鼻中隔穿孔原因

1.外傷

經(jing)常挖鼻(bi)(bi)，鼻(bi)(bi)外傷(shang)所致(zhi)的鼻(bi)(bi)中(zhong)隔(ge)(ge)膿腫，鼻(bi)(bi)中(zhong)隔(ge)(ge)手術損傷(shang)鼻(bi)(bi)中(zhong)隔(ge)(ge)兩側(ce)黏膜(mo)，腐蝕性(xing)和刺(ci)激性(xing)物質如鉻酸、矽(xi)塵、砷、升汞、水泥、石灰(hui)等長期刺(ci)激鼻(bi)(bi)中(zhong)隔(ge)(ge)黏膜(mo)引起的潰(kui)瘍(yang)，反復使用腐蝕性(xing)藥物燒灼鼻(bi)(bi)中(zhong)隔(ge)(ge)兩側(ce)黏膜(mo)。

2.鼻的特殊性傳染病

如結核、狼瘡、麻風引起的(de)穿孔(kong)多(duo)(duo)在鼻(bi)中隔軟(ruan)骨(gu)部(bu)，梅毒(du)性(xing)穿孔(kong)多(duo)(duo)位于鼻(bi)中隔骨(gu)部(bu)，且發鞍鼻(bi)。

3.急性傳染病

如白喉、天花、傷寒(han)和猩紅熱等。

4.其他

①Wegener肉芽腫(zhong)、鼻(bi)腔癌、異物和結石。②鼻(bi)外(wai)傷導致鼻(bi)中隔損傷處理不當。③鼻(bi)中隔膿(nong)腫(zhong)處理不當。④引起鼻(bi)中隔潰瘍的(de)疾(ji)病病程遷延過久。

該圖片由注冊用戶"橘子de殿堂"提供，版權聲明反饋

鼻中隔癥狀

鼻(bi)中隔(ge)穿(chuan)(chuan)孔(kong)病(bing)因的多(duo)樣性決定了它既(ji)可表現(xian)為(wei)一(yi)獨(du)立疾病(bing)，也可作(zuo)為(wei)某一(yi)疾病(bing)的局部表現(xian)。僅就鼻(bi)中隔(ge)穿(chuan)(chuan)孔(kong)而言，其主要表現(xian)為(wei)鼻(bi)腔干燥和(he)膿痂形成，常(chang)伴有(you)(you)頭痛和(he)鼻(bi)出血。小(xiao)穿(chuan)(chuan)孔(kong)者(zhe)若在鼻(bi)中隔(ge)前段，呼吸(xi)時常(chang)發生吹哨(shao)聲(sheng)；若位(wei)于鼻(bi)中隔(ge)后段，則(ze)無(wu)吹哨(shao)聲(sheng)。結核和(he)病(bing)毒引起膿痂有(you)(you)臭味。

鼻中隔檢查

經鼻(bi)鏡檢(jian)查(cha)可見鼻(bi)中(zhong)隔貫穿(chuan)(chuan)性穿(chuan)(chuan)孔(kong)，穿(chuan)(chuan)孔(kong)處結痂，穿(chuan)(chuan)孔(kong)邊緣糜爛、易出血。有(you)時較小的(de)穿(chuan)(chuan)孔(kong)常被結痂覆(fu)蓋而忽略，應除(chu)去結痂仔細檢(jian)查(cha)其穿(chuan)(chuan)孔(kong)大小，位(wei)置(zhi)，形狀。

