微波热凝结合慢咽合剂对慢性肥厚性咽炎咽黏膜病理组织学的影响

目的 观察微波热凝与慢咽合剂联合治疗对慢性肥厚性咽炎患者咽黏膜病理组织学的影响。方法 慢性肥厚性咽炎患者120例，随机分为两组，治疗组62例，先予微波热凝治疗，然后加服慢咽合剂；对照组58例，仅采用微波热凝治疗。所有患者均分别在治疗前及治疗结束后2周取同一部位咽黏膜组织作病理组织学检查，并评定临床疗效。结果 治疗组治疗后咽黏膜组织的炎性细胞浸润程度明显轻于对照组，伴纤维组织增生，较少出现淋巴组织增生或淋巴滤泡形成，而对照组常伴有淋巴组织增生及淋巴滤泡形成。治疗组疗效明显优于对照组（P=0．001），复发率明显低于对照组（P=0．005）。结论 微波热凝与慢咽合剂联合治疗慢性肥厚性咽炎可明显减轻咽黏膜的炎性细胞浸润程度。临床疗效显著。     

咽部微波热凝导致瘢痕形成4例报告

应用微波热凝治疗咽部淋巴滤泡增生,术后发生咽后壁黏膜瘢痕形成及组织结构改变,导致咽部异物不适感及紧缩感4例,均为女性,34～56岁,平均42岁,发生于手术后1～4年不等 .局部检查见瘢痕均位咽后壁黏膜,局部隆起,高低不平,色泽鲜红,触之微硬.呈条梭状隆起3例,环行隆起1例.患者均有异物感、紧缩感及咽部干燥感.1例咽腔结构变形,鼻音较重,音色改变.     

鼻息肉手术疗效及术后鼻腔黏膜转归与嗜酸性粒细胞局部浸润的相关性探讨

目的探讨嗜酸性粒细胞局部浸润程度对鼻息肉手术疗效及术后鼻腔黏膜转归的影响。方法鼻息肉患者50例，分别于鼻内镜术中取息肉组织标本及术后恢复期取上颌窦口周边水肿黏膜标本备检；另取20例正常志愿者中鼻甲黏膜组织标本作为对照。Chromotrope 2R特染法检测标本嗜酸性粒细胞浸润程度，分析评价其浸润程度对术后鼻腔黏膜恢复过程的影响。结果鼻息肉组织中嗜酸性粒细胞浸润程度显著高于中鼻甲黏膜组织（P〈0.01），且随时间进程而呈现不同的变化规律。嗜酸性粒细胞浸润程度越明显，鼻腔黏膜恢复过程越慢，鼻息肉复发越快。结论局部黏膜的嗜酸性粒细胞浸润在鼻息肉的形成和发展中起重要作用，可能延迟术后鼻窦、鼻腔黏膜的上皮化进程而影响手术疗效。     

鼻硬结症之颈淋巴结病

硬结症除常发生于鼻、咽、喉外,在文献中还可见到原发于上颌窦及继发于咽鼓管和中耳腔、上颌窦、经鼻泪管侵犯泪道及颅内扩散者,硬结症侵及淋巴结,在既往的英文文献中尚未见有报导,本文报告两例: 例一:女,50岁。鼻堵8个月,3个月来双侧颈部有渐进性、无痛性肿块,曾经12次鼻窦部位的短波疗法。检查可见双鼻腔(鼻底、侧壁、中隔)有粉红色、软、易出血的肉芽肿浸润。双侧颈上深淋巴结增大,硬,局部皮肤正常。鼻部病     

鼻内境泪囊鼻腔造孔术远期疗效随访

目的总结分析慢性泪囊病变患者鼻内镜下经鼻行泪囊鼻腔造孔术治疗的临床远期随访观察结果，探讨影响手术远期疗效的因素。方法对275例（310眼）慢性泪囊病变患者采用鼻内镜下经鼻行泪囊鼻腔造孔术。术前行泪囊碘油造影，手术在局部麻醉或全身麻醉下进行，根据泪囊大小或病变情况决定术终泪道放置泪道硅胶扩张管。术后随访包括鼻内镜检查处理、泪道冲洗及鼻腔局部糖皮质激素应用。结果随访3～60个月，随访超过1年（远期）者211例（230眼），治愈率75．3％，好转率11．7％，无效13．0％，总有效率87．0％。9眼术后1年发现自然泪道复通，但泪囊鼻腔造孔瘢痕闭锁。无手术并发症。结论鼻内镜下泪囊鼻腔造孔术远期效果较好。扩大造孔骨窗，减少黏膜损伤和手术创面，以及随访清创有助于提高手术成功率。鼻泪管黏膜在手术造孔引流后，有可能发生可逆性转变，重新发挥泪道的泪液排泄作用。     

