鼻内窥镜下切割吸引器切除鼻咽血管纤维瘤

目的　探讨鼻咽血管纤维瘤的手术方式。方法　对 17例鼻咽血管纤维瘤患者采用切割吸引器逐渐切除肿瘤 ,并将其根部骨膜去除。结果　 17例患者均一次手术成功 ,未见肿瘤组织残留 ,术后随访 8个月至 5年 ,未见肿瘤复发 ,未出现严重的并发症。结论　鼻腔内窥镜下切割吸引器切除鼻咽血管纤维瘤是治疗鼻咽血管瘤的较好术式 ,值得推广。     

鼻内窥镜下切割吸引器切除鼻咽血管纤维瘤

目的 探讨鼻咽血管纤维瘤的手术方式。方法 对17例鼻咽血管纤维瘤患者采用切割吸引器逐渐切除肿瘤，并将其根部骨膜去除。结果 17例患者均一次手术成功，未见肿瘤组织残留，术后随访8个月至5年，未见肿瘤复发，未出现严重的并发症。结论 鼻腔内窥镜下切割吸引器切除鼻咽血管纤维瘤是治疗鼻咽血管瘤的较好术式，值得推广。     

鼻内镜下鼻咽部扩大鼻咽肿瘤切除术

目的 探讨鼻内镜下鼻咽部扩大鼻咽肿瘤切除的手术方法。方法 对9名于1998～2002年因鼻咽部肿瘤在我科行鼻内镜下鼻咽部扩大鼻咽肿瘤切除术的患者资料进行回顾性研究,对其手术方式、适应证、手术并发症等进行探讨。结果 9名患者（纤维血管瘤5人，囊性腺癌1人，鳞癌1人，血管外皮瘤1人， 恶性淋巴瘤1人）均手术顺利，肿瘤清除彻底，无副损伤，恶性肿瘤术后行综合治疗，随访2～5年，未见鼻咽部肿瘤复发。结论对适当范围的鼻咽部肿瘤，采用内镜下鼻咽部扩大鼻咽肿瘤切除的手术方法，不仅扩大了手术视野，有利于肿瘤暴露切除止血，而且副损伤小，面部不留疤痕。     

超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用(英文)

目的探讨经导管超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用价值。方法 12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和/或明胶海绵颗粒栓塞肿瘤供血动脉,全部患者于栓塞后3～7d 手术切除肿瘤。结果 12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果结论本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻叫血管纤维瘤摘除术前的临床应用是安全有效的。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的 研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法 对25例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术，术中配合使用电动吸切器切除肿瘤，术后随访12～60个月。结果 全部25例均在鼻内窥镜下一次完整切除肿瘤。25例中2例分别于术后12个月和16个月内复发，其余23例在随访期内未见复发。结论 使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效，对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的　研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法　对 2 5例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术 ,术中配合使用电动吸切器切除肿瘤 ,术后随访 12～ 60个月。结果　全部 2 5例均在鼻内窥镜下一次完整切除肿瘤 ,2 5例中 2例分别于术后 12个月和 16个月内复发 ,其余 2 3例在随访期内未见复发。结论　使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效 ,对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用

目的探讨经导管超选择动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用价值。方法12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和/或明胶海绵颗粒栓塞肿瘤供血动脉,全部患者于栓塞后3-7d手术切除肿瘤。结果12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果。结论本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用是安全有效的。     