鼻中隔治療

1.鼻(bi)中隔(ge)黏膜瓣(ban)修補法

（1）減張縫合法(fa)適用(yong)于位于鼻(bi)中(zhong)(zhong)隔前(qian)(qian)下(xia)方的(de)(de)小穿(chuan)孔(kong)(kong)(kong)。局部表面和浸潤(run)麻醉后，將穿(chuan)孔(kong)(kong)(kong)邊緣去少許以形(xing)成新鮮創面。在穿(chuan)孔(kong)(kong)(kong)邊緣的(de)(de)前(qian)(qian)上(shang)方1～2cm處(chu)做一弧(hu)形(xing)切口，其(qi)(qi)長(chang)度應超過穿(chuan)孔(kong)(kong)(kong)直(zhi)徑。自穿(chuan)孔(kong)(kong)(kong)創緣分離鼻(bi)中(zhong)(zhong)隔兩側(ce)黏骨(gu)膜至弧(hu)形(xing)切口，以松(song)解黏骨(gu)膜，然(ran)后將其(qi)(qi)向后下(xia)拉并(bing)覆蓋(gai)穿(chuan)孔(kong)(kong)(kong)，將此中(zhong)(zhong)隔軟組(zu)織(zhi)瓣膜片后下(xia)方1～2cm處(chu)，將其(qi)(qi)組(zu)織(zhi)瓣膜牽拉向前(qian)(qian)上(shang)遮蓋(gai)穿(chuan)孔(kong)(kong)(kong)，并(bing)在穿(chuan)孔(kong)(kong)(kong)的(de)(de)前(qian)(qian)上(shang)緣處(chu)縫合。

（2）鼻(bi)中(zhong)隔(ge)(ge)黏(nian)(nian)(nian)膜(mo)瓣(ban)轉位修(xiu)補法在(zai)鼻(bi)中(zhong)隔(ge)(ge)左側(ce)黏(nian)(nian)(nian)膜(mo)上(shang)(shang)，自穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)上(shang)(shang)方繞(rao)過穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)后(hou)緣(yuan)至穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)下(xia)方，做一(yi)弧形(xing)切(qie)(qie)口。再自切(qie)(qie)口起(qi)點繞(rao)過穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)前緣(yuan)做另一(yi)弧形(xing)切(qie)(qie)口，兩(liang)者匯合(he)成一(yi)梭(suo)形(xing)，中(zhong)間為(wei)穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)，上(shang)(shang)下(xia)各(ge)為(wei)一(yi)三角(jiao)(jiao)形(xing)黏(nian)(nian)(nian)膜(mo)瓣(ban)，然后(hou)將穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)上(shang)(shang)下(xia)兩(liang)個三角(jiao)(jiao)形(xing)黏(nian)(nian)(nian)膜(mo)瓣(ban)自尖(jian)端(duan)向(xiang)穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)邊緣(yuan)剝離，形(xing)成以穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)緣(yuan)為(wei)蒂的(de)黏(nian)(nian)(nian)膜(mo)瓣(ban)。將穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)上(shang)(shang)面的(de)黏(nian)(nian)(nian)膜(mo)瓣(ban)向(xiang)下(xia)翻，下(xia)端(duan)黏(nian)(nian)(nian)膜(mo)瓣(ban)向(xiang)上(shang)(shang)翻。這樣(yang)便形(xing)成了(le)穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)部右側(ce)黏(nian)(nian)(nian)膜(mo)。左側(ce)穿(chuan)(chuan)(chuan)孔(kong)(kong)(kong)(kong)的(de)覆蓋與(yu)單(dan)側(ce)減張縫合(he)法相同，但要保證黏(nian)(nian)(nian)膜(mo)瓣(ban)的(de)寬度。

2.鼻(bi)甲黏膜瓣修補法(fa)

（1）中鼻甲黏膜(mo)轉位法將(jiang)穿(chuan)孔緣切除少許以形(xing)(xing)成新的(de)創面(mian)。在同側(ce)中鼻甲上(shang)做(zuo)倒(dao)“U”形(xing)(xing)切口，由上(shang)而(er)下(xia)剝離黏膜(mo)瓣至蒂(di)部，將(jiang)此黏膜(mo)瓣向下(xia)翻蓋于穿(chuan)孔并將(jiang)其縫合于穿(chuan)孔周圍(wei)的(de)創緣上(shang)。對側(ce)鼻腔(qiang)填塞，2～3周后切斷蒂(di)部。

（2）下鼻甲黏(nian)膜轉(zhuan)位法(fa)方法(fa)同(tong)上，所不同(tong)的是于下鼻甲表面(mian)做正“U”形切口，黏(nian)膜瓣向上翻蓋于高于下鼻甲水平的鼻穿孔上。

