镍钛记忆合金支架治疗鼻腔狭窄

镍钛记忆合金支架治疗鼻腔狭窄 郁 琪 季 超 [摘要] 目的:探讨镍钛记忆合金支架在鼻腔狭窄治疗中的作用。方 法:回顾总结4例鼻腔狭窄病例用镍钛记忆合金支架治疗的临床资料。 结果:4例鼻腔狭窄术后安放支架后，随诊6个月，既恢复鼻腔通畅， 又恢复了外观，无再狭窄。结论:镍钛记忆合金支架可使鼻腔狭窄术 后，扩张管腔，防止狭窄，具有使用方便，疗效可靠的优点，可作为 鼻腔狭窄治疗的常规手段之一。 关键词鼻腔狭窄、支架 : The treatment of stricture of nasal cavity with Ni-Ti shape memory alloy stand Yu Qi Ji Chao (Department of Otolaryngology ,The first people’s Hospital of Nantong City Nantong 226001) [Abstract] Objective To evaluate the use of Ni-Ti shape memory alloy stand in the treatment of stricture of nasal cavity . Methods The clinical materials of 4 patients with stricture of nasal cavity were analyzed .All patient accepted the treatment with Ni-Ti shape memory alloy stand. Results The fellow up survey for these patients lasted for 6 months. All of them have freely and satisfaction surface of nasal cavity affter the operation. Conclusion Ni-Ti shape memory alloy stand expand nasal cavity and preventive recurrent structure nasal cavity.There are advantage of simple method and better benefit treatment results. It can be used as a routine method in the treatment of stricture of nasal cavity. real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of Key: Stricture nasal cavity Shape memory alloy stand 烧伤(激光、微波、火焰等)(外伤、炎症后，疤痕挛缩或粘连，可造成鼻腔狭窄。既造成鼻腔通气障碍，又造成鼻面部畸形缺陷。治疗都采用手术切除疤痕、松解，术后为了防止再狭窄，采用填塞或采用相应直径大小的塑料管扩张，需要放置6个月以上。患者不能接受，或不能坚持，异物反应、炎症、感染、挛缩可造成再狭窄。镍钛记忆合金是一种具有形状记忆功能，超弹性、耐疲劳、耐腐蚀、耐磨损、 [1]生物相容性好和无毒等优点。我们应用镍钛合金支架治疗4例鼻腔狭窄，疗效满意，现报道如下: 材料与方法 一、 临床资料。 1998年~2002年共治疗4例患者，年龄25~40岁，男性2例，女性2例，右侧1例，左侧3例，1例激光、1例微波治疗肥厚性鼻炎时，烧伤鼻腔粘连后形成，2例外伤后感染致疤痕挛缩，分别于伤后2~4个月发生鼻腔狭窄。2例发生在鼻腔鼻内孔处，2例发生在鼻前庭前下外侧部，其中2例并发鼻翼塌陷畸形，狭窄后鼻腔内径为0.2~0.6mm。具体见表: 4例鼻腔狭窄患者临床资料 序号 性别 年龄(岁) 原因 部位 发生时间鼻翼塌陷 (月) 1 25 2 男 微波灼伤 右鼻内孔 无 2 30 3 女 激光灼伤 左鼻内孔 无 3 32 2.5 女 挫伤炎症 左鼻翼外侧 有 4 40 4 男 挫伤炎症 左鼻翼外侧 有 二、 材料。 选用江苏法尔胜集团公司金属研究所研制的网格型镍钛记忆合金real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of 支架，其规格根据患者健侧鼻腔相应部位内径来决定支架直径大小,鼻内孔处支架分别为直径1.2、前后长0.6;直径1.0、前后长0.6。鼻翼处支架分别为直径1.2、前后长0.8;直径1.3、前后长0.8。网格丝直径为0.3mm，支架采用裸支架，其相变温度为33?~35?。 三、 治疗方法。 3例采用疤痕切除后，前臂内侧游离中厚皮瓣修复，1例采用单纯疤痕切除，另2例采用术后立即安放支架扩张，2例采用术后一周内安放支架，安放支架时采用4?以下冰水和冰块使支架变形，创面周围放入一层凡士林纱条，然后将支架放入狭窄部位，即刻恢复形态，使支架牢固嵌在狭窄部位，以后半月检查一次，消毒重新置入，6月后撤除。 结 果 4例均在安放支架当日有鼻腔胀痛。三日后症状逐渐减轻，1周后无不适。安放后直径约大于健侧鼻腔相应部位直径。4例经6个月的门诊随访，半月随访一次，均扩张效果满意。取出支架后，鼻腔原狭窄部位比术后即行扩张的直径缩小1~2mm。单纯切除疤痕，未植皮而安放支架病例，术后缩窄较明显，手术部位的硬度比健康部位较硬一些，基本上满足了通畅和外形的要求。取出支架后皮肤存留网格样压痕，二周后消失，未发现皮肤、软骨被压坏死及其他副作用。 讨 论 一、 鼻腔狭窄原先的治疗方法比较繁锁陈旧。对于鼻腔狭窄原先的治 疗方法，是采用疤痕切除或疤痕切除+游离皮瓣移植，然后为了防 止再狭窄，采用纱条填塞扩张，由于不能通气，填塞时间不能长 久，故后来采用塑胶管扩张，可造成异物反应、感染、增生肉芽 生长、再次狭窄。安放的导管，大一些放不进，小一些易脱出，real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of 脱出后如未及时就诊，可造成重新狭窄而前功尽弃。 二、 我国自1980年首次在口腔正畸应用镍钛形状记忆合金以来，作为 [2]一种新型医学生物材料已广泛应用于临床各领域。