局限性残留、复发鼻咽癌的鼻内镜进路救援性外科治疗

背景与目的:对于放疗后鼻咽局限性残留、复发鼻咽癌,二程放疗可以使部分患者得到长期局部控制,但其放射性后遗症也相当严重:而救援性外科手术在取得相仿甚至更优疗效的同时,避免了这些放射性后遗症.然而,传统开放式手术进路创伤大,术野欠清晰,难以按肿瘤外科原则进行连续、整块切除.本研究旨在探索一种新的微创性鼻内镜进路的复发鼻咽癌外科治疗方法.方法:从2004年9月至2007年1月,25例放疗后鼻咽局限性残留或复发鼻咽癌患者在中山大学肿瘤防治中心进行经鼻内镜鼻咽切除术,将鼻咽肿瘤和足够的安全边缘连续、整块切除.观察其疗效和并发症.结果:25例患者均在鼻内镜进路下按肿瘤外科手术原则进行根治性整块切除,仅1例切缘阳性,鼻咽创面愈合良好,均未追加术后放疗.中位随访时间13个月(3～31个月),1例原位残留,3例术后原位复发,无远处转移和死亡.1年总生存率100%,无局部复发生存率达86.0%.无张口、吞咽、发音困难和其他手术并发症发生,无围手术期死亡.结论:鼻内镜进路鼻咽癌救援手术能充分暴露鼻咽以及咽旁间隙浅部,能将鼻咽残留、复发病灶按肿瘤外科原则进行连续、整块根治性切除,并发症少而轻,近期疗效满意.     

骶尾部肿瘤手术治疗的中远期评价

目的 评价骶尾部肿瘤手术治疗的中远期效果.方法 回顾分析1993年4月至2010年2月收治的47例骶尾部肿瘤患者,其中包括脊索瘤13例,囊肿6例,骨巨细胞瘤4例,脂肪瘤3例,皮脂腺瘤3例,软骨肉瘤3例,恶性源性肿瘤3例,转移癌3例,纤维瘤2例,畸胎瘤2例,神经纤维瘤、纤维脂肪错构瘤、神经节细胞瘤、良性间叶瘤、低度恶性纤维母细胞瘤、孤立性纤维瘤、恶性神经鞘瘤各1例.术前主要临床症状：骶尾区疼痛37例,臀部及大腿麻痛33例,大小便障碍5例,双侧下肢肿胀、难以入睡1例.术前行选择性瘤血管栓塞术15例.6例行前后路联合手术,41例行后路手术.良性肿瘤全部为瘤外切除,恶性肿瘤为瘤内切除.结果 术中出血量500～5000ml,平均3000ml,术前行选择性瘤血管栓塞者术中平均出血量为1300ml.13例失访,余34例患者获得随访2-11年,平均随访时间6.4年.8例脊索瘤术后均反复出现局部复发,最快者为术后1个月复发,因其他脏器发生转移而死亡;4例骨巨细胞瘤3例失访,1例随访3年下肢功能、感觉活动良好,无大小便障碍.3例软骨肉瘤术后1例出现复发后死亡,2例无瘤生存;2例转移性癌和3例恶性源性肿瘤术后均死亡.全部良性肿瘤预后较好.结论 骶尾部肿瘤发病率较低,起病隐匿、症状轻微者占多数.术前行选择性瘤血管栓塞能够有效降低术中出血的风险.良性肿瘤可进行边缘完整的切除,预后良好;而单纯手术治疗对骶尾部恶性肿瘤来讲,复发率高,预后差,采用全骶骨切除或手术联合放化疗可望降低术后复发率,改善预后.     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中,22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术,4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9~60个月。1例术后30个月复发,其它25例未见复发,全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变,而对广泛病变则应采用鼻内镜联合鼻侧切开术,术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的临床效果观察

目的 探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤(SNIP)的临床效果.方法 回顾性分析93例行鼻内镜手术治疗的SNIP患者的临床资料,对患者进行Krouse分期,比较不同手术方法(单纯鼻内镜手术、鼻内镜联合改良柯-陆氏手术、鼻内镜联合鼻外进路手术)的治疗效果及术后复发情况.结果 所有患者均一次性完成手术,手术时间47~196 min,平均(94.3±25.9)min;术中出血量34~281 ml,平均(97.3±29.0)ml;术后随访时间26~62个月,平均(39.4±10.9)个月.19例KrouseⅠ期患者均采用单纯鼻内镜手术治疗,复发1例(5.26%).45例KrouseⅡ期患者中,32例采用单纯鼻内镜手术治疗,复发2例(6.25%);13例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(7.69%),两种手术方法的复发率比较,差异无统计学意义(P>0.05).25例KrouseⅢ期患者中,10例采用单纯鼻内镜手术治疗,复发6例(60.00%);15例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(6.67%),两种手术方法的复发率比较,差异有统计学意义(P<0.05).4例KrouseⅣ期患者均采用鼻内镜联合鼻外进路手术治疗,复发1例(25.00%).结论 鼻内镜手术治疗SNIP效果较好,复发率低,应根据患者肿瘤分期制定手术方案,并于术后定期复查以有效预防肿瘤复发.     

