中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
2期
96-100
,共5页
苏英锋%孙秀珍%刘迎曦%于申%王吉喆%宿芳
囌英鋒%孫秀珍%劉迎晞%于申%王吉喆%宿芳
소영봉%손수진%류영희%우신%왕길철%숙방
耳鼻喉外科手术%空气流动%鼻腔
耳鼻喉外科手術%空氣流動%鼻腔
이비후외과수술%공기류동%비강
Otorhinolaryngologic surgical procedures%Air movements%Nasal cavity
目的 探讨鼻中隔矫正术或联合下鼻甲骨折外移术对鼻腔气流场及气道结构的影响.方法 对2006-2009年诊治的6例"C"型鼻中隔偏曲患者行鼻中隔矫正术或联合下鼻甲骨折外移术,术前及术后分别行鼻CT检查,根据CT分别对手术前后鼻腔气道结构进行表面三维重建,设定边界条件并求解Navier-Stokes方程.对比分析手术前后通气量为12 L/min时气流场、气道结构变化.采用SPSS 12.0软件进行非参数秩和检验.结果 术前气道总面积、总鼻道中、下部面积宽敞侧分别为(1.61±0.18)、(0.40±0.10)、(0.40±0.14)cm2,狭窄侧分别为(1.30±0.18)、(0.33±0.05)、(0.36±0.10)cm2,双侧对比差异无统计学意义(Z值分别为1.782、1.363、0.526,P值均＞0.05);气道总流量、总鼻道中、下部流量、下鼻甲厚度宽敞侧分别为(361±68)、(131±25)、(100±28)ml,(0.93±0.10)cm,狭窄侧分别为(178±33)、(59±26)、(59±18)ml,(0.58±0.12)cm,双侧对比差异均有统计学意义(Z值分别为2.207、2.201、2.201、2.214,P值均＜0.05);双侧气流形式均紊乱.术后气道总面积宽敞侧、狭窄侧分别为(2.55±0.44)、(2.20±0.72)cm2,术后狭窄侧总鼻道中、下部面积分别为(0.58±0.13)、(0.81±0.26)cm2,术后宽敞侧下鼻甲厚度为(0.73±0.08)cm,与术前对比差异均有统计学意义(Z值分别为2.201、2.201、2.201、2.201、2.264,P值均＜0.05);双侧气流形式稳定.术后气道阻力[(0.16±0.01)kPa·L-1·s-1]较术前[(0.41±0.03)kPa·L-1·s-1]明显减小,差异有统计学意义(Z=-2.207,P=0.027).结论 鼻中隔偏曲患者术前鼻腔气道呈失代偿性改变,通气功能减退;行鼻中隔矫正术或联合下鼻甲骨折外移术后通气功能好转,但气道结构仍有继发性、自适应性改变.
目的 探討鼻中隔矯正術或聯閤下鼻甲骨摺外移術對鼻腔氣流場及氣道結構的影響.方法 對2006-2009年診治的6例"C"型鼻中隔偏麯患者行鼻中隔矯正術或聯閤下鼻甲骨摺外移術,術前及術後分彆行鼻CT檢查,根據CT分彆對手術前後鼻腔氣道結構進行錶麵三維重建,設定邊界條件併求解Navier-Stokes方程.對比分析手術前後通氣量為12 L/min時氣流場、氣道結構變化.採用SPSS 12.0軟件進行非參數秩和檢驗.結果 術前氣道總麵積、總鼻道中、下部麵積寬敞側分彆為(1.61±0.18)、(0.40±0.10)、(0.40±0.14)cm2,狹窄側分彆為(1.30±0.18)、(0.33±0.05)、(0.36±0.10)cm2,雙側對比差異無統計學意義(Z值分彆為1.782、1.363、0.526,P值均＞0.05);氣道總流量、總鼻道中、下部流量、下鼻甲厚度寬敞側分彆為(361±68)、(131±25)、(100±28)ml,(0.93±0.10)cm,狹窄側分彆為(178±33)、(59±26)、(59±18)ml,(0.58±0.12)cm,雙側對比差異均有統計學意義(Z值分彆為2.207、2.201、2.201、2.214,P值均＜0.05);雙側氣流形式均紊亂.術後氣道總麵積寬敞側、狹窄側分彆為(2.55±0.44)、(2.20±0.72)cm2,術後狹窄側總鼻道中、下部麵積分彆為(0.58±0.13)、(0.81±0.26)cm2,術後寬敞側下鼻甲厚度為(0.73±0.08)cm,與術前對比差異均有統計學意義(Z值分彆為2.201、2.201、2.201、2.201、2.264,P值均＜0.05);雙側氣流形式穩定.術後氣道阻力[(0.16±0.01)kPa·L-1·s-1]較術前[(0.41±0.03)kPa·L-1·s-1]明顯減小,差異有統計學意義(Z=-2.207,P=0.027).結論 鼻中隔偏麯患者術前鼻腔氣道呈失代償性改變,通氣功能減退;行鼻中隔矯正術或聯閤下鼻甲骨摺外移術後通氣功能好轉,但氣道結構仍有繼髮性、自適應性改變.