耳鼻咽喉科也 [3][4]将此材料应用在治疗喉气管狭窄，外耳道狭窄和食道狭窄等。 镍钛形状记忆合金在相变区具有形状记忆特性和超弹性，在低温 下(0?左右，处于马氏体状态)，比较柔软可以变形。将其加热 到人体温度时，(高温相状态)立刻恢复到原来设计的形状，产生 持续柔和的恢复力。而此时材料较硬，富有弹性，可起到矫形或 支撑作用。目前在医疗领域得到广泛应用，如冠心病的冠状动脉 支架，胆管狭窄的胆管支架，前列腺增生尿道支架等，其优良的 生物相容、耐腐蚀、耐磨性、无毒等症状，被称为21世纪的新型 生物功能材料。 三、 在鼻腔狭窄的治疗中，镍钛记忆合金支架是防止术后再狭窄的较 理想的材料之一，从本文治疗来看效果很好，手术前将量好健侧 相应鼻腔部位直径，相应的长度通知厂方，定做支架，可术后立 即安放，也可术后一周内安放，尽早安放以防止再狭窄。根据本 文结果，应在相应的直径上增加1~2mm,以防撤除支架后的回缩， 尽量矫枉过正一些，在切除疤痕后是否植皮，根据本文的经验， 采用游离中厚皮瓣植皮，能防止恢复过程的回缩，在植入的支架 中，我们植入的裸支架有网状压痕，现在有生物膜性支架，采用 这种新型支架，也可能就没有网格状压痕。 参 考 文 献 1、 彭解人，宋新汉.镍钛记忆合金在耳鼻咽喉科的应用.国外医学耳鼻咽喉科学分册，1998，22:272-275. real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of 2、 卢世璧.镍钛形状记忆合金在外科领域的应用前景.中华外科杂志， 1993，31:259. 3、 彭解人，宋新汉，郑亿庆等.镍钛记忆合金支架治疗喉气管狭窄.中 华耳鼻咽喉科杂志，1999，34:368-370. 4、 王文平，鲍垂，刘玉怀等.镍钛形状记忆合金外耳道支架治疗烧伤 后外耳道狭窄.中华耳鼻咽喉科杂志，1999，34:115. real, in each pen business lending Qian not for by pen query, led to mortgage failure of. (Vi) not in accordance with the relevant provisions of the Bank operation, failed to identify false documents, certificates, authorizations, warrants, etc. (VII) in the credit risk management system to provide false information, is not required by the guest rating credit management objective, impartial ratings of credit, resulting in credit decision-making errors. (H) the investigation report conclusions of false record, misleading statement or material omission, resulting in credit decision-making errors. (I) the orders, directives, orders, suggest that others not involved in the investigation business, issued by the investigators. (10) without the approval of authorities, after the first credit investigation, credit first and then record, counter-current process operations such as operation prior to approval. (11) article does not meet the risk management Department, Marketing Management Department to carry out supervision and inspection and due diligence evaluations or providing false information. (12) other violations result in credit business at substantial risk or significant potential risk behaviours. Sixth chapter supplementary articles article 28th of this approach by the Head Office of risk management Department is responsible for the interpretation and amendment. 29th spontaneous herein from the date of implementation. Qilu silver computer transmission of qilu Bank documents (2012), No. 289Qilu Bank personal credit on issuing the Notification Guide to business risk management branch, jurisdiction and the jurisdiction of business lines, Jinan branch, head office departments within its jurisdiction: in order to improve the quality of individual credit business, optimize the structure of assets, promotion of