鼻内镜下鼻腔内翻性乳头状瘤电凝电刀手术治疗后初步观察

目的：探讨鼻内窥镜下电凝电刀手术治疗鼻腔内翻性乳头状瘤的方法和初步疗效。方法：对2008年11月至2010年12月诊治的20例鼻腔内翻性乳头状瘤的临床资料进行回顾性分析,全部患者均接受鼻内窥镜下鼻腔乳头状瘤切除术的手术方案。按Krouse分级,其中1级局限于鼻中隔患者3例和2级病变位于鼻腔上颌窦口周围患者10例,病变侵及筛窦5例,均全程采用电凝电刀完成手术治疗,属3级病变的既往手术复发者2例,病变累及全组鼻窦伴轻度骨质破环2例,采用电刀电凝结合电动吸切器完成手术治疗,手术过程均在全麻鼻内窥镜下进行。结果：除2例复发的属3级病变的鼻腔乳头状瘤病例,均完成肿瘤根治切除,术中出血较少,除2例复发性内翻性乳头状瘤患者出血约150ml外,其余18例原发性患者出血量为10-50ml,中位数出血量35ml。手术时间短,为20-60min,术中术野清晰,无颅-额-眶手术并发症,术后1天抽取纱条,3天后出院,3个月后复查见术腔完全上皮化。随访3-6个月,中位随访时间4个月,20例鼻腔乳头状瘤病例术前鼻塞,血性脓涕,头痛等症状均缓解,无复发病例。结论：电凝电刀手术治疗鼻腔内翻性乳头状瘤具有手术损伤小,手术时间短,手术视野清晰,对病变的基底及安全边缘切除彻底,不易造成瘤组织的血行播散,术中及术后出血少,围手术期不良反应轻,术后不易复发等优点,对于1级和2级病变可做到肿瘤完整切除,是一种较好的微创治疗鼻腔内翻性乳头状瘤的方法。     

鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤,4例经鼻腔和鼻外切口双径路手术治疗,其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻,经治疗后好转;1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤,术后出现患侧内眦外移;4例良性骨源性病变患者行鼻内镜下病变部分切除术,其余病例均彻底切除肿瘤而无明显并发症,随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势,在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。     

Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument

To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith–Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6 months and 1 year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6 months. One from each group had recurrence of symptoms. At the end of 12 months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.     

鼻内窥镜在鼻腔鼻窦内翻性乳头状瘤切除术中的应用

目的　探讨和完善鼻内窥镜下彻底切除鼻内翻性乳头状瘤 ,降低术后复发率的手术方法及其适应证。方法　 1993年 2月至2 0 0 2年 6月住院的临床及病理诊断为鼻内翻性乳头状瘤 48例 ,其中 3 0例有 1～ 4次前期经鼻或鼻侧切开手术史。 3 7例患者采用鼻内窥镜经鼻肿瘤切除术 ;11例患者肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦外 ,同时广泛侵及上颌窦内采用鼻内窥镜经鼻肿瘤切除 ,同时在内窥镜下经上颌窦前壁或下鼻道开窗联合径路肿瘤切除术 ,全部病例随访 10～ 3 6个月。结果　 48例中 1例术后复发 ,47例未复发 ,治愈率 97.9%。 8例 ( 16.7% )术后换药期间发现术腔局部出现瘤样组织 ,病理证实为内翻性乳头状瘤 ,内窥镜下以YAG激光处理局部创面 ,随诊 18个月 ,未再发现有瘤样组织。结论　辅以YAG激光治疗的内窥镜经鼻内翻性乳头状瘤切除术 ,有利于彻底切除肿瘤 ,该术式避免了面部疤痕 ,但对肿瘤已广泛侵及上颌窦内者宜采用联合径路术。     

Endoscopic resection of pleomorphic adenoma of the nasal septum

Pleomorphic adenomas originating from the minor salivary glands are rare in the nasal cavity. Total surgical excision is the preferred treatment for pleomorphic adenomas. Lateral rhinotomy, midfacial degloving, transpalatal surgery and endoscopic surgery are among the surgical approaches. Endoscopic tumor removal produces less morbidity, reduces blood loss during surgery, decreases hospital stay, avoids external scars and excessive unnecessary resection, enables the surgeon to better visualize the tumor margins, and has a low recurrence rate. However, only 3 pleomorphic adenomas of the nasal septum have been removed by the endoscopic approach to date. In this paper we report on a case of pleomorphic adenoma of the nasal septum that was removed successfully by the endoscopic approach without any recurrences.     

