鼻内镜下咽喉部异物取出术126例报告

我科自引进鼻内镜以来,不仅将它应用于鼻腔及鼻咽部疾病的检查及治疗中,同时也将它推广于咽喉部异物的治疗中,2000年~2005年我科应用鼻内镜行咽喉部异物取术126例,现报道如下。1资料与方法1.1临床资料126例病人中,男74例,女52例;年龄10~69岁。病程20 min至15 d。入院时主要症状为咽喉部异物感,咽痛、吞咽时咽喉部刺痛及吞咽困难等。1.2治疗方法采用国产70°鼻内镜及监视系统。病人取正坐位。1%丁卡因咽喉部表面麻醉。待麻醉充分后,病人将舌伸出,嘱其用纱布包裹舌前1/3,避免下切牙损伤舌系带,病人用左手把舌拉向前下方。乙醇棉球擦拭镜面后,…     

臭鼻症手术治疗的远期后果

向鼻底和中隔粘膜下镇入塑料移植物的鼻腔缩窄术是臭鼻症的有效疗法之一，可恢复鼻腔内解剖结构的正常关系，术后患者主观症状可明显改善。但术后1～3年观察，可见到部分移植物脱出和中隔穿孔等并发症。文内引2例远期并发症。一例为术后26年复查时见因总鼻道狭窄致成双侧慢性化脓性上颌窦炎，用常规疗法疗效不好，经取除部分移植物、鼻道变宽治愈。另例为术后25年复查，见中隔软骨部穿孔及出血性由芽，经取除部分移植物后治愈。臭鼻症手术治疗的远期后果     

内窥镜下经皮胃造口术(PEG)耳鼻喉科—头颈外科的一个有效手段

[英]／SelzPA…／／ArchotolaryngolHeadNeckSurg．－1995，121（11）．－1249～1252患头颈部肿瘤的病人常因治疗后未能经四摄入足够的营养，而导致营养耗尽。传统的办法是采用鼻胃管、非肠道给营养或作胃造日本。但是置放鼻胃管可引起病人不适、鼻窦炎、误吸、鼻胃管阻塞、咽喉部刺激及管子意外脱出等共发症；非肠道给营养费用昂贵，又有中央静脉导管的置放及护理问题；而胃造口长的井发症或死亡率为6／～25％。从八十年代起，由Ganderer与Ponsky介绍的经发行内窥镜下胃造口水（PE（i），已被接受用作需长期肠内营养支持的首选方法。…     

鼻内镜下低温等离子手术治疗窄基型咽喉部血管瘤的临床应用

咽喉部血管瘤在临床较少见,其治疗方法较多,手术治疗具有较好的疗效,但咽喉部,特别是舌根部手术,由于其解剖位置深、血运丰富、手术空间狭小,术后易出血及喉部梗阻等严重并发症,故既往传统手术难度较大。我科2009-2014年探索应用鼻内镜下低温等离子射频手术治疗咽喉部窄基型血管瘤患者13例,疗效满意,现报告如下。1资料与方法1.1临床资料13例患者中,男9例,女4例;年龄17~53     

鼻内镜电视监视系统下咽喉部手术

咽喉部良性肿物中以舌扁桃体肥大、咽喉乳头状瘤、血管瘤、会厌潴留囊肿、声带息肉、声带小结多见。其治疗是在间接喉镜或直接喉镜下行肿物切除。近年来随着国产鼻内镜在基层普及且缺少纤维喉镜或喉显微手术器械，使用鼻内镜电视监视系统下行咽喉部检查及手术亦可带来满意效果。我科1999～2003年12月采用此方法行咽喉部手术216例，现报告如下。     

累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤的鼻内镜手术治疗

目的 探讨包括骨瘤、骨化纤维瘤、骨纤维异常增殖症在内的累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤鼻内镜手术治疗策略。 方法 经鼻内镜治疗鼻腔鼻窦骨源性良性肿瘤140例,包括骨瘤116 例,骨化纤维瘤14例,骨纤维异常增殖10例。手术方式包括:单纯鼻内镜手术95例,影像导航辅助鼻内镜手术24例,鼻内镜联合鼻外入路21例。 结果 患者均顺利完成手术,未发生严重并发症。骨瘤均彻底切除。骨化纤维瘤12例得到彻底切除,2例有病变残留。骨纤维异常增殖症10例采取姑息性手术,术后面部外观得以恢复,病变对周围组织地压迫症状得以缓解。术后随访6~36个月,骨瘤术后无复发,骨化纤维瘤术后复发2例,骨纤维异常增殖症1例术后视力无改善,其余患者症状得到不同程度的缓解。 结论 骨瘤、骨化纤维瘤及骨纤维异常增殖是鼻窦常见的良性纤维骨性病变。三者临床症状相似。高分辨率CT和(或)MRI是早期诊断的重要手段。影像导航引导鼻内镜并必要时联合鼻外入路手术是治疗该类疾病的有效方法。手术时机及手术方式的选择应依据病变类型、患者症状、肿瘤位置及范围综合考虑。     

