Abstract：
OBJECTIVE: To evaluate the outcome of a routine postoperative endoscopic micro-debridement of granulation tissue after stentless transnasal endoscopic repair of choanal atresia (CA).
METHODS: This prospective case series included congenital CA patients who underwent stentless transnasal endoscopic repair, followed by an endoscopic second look and micro-debridement of granulation tissue at 1-2 weeks post-repair. Patients were followed every three months for assessment of nasal airway symptoms and objective evaluation by flexible nasolaryngoscopy.
RESULTS: Sixteen CA patients (8 bilateral and 8 unilateral) underwent surgical repair (12 primary and 4 revisions). The median age was 13 days (range 1 day-6 months) in bilateral and 3 years (range 7 months-15 years) in unilateral atresia. The mean follow-up was 1.5 years (range 1 year-3 years). In primary procedures, the obstruction was bony-membranous in 7 cases and bony in 5 cases. The mean interval time between the CA repair and re-examination was 10.75 days (range 6-18 days). Clinically significant neochoanal restenosis was not encountered.
CONCLUSIONS: Re-examination under general anesthesia with endoscopic micro-debridement of granulation tissue is a safe, potentially effective adjunct when done during the proliferative phase of neochoanal wound healing. This procedure might help in maintaining neochoanal patency by remodeling tissue healing process. Large-scale, long-term cohort studies are imperative.
METHODS: This prospective case series included congenital CA patients who underwent stentless transnasal endoscopic repair, followed by an endoscopic second look and micro-debridement of granulation tissue at 1-2 weeks post-repair. Patients were followed every three months for assessment of nasal airway symptoms and objective evaluation by flexible nasolaryngoscopy.
RESULTS: Sixteen CA patients (8 bilateral and 8 unilateral) underwent surgical repair (12 primary and 4 revisions). The median age was 13 days (range 1 day-6 months) in bilateral and 3 years (range 7 months-15 years) in unilateral atresia. The mean follow-up was 1.5 years (range 1 year-3 years). In primary procedures, the obstruction was bony-membranous in 7 cases and bony in 5 cases. The mean interval time between the CA repair and re-examination was 10.75 days (range 6-18 days). Clinically significant neochoanal restenosis was not encountered.
CONCLUSIONS: Re-examination under general anesthesia with endoscopic micro-debridement of granulation tissue is a safe, potentially effective adjunct when done during the proliferative phase of neochoanal wound healing. This procedure might help in maintaining neochoanal patency by remodeling tissue healing process. Large-scale, long-term cohort studies are imperative.
摘要：
目的：评估无支架经鼻内镜修复后鼻孔闭锁（CA）术后肉芽组织常规内镜显微清创的效果。
方法：本前瞻性病例系列包括接受无支架经鼻内镜修复的先天性CA患者，随后在修复后1-2周进行内窥镜第二次观察和肉芽组织的微清创术。每三个月对患者进行一次随访，以评估鼻气道症状并通过鼻喉镜进行客观评估。
结果：16例CA患者（8例双侧和8例单侧）接受了手术修复（12例原发和4例修正）。双侧中位年龄为13天（1天-6个月），单侧闭锁为3年（7个月-15年）。平均随访时间为1.5年（1年-3年）。在主要程序中，梗阻为骨膜7例，骨性5例。CA修复和重新检查之间的平均间隔时间为10.75天（范围6-18天）。没有遇到临床上显着的新鼻孔再狭窄。
结论：全身麻醉下内镜下肉芽组织显微清创术复检是一种安全的，在新鼻孔伤口愈合的增殖期进行时，可能是有效的辅助手段。此程序可能有助于通过重塑组织愈合过程来维持新鼻孔通畅性。大规模,长期队列研究势在必行.
方法：本前瞻性病例系列包括接受无支架经鼻内镜修复的先天性CA患者，随后在修复后1-2周进行内窥镜第二次观察和肉芽组织的微清创术。每三个月对患者进行一次随访，以评估鼻气道症状并通过鼻喉镜进行客观评估。
结果：16例CA患者（8例双侧和8例单侧）接受了手术修复（12例原发和4例修正）。双侧中位年龄为13天（1天-6个月），单侧闭锁为3年（7个月-15年）。平均随访时间为1.5年（1年-3年）。在主要程序中，梗阻为骨膜7例，骨性5例。CA修复和重新检查之间的平均间隔时间为10.75天（范围6-18天）。没有遇到临床上显着的新鼻孔再狭窄。
结论：全身麻醉下内镜下肉芽组织显微清创术复检是一种安全的，在新鼻孔伤口愈合的增殖期进行时，可能是有效的辅助手段。此程序可能有助于通过重塑组织愈合过程来维持新鼻孔通畅性。大规模,长期队列研究势在必行.