3.鼻(bi)底、鼻(bi)中隔黏膜修補法

于一側鼻腔下鼻道外側(ce)壁做一前后方向(xiang)(xiang)切口，自此切口向(xiang)(xiang)下至鼻底，再向(xiang)(xiang)上分(fen)離(li)黏(nian)骨(gu)膜(mo)和黏(nian)軟骨(gu)膜(mo)，分(fen)離(li)范圍盡量大，向(xiang)(xiang)上可達(da)穿(chuan)孔上緣。對側(ce)同法(fa)處理。然后在穿(chuan)孔上緣前后向(xiang)(xiang)切取一窄條黏(nian)膜(mo)瓣，將雙側(ce)黏(nian)膜(mo)瓣向(xiang)(xiang)上轉(zhuan)位，位置蓋于穿(chuan)孔上，雙側(ce)分(fen)別對位縫(feng)合(he)。

4.鼻外組(zu)織(zhi)游(you)離移植(zhi)法

用于(yu)修補鼻(bi)中(zhong)(zhong)隔(ge)穿(chuan)(chuan)孔(kong)的鼻(bi)外組織為顳筋(jin)(jin)膜闊筋(jin)(jin)膜、脛骨骨膜等。游離移植(zhi)片應略大于(yu)穿(chuan)(chuan)孔(kong)。于(yu)左側鼻(bi)中(zhong)(zhong)隔(ge)穿(chuan)(chuan)孔(kong)的前方做一(yi)縱切(qie)口，自(zi)切(qie)口處用剝(bo)(bo)(bo)離子剝(bo)(bo)(bo)離穿(chuan)(chuan)孔(kong)周圍黏膜。將取下(xia)的筋(jin)(jin)膜自(zi)切(qie)口內放入并嵌置于(yu)穿(chuan)(chuan)孔(kong)周圍已剝(bo)(bo)(bo)離開的兩層黏膜間，然(ran)后用縫線固定，鼻(bi)腔內填(tian)塞(sai)壓(ya)迫。

5.非手術閉合(he)法(fa)

根(gen)據穿(chuan)(chuan)孔(kong)(kong)大(da)小選擇不同規格(ge)的“H”形硅膠鈕扣(kou)，將其嵌(qian)置于穿(chuan)(chuan)孔(kong)(kong)部位(wei)，扣(kou)的兩葉(xie)分別位(wei)于鼻中(zhong)(zhong)隔兩側(ce)，兩葉(xie)中(zhong)(zhong)間(jian)的中(zhong)(zhong)心軸部位(wei)于穿(chuan)(chuan)孔(kong)(kong)正中(zhong)(zhong)。

鼻中隔穿孔能自愈嗎

鼻中隔(ge)穿(chuan)孔(kong)分幾種情況，有前(qian)部穿(chuan)孔(kong)及后部穿(chuan)孔(kong)，后部穿(chuan)孔(kong)沒(mei)什(shen)(shen)么(me)問題，如果(guo)是(shi)前(qian)部穿(chuan)孔(kong)，那(nei)要看你是(shi)什(shen)(shen)么(me)原因引起(qi)的，如果(guo)是(shi)手(shou)術后引起(qi)的，那(nei)么(me)經過(guo)醫生局部處(chu)理，有可(ke)能能長好，如果(guo)是(shi)不(bu)知怎么(me)自行穿(chuan)孔(kong)，那(nei)自愈的可(ke)能很(hen)小(xiao)，如果(guo)是(shi)用藥導致穿(chuan)孔(kong)也是(shi)自愈可(ke)能不(bu)大。

鼻中隔穿孔預防

在(zai)生(sheng)活(huo)中注意衛生(sheng)，多飲水，防(fang)止鼻(bi)(bi)腔(qiang)干燥；如(ru)鼻(bi)(bi)部手術后(hou)，做好(hao)相關的預(yu)防(fang)工(gong)作，防(fang)止出現(xian)并發癥。