咽异感症的暗示治疗

咽异感症是指咽喉部有异物感、紧迫感、瘙痒感、烧灼感、干燥感、呼吸不畅等不适感觉。女性患者多于男性。病因多为心理、神经因素。患者常多处投医，但疗效欠佳。近年来，我们在排除鼻腔、鼻窦及咽喉部器质性病变后采用暗示治疗，并结合中西药物治疗，疗效较好。现报告如下。     

真菌性鼻窦炎的内窥镜治疗

目的 探讨经鼻内窥镜治疗真菌性鼻窦炎的手术方法、疗效及适应症。方法 对我科近年经鼻内窥镜治疗或同时施行Caldwell-Luc手术的21例真菌性鼻窦炎进行总结分析。结果 21例原症状手术后均消失，术后2－3个月鼻内窥镜检查，窦腔内上皮化，窦口引流通畅，随访6个月－5年，21例均治愈，无一例复发。结论 经鼻内窥镜处理窦口鼻道复合体病变，保持窦口引流通畅是预防复发的重要因素之一，在处理筛窦、蝶窦病变时，内窥镜具有无可比拟的优势，严重上颌窦真菌病仍不能替代Caldwell-Luc手术，术后鼻内窥镜下清理术腔，可巩固疗效，促使早日痊愈。     

面掀翻及改良半面掀翻联合鼻内镜技术在鼻科手术中的应用

目的：探讨面中部掀翻及改良半面掀翻径路鼻内镜辅助治疗鼻科疾病的方法和疗效。方法：30例患者，采用面中部掀翻术4例，半面掀翻术3例，改良术式23例。改良术式采用以患侧为主的上颌窦根治术切口，不作鼻小柱贯通切口，先完整剥离健侧的鼻中隔皮肤、黏软骨膜和骨膜及鼻底黏骨膜，不作健侧前庭切口，保留健侧鼻腔软组织结构的完整性，再作鼻中隔软骨及患侧皮肤、黏软骨膜切口与鼻前庭弧形切口，掀翻患侧半面中部软组织并联合鼻内镜切除病变。结果：所有创口一期愈合。随访6个月～3年，4例面中部掀翻术后鼻前庭狭窄1例；3例半面掀翻术中鼻中隔穿孔1例；改良术式联合鼻内镜23例无并发鼻前庭狭窄和鼻中隔穿孔等症。结论：面中部掀翻及改良半面掀翻径路联合鼻内镜，术野暴露充分，面部不留瘢痕，手术操作方便、安全；改良术式健侧鼻腔术后不必填塞，无鼻前庭狭窄等并发症发生。     

中鼻甲外折术治疗鼻睫神经痛18例报告

报告对３６例鼻睫神经痛患者，采用中鼻甲外折术、中鼻甲切除术各治疗１８例术后均随访１的以上。结果：两组治率、有效率相同。但中鼻甲切除术后需鼻腔填塞止血（８７．２％），并发嗅觉减（６６．７％）；中鼻甲外折术术中创伤小，术后不需鼻腔填塞，无嗅觉减退等并妆症。表明中鼻甲外折术是治疗鼻睫神经痛较理想的方法。     

妊娠期耳鼻喉疾病孕妇临床护理分析

目的分析妊娠期耳鼻喉疾病孕妇临床护理方法其效果。方法回顾性我院收治的78例妊娠期耳鼻喉疾病孕妇参与本研究,按照护理方法的差异将其分为对照组与观察组,每组39例,对两组护理前后的心理状态进行比较。结果护理1个月后,观察组与对照组HAMD评分、HAMA评分均有所降低,但观察组降低幅度明显大于对照组(P<0.05)。结论对妊娠期耳鼻喉疾病孕妇实施综合护理,可以帮助其改善心理状态,促进孕妇身心健康。     

3D打印技术在耳鼻喉科住院医师规范化培训中的应用探索

目的 观察3D打印技术在耳鼻喉科住院医师规范化培训中应用的效果,探讨其应用的可行性及有效性。 方法 结合耳鼻喉科住院医师规范化培训教学大纲要求,运用3D打印技术制作仿真模型,应用于规范化培训理论教学中,并在此基础上进行手术指导,完成实践教学。 结果 3D打印模型有助于住院医师形成空间立体概念,短时间内理解并掌握复杂的解剖结构,有效提高其手术技能,缩短培养周期。 结论 3D 打印技术在耳鼻喉科住院医师规范化培训中具有良好的应用前景。     

Infections of the ears, nose, and throat in children with primary immunodeficiencies.