목적 탐토비중격교정술혹연합하비갑골절외이술대비강기류장급기도결구적영향.방법 대2006-2009년진치적6례"C"형비중격편곡환자행비중격교정술혹연합하비갑골절외이술,술전급술후분별행비CT검사,근거CT분별대수술전후비강기도결구진행표면삼유중건,설정변계조건병구해Navier-Stokes방정.대비분석수술전후통기량위12 L/min시기류장、기도결구변화.채용SPSS 12.0연건진행비삼수질화검험.결과 술전기도총면적、총비도중、하부면적관창측분별위(1.61±0.18)、(0.40±0.10)、(0.40±0.14)cm2,협착측분별위(1.30±0.18)、(0.33±0.05)、(0.36±0.10)cm2,쌍측대비차이무통계학의의(Z치분별위1.782、1.363、0.526,P치균＞0.05);기도총류량、총비도중、하부류량、하비갑후도관창측분별위(361±68)、(131±25)、(100±28)ml,(0.93±0.10)cm,협착측분별위(178±33)、(59±26)、(59±18)ml,(0.58±0.12)cm,쌍측대비차이균유통계학의의(Z치분별위2.207、2.201、2.201、2.214,P치균＜0.05);쌍측기류형식균문란.술후기도총면적관창측、협착측분별위(2.55±0.44)、(2.20±0.72)cm2,술후협착측총비도중、하부면적분별위(0.58±0.13)、(0.81±0.26)cm2,술후관창측하비갑후도위(0.73±0.08)cm,여술전대비차이균유통계학의의(Z치분별위2.201、2.201、2.201、2.201、2.264,P치균＜0.05);쌍측기류형식은정.술후기도조력[(0.16±0.01)kPa·L-1·s-1]교술전[(0.41±0.03)kPa·L-1·s-1]명현감소,차이유통계학의의(Z=-2.207,P=0.027).결론 비중격편곡환자술전비강기도정실대상성개변,통기공능감퇴;행비중격교정술혹연합하비갑골절외이술후통기공능호전,단기도결구잉유계발성、자괄응성개변.
Objective To explore the effect of septoplasty or in combination with outfracture of the inferior turbinate in patients with nasal septum deviation on the airflow field and the nasal airway structure.Methods Six patients with nasal septum deviation underwent spiral CT imaging scans before surgery and during the follow-up.The 3D finite element meshes of the nasal airway were developed from the above CT scans.Given three preconditions,the nasal airflow fields were described by the Navier-Stokes and continuity equations at the inspiratory flow rate of 12 L/ min. The whole airflow patterns were obtained and then compared with the airflow filed and airway structure changes before and after surgery.SPSS 12.0 software was used to analyze the data.Results Before surgery,area of the common airway and the middle and ventral medial regions in the concave side were (1.61 ± 0.18),(0.40 ± 0.10),(0.40 ± 0.14) cm2 respectively,and those of convex side were (1.30 ±0.18),(0.33 ±0.05),(0.36 ±0.10) cm2 respectively.The differences between both sides were of no statistical significance (Z value was 1.782,1.363,0.526 respectively,all P ＞ 0.05).Airflow of the above airways were (361 ± 68),(131 ± 25),(100 ±28) ml respectively in concave side and (178 ± 33),(59 ± 26),(59 ± 18) ml respectively in convex side, which differences were significant statistically (Z value were 2.207,2.201,2.201respectively,all P ＜ 0.05＝.The inferior turbinate in concave side [(0.93 ± 0.10) cm] was statistically (Z=2.214,P＜0.05＝ bigger than that in convex side[(0.58 ±0.12)cm] before surgery.The airflow fields were in disorder in both ill-airways.After surgery,area of the common airway was (2.55 ±0.44) cm2in concave side and (2.20 ± 0.72)cm2 in convex side respectively,and area of the middle and ventral medial regions in the convex side were (0.58 ± 0.13),(0.81 ± 0.26)em2 respectively,which differences were of significance statistically when comparing to areas before surgery (Z value were 2.201,2.201,2.201,2.201,P ＜0.05＝.The airflow passed through nasal airway orderly in both sides.But the thickness of inferior turbinate was (0.73 ±0.08)cm in concave side after surgery,which difference was significant statistically in comparison to that before surgery (Z = 2.264,P ＜ 0.05＝.Consequently,nasal resistance decreased from (0.41 ± 0.03) k Pa · L- 1 · s - 1 to (0.16 ± 0.01) kPa · L -1 · s - 1 after surgery,the difience was significantly(Z = -2.207,P = 0.027).Conclusion Septoplasty or in combination with outfracture of the inferior turbinate,followed by the self-adaptation consecutively,could improve the airway and breathing capacity of the nose.