A Comparison of Microdebrider Assisted Endoscopic Sinus Surgery and Conventional Endoscopic Sinus Surgery for Nasal Polypi

Nasal polyposis is often encountered in rhinology practice. Those who fail conservative management, a definitive surgery is essential to achieve sufficient ventilation and drainage of the affected sinuses by using either microdebrider or conventional instruments for functional endoscopic sinus surgery (FESS). A prospective study was conducted on 40 cases of nasal polypi in a tertiary care hospital. 20 cases were operated by conventional endoscopic instruments and 20 using the microdebrider. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund–Mackay scoring system and the data was statistically analysed. There was no statistically significant difference in surgical outcome for patients when either conventional endoscopic instruments or microdebrider was used. However, there was a significant symptomatic improvement in cases undergoing microdebrider FESS. Microdebrider assisted polypectomy is precise, relatively bloodless surgery though the precision depends on the surgeon’s anatomical knowledge and operative skills. Study substantiates that these instruments are helpful but not a prerequisite for successful outcomes in FESS. The study re-emphasises the utility of the microdebrider to young learning FESS surgeons.     

胸腔镜术治疗肺转移瘤的可行性分析

背景与目的:随着内镜外科和影像学技术的进步,胸腔镜术治疗肺转移瘤的应用越来越广泛,本研究拟对胸腔镜术治疗肺转移瘤的可行性进行探讨。方法:对经胸腔镜术治疗的17例肺转移瘤患者的资料进行回顾性分析。结果:本组17例肺转移瘤均为原发肿瘤治疗后随访时发现,均位于肺外周,且排除肺外转移。其中孤立性转移瘤10例,单侧多发转移瘤4例,双侧多发转移瘤3例,全部行胸腔镜下肺楔形切除术。无手术死亡,无术后严重并发症,无切口肿瘤种植。术后局部复发5例,4例为多发肺转移患者,另1例软组织肉瘤孤立转移患者再次行胸腔镜术切除复发性肺转移瘤。1、3、5年生存率分别为77.3%、53.1%和34.8%。结论:对外周肺野、直径≤3cm、特别是孤立性肺转移瘤采用胸腔镜术治疗完全可行、有效,双肺转移瘤亦可一期切除。     

Nasal Endoscope: An Armamentarium in the Management of Sinonasal Inverted Papilloma

Sinonasal inverted papillomas (SIP) are unique group of locally aggressive benign neoplastic lesions arising from mucosa of sinonasal tract with potential for recurrences and known association with squamous cell carcinoma in 5–15 % of cases. This study was conducted was to assess the efficacy and usefulness of the nasal endoscope in treating SIP. We reviewed 28 biopsy proven cases of SIPs that were treated at our hospital between June 2009 and September 2013. Average patient age was 46 years. Fourteen were treated by transnasal endoscopic excision of tumor with noted recurrence of 21.43 %. Thirteen were treated by endoscopic assisted open surgery which had 23 % recurrence. Three patients had malignant inverted papillomas, of whom two (7 %) were found to have synchronous squamous cell carcinoma and one (3.6 %) had metachronous squamous cell carcinoma. No evidence of recurrence was found in rest during our follow up. The endoscopic approach is the preferred method for the treatment of the majority of inverted papillomas. Powered instrumentation is extremely useful to achieve good results. Although significant number of cases was done by external approach by lateral rhinotomy, the endoscopic assistance is required to ensure complete removal of the tumour to reduce the recurrence rates. Close follow up of the patient for a longer period of time is necessary for the early detection of recurrence and to allow for surgical salvage.