Children who suffer from primary immunodeficiencies have long been thought to be subject to infections of the ears, nose, and throat due to unusual or resistant organisms. A retrospective chart review was undertaken at Children's Hospital of Pittsburgh from 1979 to 1989 to determine the types and frequency of infections of the ears, nose, and throat, and the bacteriologic findings from cultures of the sinuses, ears, and head and neck abscesses, when obtained. Seventy-five patients were identified with primary immunodeficiencies, and 80% suffered from infections of the ears, nose, and throat. Cultures obtained from 33% of the group showed the majority of the organisms commonly seen in ear and sinus infections. We conclude from this study that children with primary immunodeficiencies who require hospitalization frequently have an infection of the ears, nose, and throat, and that the infection is usually caused by community acquired bacteria. Empiric treatment may therefore be directed to common organisms causing these infections.     

清热泻下法治疗鼻咽喉炎性疾病的临床观察

目的 探讨清热泻下合剂治疗鼻咽喉炎性疾病的疗效。方法 对鼻咽喉的炎性疾病的病人应用清热泻下合剂治疗并设对照组,观察临床疗效和作用机理。结果 清热泻下合剂和对照组比较有很好的疗效,差异有显著性意义(P<0.05)。结论 清热泻下合剂治疗鼻咽喉炎性疾病有很好的临床效果,值得临床推广。     

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.     

Sudden death after major head and neck surgery

PURPOSE OF REVIEW: This review will discuss the mortality after major ear, nose and throat surgery, particularly sudden death. It will also discuss the postoperative follow-up of patients. RECENT FINDINGS: Sudden death is a rare event after major ear, nose and throat surgery, and occurs mainly during the first three postoperative days. SUMMARY: In more recent studies, the mortality rate after neck dissection was below 4%, which is at a lower value than reported in previous studies. Sudden deaths have been described, however, mainly during the first three postoperative days. Alcoholism and perioperative hypotension are two predictive factors for cardiac complications. Careful follow-up of these patients during the early postoperative period should be performed to reduce the mortality by shortening the delay of care.     

Ear, nose, and throat operations in the United States, 1979 to 1984

Using data from the National Center for Health Statistics for 1979 to 1984, I found a 5% decrease in total ear, nose, and throat (ENT) operations, the largest decline of any surgical specialty. For the same five-year period, the number of ENT surgeons increased 15%. In 1983, ENT surgeons performed 478 000 operations on tonsils and adenoids, an 18% decrease from the 1979 total (584 000). The removal of tonsils and adenoids is the eighth most common operation performed in the United States. The second most common ENT operation, nose repair and plastic operations (263 000), is the country's 14th most frequent operation. The 20 most common ENT operations constitute 87% of all ENT operations. In 1983, ENT operations represented 9% of all surgery in this country. These figures show that numbers of ENT surgical operations have decreased over the last five years, despite a constantly increasing number of ENT surgeons.     

咽喉反流性疾病的发病机制及诊疗进展

近年来,随着社会生活节奏的加快,人们饮食习惯的改变,出现越来越多的消化道及咽喉疾病.咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)作为耳鼻咽喉科的一类疾病,其发病率也呈现不断上升的趋势.长期以来,LPRD并未受到耳鼻咽喉科医师的重视,诊断也是建立在胃食管反流疾病(gastroesophageal reflux disease,GERD)的认识之上,常常漏诊和误诊.因此,明确LPRD的发病机制及诊疗方法并与GERD相区别有着重要的意义.     

Foreign bodies in the ear,nose, and throat in Japan: association with sociocultural and geographical conditions

ObjectiveForeign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.MethodsFrom April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency.ResultsThe incidence of throat FBs was significantly higher in July and January (p < 0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r = 0.76, p = 0.0043; r = 0.57, p = 0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose.ConclusionsFBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.     

Selected aspects of modern epidemiology of ENT-mycoses

The prevalence of mycosis affecting ears, nose, and throat was analysed based on the literature data and the results of original observations of 3964 patients who applied for medical aid to the counseling department of our centre during the period from 2005 to 2007. The study revealed a relative increase in the occurrence of ear, nose, and throat mycosis in the structure of chronic inflammatory pathology. Specifically, the frequency of mycotic otitis rose to 25.2%, mycotic infestation of the pharynx in patients with pharyngitis and tonsillitis to 28.7%, mycotic infestation of the larynx associated with chronic laryngitis to 20%, and mycosis in patients presenting with chronic inflammation of the nasal cavity or paranasal sinuses to 7%. The spectrum of pathogenic fungi affecting ears, nose, and throat has been identified. The enhanced contribution of various non-albicans Candida strains to the development of chronic inflammation is documented. Aspergillus species are shown to play the increasingly more important role in the affection of palatal tonsils, laryngeal and pharyngeal mucosa.