利咽汤治疗慢性咽炎的疗效观察

慢性咽炎是咽部黏膜的非特异性炎症，多为屡发急性咽炎，病程迁延而成。同时，与局部和全身的慢性刺激因素有密切关系。表现为咽部各种不适感如干燥，微痒，微痛，异物感，痰黏着感等。时轻时重，喜清嗓。局部表现为咽部黏膜慢性充血肥厚，侧索增粗，咽后壁淋巴滤泡增生等，中医称其为“慢性喉痹”或“虚火喉痹”。     

鼻内镜下鼻腔泪囊造孔术泪囊定位新方法的应用

目的探讨内镜下鼻腔泪囊造孔术中鼻内泪囊定位新方法的可行性。方法以枪状咬骨钳自下而上咬除泪骨前部骨质及上颌骨额突,先暴露鼻泪管而后再暴露泪囊内侧壁黏膜。结果用此法较易寻找到泪囊,不易损伤周围重要组织如筛前动脉、鼻泪管、眶纸样板、前组筛窦等,术后疗效佳,术后造孔不易闭锁。结论内镜下鼻内寻找泪囊法可行,值得推广应用。     

耳科学领域中的免疫学(II中耳和外耳免疫性疾病)

中耳免疫性疾病一、中耳炎的免疫学因素1 急性中耳炎与炎症反应和免疫防御作用:急性中耳炎的病因是复杂和多因素的,鼻咽部和咽鼓管的病原菌能引起中耳的炎症,其特点是中耳黏膜的炎症反应伴鼓膜下白细胞、巨噬细胞和肥大细胞等的浸润,中耳腔渗出液中含有大量炎性介质,如廿烷类(eicosanoids)、细胞因子和组胺,清除渗出液和病原菌基于非特异性因素(如黏液纤毛清除系统和吞噬细胞)和特异性免疫应答[1] 。中耳的免疫防御屏障是中耳的淋巴组织,其可产生局部特异性免疫应答,细菌和病毒等作为抗原可以引起炎症反应;B淋巴细胞(分泌IgG、IgA和IgM)…     

梨状窝异位扁桃体3例并文献复习

异位扁桃体是指发生在正常咽淋巴环以外部位上的特殊淋巴组织,临床上较少见,我科2006-03-2008-10共发现3例,现报告如下. 1 病例报告 例1,女,62岁,2006年12月因"咽部不适,异物感2个月"而入院,既往无反复咽痛史.体检:颈软,颈部未触及肿块,气管居中,心、肺、腹部及神经系统检查正常.咽部黏膜稍充血,双扁桃体Ⅰ度大小,位于扁桃体窝内.间接喉镜下示:左梨状窝正中部见小指头大小突起新生物,呈暗红色, 可见有血管纹,界限清楚,表面黏膜光滑,喉腔未见异常.CT示:左侧梨状窝见类圆柱状软组织密度灶.入院后先后2次经间接喉镜、纤维喉镜活检,病理报告:下咽部黏膜慢性炎症伴间质水肿.术前诊     

嗜酸性粒细胞浸润对鼻息肉术后鼻腔黏膜转归及疗效的影响

目的：探讨嗜酸性粒细胞（eosinophils, EOS）浸润对鼻息肉术后鼻腔黏膜转归及疗效影响的因素。方法：对于50例鼻息肉患者术中及部分术后复发的鼻息肉组织和上颌窦口周边水肿组织采用Chromotrope 2R特染,检测以上标本中嗜酸性粒细胞在功能性鼻窦内窥镜术后术腔黏膜恢复过程中的表达水平,并进行相关分析。结果：鼻息肉组织中EOS水平明显高于中鼻甲黏膜组织,且随时间呈现不同的变化规律（P＜0.01）;EOS浸润程度越深,鼻腔黏膜恢复越慢,鼻息肉复发越快。结论：EOS浸润在鼻息肉的形成和发展中起重要作用,提示其可能参与延迟鼻窦、鼻腔黏膜上皮化的进程,可作为疗效判断的指标之一。     

