous+nasal+septum.">Do laws of biomechanics work in reconstruction of the cartilaginous nasal septum.</a> European Archives of Oto-Rhino-Laryngology. 253 (4-5), 309-312 (1996).</li><li>D'Ascanio, L., Manzini, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quick+septoplasty:+surgical+technique+and+learning+curve.">Quick septoplasty: surgical technique and learning curve.</a> Aesthetic Plastic Surgery. 33 (6), 814-818 (2009).</li></ol>

2LoRs 程序是基于胚胎和解剖知识的歪鼻隔膜。鼻中隔由三种不同成分组成: 前膜、中间软骨、后骨和下骨骼。在鼻中隔发育过程中, 不同的组分僵化不同的时间序列。通常认为, 当软骨仍在生长时, 骨骼就能完成伸展。因此, 应力堆积在相邻的骨间隔软骨的边缘, 导致最初的力量, 可能会变形的鼻中隔。因此, 在大多数情况下, 鼻中隔偏离一定程度从中线位置14。因此, 2LoRs 的原则是改...

内镜鼻中隔成形术是耳鼻咽喉部常见的手术方法, 用于治疗鼻中隔偏1引起的鼻气道梗阻。鼻中隔成形术鼻气道梗阻的目的是为鼻气道通畅提供功能性改善, 其原则是矫正间隔偏差, 以最小的手术侵袭率2。
鼻中隔成形术的起点, 今天仍然使用的做法, 追溯到自由和基利安出版的技术在第二十世纪初, 叫黏膜下切除 (SMR)3。SMR 的特点是它直接去除了 subperichondrial 平面上的鼻软骨的偏差, 留下一个 L 形的支撑结构支持鼻子4,5的外观。SMR 在当时的技术上表现出优势, 因此逐渐得到了认可。二十世纪九十年代, 内窥镜应用于鼻中隔成形术1。手术现场的光照和可视化程度均有明显提高, 切除术可直接、准确地进行6。在此之后, 对 SMR 的适应症进行了扩展, 并开发了各种鼻中隔成形术技术。虽然这些技术可以在切口、皮瓣抬高、切除、缝合或包装等方面多样化, 但直接去除的本质并没有改变。因此, 一旦软骨明显切除, 并发症如大间隔穿孔或鞍鼻畸形将发生7,8。
正如卡托和洛林在1948年提出的, 偏软骨切除术应保守9。不同于直接去除软骨的偏差, 软骨的生物力学应用于鼻中隔成形术需要利用软骨的固有弹性特性, 以矫正软骨的偏差由有限的手术干预, 如部分切口 (如划伤或薄片) 和全切口 (例如, 全切或楔形)。在 1958年, 吉布森和戴维斯首次报道, 由于其生长模式10, 软骨有一个内部的自锁应力系统。部分切口在凹边将释放重音, 从而减少软骨的鞠躬, 而凸边切口将增加鞠躬。在 1963年, Kenedi, 吉布森和亚伯拉罕进一步展示了自锁应力系统通过一系列的研究绘制的力量分布在肋骨软骨截面11。同年, 史丹斯壮验证了部分切口对 antihelix12的影响。几年后, 南联盟公布的结果, 在人鼻中隔软骨, 是一致的13。换句话说, 软骨的生物力学可以通过释放软骨中的力量来改变软骨的形态。在此基础上, 提出了利用软骨生物力学特征的外科手术方法14。
结合以前的手术程序与鼻中隔的胚胎和解剖学知识, 在这里, 一个改良内镜鼻中隔成形术程序与技术的有限两线切除 (2LoRs) 在后和下连接软骨和骨间隔 (图 1) 详细介绍。本程序建议在外部鼻畸形缺席时矫正鼻中隔偏鼻, 改善鼻腔通畅, 或改善进入中鼻道或中部鼻甲腋区作为术前手术的途径。这一程序也可以用于儿童纠正间隔偏差, 因为它的微创方法。

<table border="0" cellpadding="0" cellspacing="0" style="width:755px;" width="755">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasal Endoscopy (0o)</td>
			<td style="width:221px;">Karl Storz-Endoskope</td>
			<td style="width:127px;">7230 AA</td>
			<td style="width:180px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Tetracaine</td>
			<td style="width:221px;">Eye &#38; ENT Hospital of Fudan University</td>
			<td style="width:127px;">180130</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Epinephrine Hydrochloride Injection</td>
			<td style="width:221px;">Shanghai Harvest Pharmaceutical Co., Ltd</td>
			<td style="width:127px;">10170405</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Number 15 blade</td>
			<td style="width:221px;">Shanghai Pudong Jinhuan Medical Products Co., Ltd</td>
			<td style="width:127px;">35T1205</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Suction Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2117.1</td>
			<td>Width: 4 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Electrocoagulation</td>
			<td style="width:221px;">Shanghai Hutong Electronics. Co.,Ltd</td>
			<td style="width:127px;">GD350-B5</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">4-0 Brided Absorbable Suture</td>
			<td style="width:221px;">Covidien Healthcare</td>
			<td style="width:127px;">SL-691</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Rongeur forcep</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2300.3</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasopore</td>
			<td style="width:221px;">Nasopore, Stryker, USA</td>
			<td style="width:127px;"></td>
			<td>Lengh: 8 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Gauze</td>
			<td style="width:221px;">Ningbo Shenyuan Medical Material Co., Ltd</td>
			<td style="width:127px;"></td>
			<td>6 cm x 60 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">5mm Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2067</td>
			<td>Width: 5 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">2mm Elevator</td>
			<td style="width:221px;">Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory</td>
			<td style="width:127px;">HBL020</td>
			<td>Width: 2 mm</td>
		</tr>
	</tbody>
</table>

endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation

内镜鼻中隔成形术是耳鼻喉科的一种外科手术, 通常用于治疗鼻中隔偏压引起的鼻气道梗阻。它的历史悠久, 有多种变体。本文以胚胎和解剖知识为基础, 采用有限的双线切除 (2LoRs) 技术, 在软骨和骨间隔的后、下交界处进行了改良的内镜鼻中隔成形术手术。鼻中隔和软骨行为的生物力学。采用此方法可以尽可能地保留四边形软骨, 有利于保留隔膜的支撑框架和刚度。2LoRs. 经证实, 鼻间隔偏差的矫正与少见的并发症是有效和合理的。本修改后的程序可适用于矫正鼻中隔不存在任何外部鼻畸形, 以改善鼻腔通畅或改善进入中道或腋窝地区的中鼻甲。它也可能被用来扩大鼻中隔成形术的迹象, 因为它的微创方法的儿童和青少年。

本研究包括成人患者 (> 18 岁) 鼻中隔偏差。鼻间隔偏差患者伴有慢性鼻窦炎、鼻肿瘤、外鼻畸形以及以前鼻中隔成形术手术史的病人除外。患者的直背部, 但谁有骶部软骨脱臼的大鼻翼, 已突出成一个鼻门廊也排除了。
本研究包括三十二例患者。患者的平均年龄为44.7 岁 (19-72 岁), 68% 为男性, 32% 为女性。输精管评分显示为平均?...

Watch this Scientific Journal Video about Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation at JoVE.com

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜鼻中隔成形术是一种具有多种变异的具有悠久历史的外科手术方法。本文的重点是一步一步的手术方法执行一项改良的鼻中隔成形术程序称为有限的两线切除术。这种手术技术可用于矫正鼻中隔偏歪, 在没有外部鼻畸形。

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