鼻中隔穿孔修复改善嗅觉和黏液纤毛清除功能：一项前瞻性研究

文献信息

中文摘要

目的： 鼻中隔穿孔（NSP）破坏正常鼻腔生理功能，并可能导致显著的功能性症状。本研究旨在前瞻性评估使用阔筋膜-肋软骨三明治移植物（FLCCSG）修复鼻中隔穿孔后嗅觉功能、鼻腔黏液纤毛清除（MCC）和生活质量（QOL）的变化。
方法： 纳入30例通过开放式鼻整形入路并置入FLCCSG进行鼻中隔穿孔修复的患者。术前及术后1、3和6个月分别使用Sniffin' Sticks测试评估嗅觉功能，使用Andersen糖精试验评估MCC，并使用SNOT-22问卷评估QOL。对功能结局进行纵向分析。
结果： 在6个月随访结束时，所有患者的鼻中隔穿孔均完全闭合。与术前相比，术后第3和第6个月观察到总嗅觉评分（TOS）和MCC时间有统计学显著改善（p < 0.001）。SNOT-22评分在术后第1、3和6个月显示显著改善（p < 0.001）。TOS平均增加7.33（95% CI：4.84-9.82），而MCC时间减少312.7秒（95% CI：-480.43至-144.96），SNOT-22评分降低18.8分（95% CI：-24.32至-13.27）。未发现穿孔大小与功能结局之间存在相关性。吸烟与嗅觉功能改善较少相关，而继发于鼻中隔手术的穿孔患者表现出更大的功能恢复。
结论： 使用FLCCSG修复鼻中隔穿孔不仅在解剖上闭合穿孔，还可使嗅觉功能、MCC和QOL获得显著且进行性的改善。

英文摘要

OBJECTIVE: Nasal septal perforation (NSP) disrupts normal nasal physiology and may lead to significant functional symptoms. This study aimed to prospectively evaluate changes in olfactory function, nasal mucociliary clearance (MCC), and quality of life (QOL) following septal perforation repair using a fascia lata-costal cartilage sandwich graft (FLCCSG).
METHODS: Thirty patients undergoing septal perforation repair via an open rhinoplasty approach with interposition of a FLCCSG were included. Olfactory function was assessed using the Sniffin' Sticks test, MCC using the Andersen saccharin test and QOL using the SNOT-22 questionnaire preoperatively and at 1, 3, and 6 months postoperatively. Functional outcomes were analyzed longitudinally.
RESULTS: At the end of the 6-month follow-up, complete closure of the septal perforation was achieved in all patients. A statistically significant improvement in total olfactory scores (TOS) and MCC times was observed at the postoperative 3rd and 6th months compared to the preoperative period (p < 0.001). SNOT-22 scores showed significant improvement at the postoperative 1st, 3rd, and 6th months (p < 0.001). The mean increase in TOS was 7.33 (95% CI: 4.84-9.82), while MCC time decreased by 312.7 s (95% CI: -480.43 to -144.96) and SNOT-22 scores decreased by 18.8 points (95% CI: -24.32 to -13.27). No correlation was found between perforation size and functional outcomes. Smoking was associated with less improvement in olfactory function, while patients with perforations secondary to septal surgery exhibited greater functional recovery.
CONCLUSION: Septal perforation repair using a FLCCSG results in significant and progressive improvements in olfactory function, MCC, and QOL beyond anatomical closure alone.