鼻内镜下泪囊鼻腔造孔术

目的总结鼻内镜下泪囊鼻腔造孔术并探讨术后鼻泪管再通现象及其原因。方法36例(39眼)慢性泪囊炎患者,男7例(7眼),女29例(32眼),年龄23￣71岁,平均39.6岁,病程半年￣12年,均在局麻、鼻内镜下行泪囊鼻腔造孔术,随访亦在鼻内镜下进行,以黏膜表面麻醉为主。结果术后8￣10周术腔逐渐上皮化,35眼泪道冲洗通畅,溢泪及溢脓症状均消失;2眼冲洗通而不畅,需加压,有冲洗液溢出;2眼泪道冲洗不通,仍有溢泪及溢脓症状。总有效率94.5%(37/39)。鼻内镜下观察,冲洗通畅者造瘘口有液体流出。随访6个月部分病人(4眼)下鼻道原鼻泪管开口处冲洗时亦有液体流出。结论慢性泪囊炎病人在行鼻内镜下泪囊鼻腔造孔术后效果好,且部分病人鼻泪管可再通。     

咽部组织中P物质血管活性肠肽含量与OSAS患者咽腔狭窄的关系

目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者咽组织中P物质 (SP)、血管活性肠肽 (VIP)的含量与咽腔狭窄的关系。方法 :对 30例OSAS患者用半定量方法检测咽组织中SP和VIP的含量并与 12例健康成人的咽组织进行对照。结果 :OSAS患者咽组织中的粘膜上皮层、小血管内皮层、平滑肌周围、腺泡及腺导管周围 ,均有SP、VIP分布 ;其含量与对照组比较明显增加。结论 :咽部SP、VIP增多引起咽组织肿胀加重 ,OSAS患者咽腔狭窄 ,提示神经源性炎症是参与OSAS发病的重要因素之一。     

Transnasal endoscopic medial maxillectomy as the initial oncologic approach to sinonasal neoplasms: the anatomic basis

OBJECTIVE: To demonstrate an anatomic basis for endoscopic medial maxillectomy with excision of the lateral nasal wall to the nasal floor, including the inferior turbinate, and nasolacrimal duct. Transnasal endoscopic medial maxillectomy involves complete resection of the lateral nasal wall with boundaries that are inferior to the nasal floor; superior to the cribriform plate and fovea ethmoidalis; anterior to the anterior maxillary wall, including the nasolacrimal duct; and posterior to within 5 mm of the eustachian tube. Transnasal endoscopic medial maxillectomy provides exposure for endoscopic resection of the orbital wall, pterygopalatine fossa, pterygoid plates, nasopharynx, and anterior skull base when indicated. DESIGN: Volumetric analysis of the maxillary sinus was performed on axial and coronal computed tomographic scans of 19 adult patients for a total of 38 maxillary sinuses. SETTING: Tertiary care medical center. PATIENTS: Nineteen adult patients with tumors of the head (but outside the sinonasal region). INTERVENTIONS: Radiographic analysis. MAIN OUTCOME MEASURES: The total volume of the maxillary sinus, volume above and below the superior attachment of the inferior turbinate, and volume anterior to the nasolacrimal duct were measured. RESULTS: The mean (SD) total volume of the maxillary sinus was 20.1 (4.2) cm(3), whereas its volume inferior to the superior attachment of the inferior turbinate was 12.9 (3.7) cm(3) and anterior to the nasolacrimal duct was 1.1 (0.6) cm(3). The mean (SD) volume of the maxillary sinus inferior to the superior attachment of the inferior turbinate was 64% (12%), whereas the nasolacrimal duct obscured the transnasal anterior exposure of the maxillary sinus. CONCLUSION: Without excision of the lateral nasal wall inferiorly to the nasal floor and anteriorly, including the nasolacrimal duct, over half of the maxillary sinus would be inaccessible for procedures directed at neoplasms within the maxillary sinus.     

Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.     

鼻内鼻窦手术损伤泪道的解剖学分析

为了减少或避免易内鼻窦手术损伤泥道，在20具成人尸头标本上，观测泪道与鼻腔外侧壁的毗邻关系。发现前筛气房与泪囊窝关系密切，气房侵及泪骨占87．5％；鼻泪管与钩突上端游离线之间距离为6.74±1．72mm，距离筛漏斗前界3．44±0．75mm，距上颌窦鼻内开口为5．50±3．73mm。鼻泪管开四位于下鼻道前端鼻甲附着处。研究表明，前筛房、钩突切除和上颌窦鼻内开窗手术范围，如果过于向前，容易损伤泪道。     

Long-term Results and Reasons for Failure of Intranasal Endoscopic Dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.     

Proboscis lateralis: a report of two cases

Proboscis Lateralis (PL) is one of the congenital anomalies of the nose which presents as obvious deformity. This is a report of two cases of the rare anomaly PL. One presented with right PL and the second presented with left PL. In this rare anomaly, the nasal cavity on one side is completely normal while on the affected side, the nasal cavity is replaced by a tube of skin and soft tissue attached to the inner canthus of the eye. This anomaly occurs sporadic as an isolated defect or in association with other anomalies. It is usually associated with failure of the paranasal sinuses and the nasolacrimal duct development. Embryologically, this anomaly is a result of imperfect fusion of the lateral nasal wall and maxillary processes (Int. J. Pediatr. Otorhinolaryngol. 23 (1992) 275).     

Endoscopic laser dacryocystorhinostomy. An unusual post-operative finding: re-opening of the nasolacrimal duct.

Endoscopic laser dacryocystorhinostomy (DCR) is a recognized technique for the surgical treatment of epiphora. Nasolacrimal duct obstruction is surgically bypassed by creating a passage from the lacrimal sac to the nasal cavity (rhinostomy). Some patients have undergone endonasal laser-assisted DCR, and were found to have an obstructed rhinostomy at follow-up. However, they reported a subjective improvement in their symptoms. Five such patients, at six months follow-up, were found to have a non-functioning rhinostomy with fluorescein dye emerging from under the inferior turbinate. These five patients along with four controls had post-operative macrodacryocystograms (MDCG) to delineate the anatomical passage by which tears were entering the nasal cavity. In the control group, clear passage of contrast into the middle meatus was demonstrated in three of the four subjects. In the study group, passage of dye to the inferior meatus, via the nasolacrimal duct was demonstrated in four of the five subjects. It is well recognized that a proportion of patients suffering from epiphora will have a natural resolution of their symptoms. Our results demonstrate that the resolution of epiphora in some operated patients was due to a re-opening of the nasolacrimal duct, and not because of a patent rhinostomy.     

轮廓化后半周膜鼻泪管在治疗上颌窦良性病变中的意义

目的 探讨轮廓化后半周膜鼻泪管在治疗上颌窦病变的临床应用效果以及手术方法和适应证。方法 30例上颌窦良性病变患者均行鼻科常规术前检查及鼻窦影像学检查。患者均采用轮廓化后半周膜鼻泪管手术，该术式通过去除鼻泪管骨管后半周骨质及依附其上的黏膜组织，从而扩大上颌窦自然开口，保留鼻泪管膜部，进入窦腔，去除病变。结果 所有患者术中彻底清除病变，完整保护鼻泪管膜部，术后恢复良好，窦腔上皮化良好，病变均无复发，无鼻周局部麻木、鼻翼塌陷、溢泪等并发症。结论 轮廓化后半周膜鼻泪管手术通过保留鼻泪管膜部，可扩大手术视野，增大手术操作空间，从而减小手术损伤，避免并发症，对于处理上颌窦的良性病变有巨大优势，并可最大限度保留鼻腔、上颌窦的生理功能，防止窦口狭窄，是值得推广的手术方式。     

半导体激光在经鼻泪囊鼻腔造口术中的应用

目的:探讨半导体激光在经鼻泪囊鼻腔造口术中的应用价值。方法:8例鼻泪管阻塞患者在鼻内窥镜下先行鼻中隔粘膜下部分切除术或鼻息肉摘除鼻窦开放术,术中用激光光纤头发出的瞄准光确定泪囊位置,用激光切除覆盖泪囊的鼻腔外侧壁粘膜和骨质,开放泪囊。结果:术后半年鼻内窥镜检查,7例泪囊造口上皮化好、无狭窄;1例泪囊造口被瘢痕封闭,经再次激光切除瘢痕并放人扩张管,随访半年造口无封闭。结论:半导体激光能明显减少出血量,减少粘连和肉芽形成,定位准确,方法简便、快捷,值得临床推广应用。