鼻内镜下泪前隐窝入路切除上颌窦良性复发性病变疗效分析

目的 探讨鼻内镜下泪前隐窝入路切除上颌窦良性复发性病变的优越性.方法 收集2014年1月至2015年2月单县中心医院耳鼻咽喉科收治的21例上颌窦良性病变术后复发患者,包括上颌窦息肉8例,上颌窦内翻性乳头状瘤7例,真菌性上颌窦炎6例.所有患者术前均行鼻内镜检查、鼻窦冠状位及轴位CT,若为单侧上颌窦病变,加行鼻窦MRI检查.经检查所有病变经中鼻道手术均无法彻底清除.手术均在控制性降压全麻下进行,选择泪前隐窝手术入路.随访8～12个月,观察术后恢复情况.结果 21例患者均经泪前隐窝入路行病变清理术,术中可充分暴露上颌窦各壁,病变清理彻底.术后病理7例内翻性乳头状瘤术后病理未见恶变.其余8例上颌窦息肉术后病理符合鼻息肉术后复发.术后患者病变无复发,保留了鼻腔结构和功能,术后无面颊部麻木、溢泪等并发症.结论 泪前隐窝入路切除上颌窦良性复发性病变,可充分暴露视野,彻底切除病变的同时,还保持了正常的鼻腔形态和功能,损伤小,并发症少,符合鼻内镜手术的微创理念.     

经鼻内镜泪前隐窝入路治疗上颌窦内翻性乳头状瘤15例体会

目的评价经鼻内镜泪前隐窝入路治疗上颌窦内翻性乳头状瘤的临床效果。方法回顾性分析经鼻内镜泪前隐窝入路术治疗15例上颌窦内翻性乳头状瘤患者资料,观察术后的创面愈合和肿瘤的复发情况。结果随访18~24个月,15例中仅2例复发,1例患者术后3个月上颌窦后壁乳头状瘤复发,1例患者术后4个月上颌窦下壁乳头状瘤复发,经清除肿瘤,电凝烧灼基底部,随访至今未见复发。结论经鼻内镜泪前隐窝入路治疗上颌窦内翻性乳头状瘤创伤小、恢复快、疗效确切、复发率低、术后便于观察术腔情况,值得临床推广应用。     

经鼻内镜泪前隐窝入路上颌窦手术的临床疗效

目的研究经鼻内镜泪前隐窝入路手术彻底切除上颌窦病变的临床应用效果。方法收集2008年8月至2016年8月采用经鼻内镜泪前隐窝入路治疗107例上颌窦内的息肉、囊肿、真菌、良性及恶性肿瘤病变的临床资料。其中鼻内翻乳头状瘤28例、上颌窦炎伴囊肿24例、复发性真菌20例、出血坏死性息肉17例、上颌窦骨瘤6例、上颌窦含牙囊肿5例、上颌窦鳞状细胞癌4例,上颌骨囊肿3例。所有患者术前均行CT检查,手术先切除鼻腔和其他鼻窦病变,开放并扩大上颌窦自然窦口,再行泪前隐窝入路切除上颌窦病变,术后肿瘤患者行下鼻道开窗。结果全部患者均能良好显露上颌窦各壁,彻底切除病变组织、无面部麻木、溢泪、眼眶青紫、视物模糊、鼻腔干燥等并发症。非肿瘤患者随访3~6个月、肿瘤患者术后一直随访。内翻乳头状瘤有4例复发,3例术后1~2年上颌窦口附近复发,经局部切除后随访3~5年未再发,另1例术后6个月中鼻甲残端处局部复发,再次手术切除病灶及中鼻甲,随访3年,未见复发。其余患者均未见复发。所有患者术后临床症状逐渐消失,下鼻甲形态良好,上颌窦腔上皮化。结论经鼻内镜泪前隐窝入路手术能够充分显露上颌窦腔,彻底切除上颌窦前内下壁及窦腔内的病变,手术操作方便,并发症少,术后观察方便,疗效满意,值得推广。     

经鼻内镜泪前隐窝径路治疗上颌窦病变

目的：探讨经鼻内镜泪前隐窝入路在上颌窦病变手术中的应用。方法回顾性分析2011年9月至2014年1月31例上颌窦病变行经鼻内镜泪前隐窝径路手术的病例资料,其中乳头状瘤19例（3例术后病理提示癌变）,出血坏死性息肉5例,真菌性鼻窦炎3例,炎性息肉4例。手术采用控制性低血压全身麻醉,经鼻内镜下泪前隐窝入路切开鼻腔外侧壁进入上颌窦,清除上颌窦内病灶。结果本组31例手术均顺利清除病灶,无任何并发症。3例乳头状瘤癌变病例术后转放疗科放疗,其余均于术后5～8 d 痊愈出院。术后随访5～33个月,仅1例乳头状瘤癌变者复发。结论经鼻内镜泪前隐窝手术治疗上颌窦病变,该术式解剖并保证鼻泪管完整,可明视下清理上颌窦各壁及隐窝内病变,有利于更好地清除病变和降低复发率。     

经鼻内镜泪前隐窝入路术治疗复杂性上颌窦内翻性乳头状瘤10例

目的 总结经鼻内镜泪前隐窝入路术治疗复杂性上颌窦内翻性乳头状瘤的临床效果.方法 采用经鼻内镜泪前隐窝入路术治疗10例复杂性上颌窦内翻性乳头状瘤患者,观察术后的创面愈合和肿瘤切除后的复发情况.结果 随访2-30个月,10例中9例未见复发;另1例患者术后3个月,上颌窦后壁乳头状瘤复发,清除肿瘤,基底部电刀烧灼,随访至今未见复发.结论 此术式刨伤小、术后恢复快、疗效确切、复发率低.     

经鼻内镜泪前隐窝入路术治疗复杂性上颌窦内翻性乳头状瘤12例

目的 总结经鼻内镜泪前隐窝入路术治疗复杂性上颌窦内翻性乳头状瘤的临床效果.方法 采用经鼻内镜泪前隐窝入路术治疗12例复杂性上颌窦内翻性乳头状瘤患者,观察术后的创面愈合和肿瘤切除后的复发情况.结果 随访18-24个月,12例中11例未见复发 另1例患者术后2个月,上颌窦后壁乳头状瘤复发,清除肿瘤,基底部电刀烧灼,随访至今未见复发.结论 此术式创伤小、术后恢复快、疗效确切、复发率低.     

鼻内镜下泪前隐窝入路治疗上颌窦良性病变

目的探讨经鼻内镜下泪前隐窝入路治疗上颌窦良性病变的适应证,并发症及手术方法。方法回顾性分析经鼻内镜下泪前隐窝入路治疗的26例上颌窦良性病变患者的资料。结果上颌窦囊肿14例,霉菌性上颌窦炎8例,上颌窦息肉4例。所有患者随访半年以上,术腔上皮化,无面部肿胀麻木、溢泪、视物模糊、脑脊液鼻漏等并发症发生。结论经鼻内镜下泪前隐窝入路治疗上颌窦良性病变是一种创伤小,手术视野广阔清晰,能够准确完整地清除病变,是较为理想的治疗方法。     

鼻内镜下泪前隐窝入路治疗上颌窦良性病变的疗效

目的 探讨鼻内镜下泪前隐窝入路治疗上颌窦良性病变的疗效.方法 回顾性分析2014年6月至2016年7月滁州市第一人民医院应用鼻内镜下泪前隐窝入路治疗36例上颌窦良性病变患者的临床资料.结果 36例患者均在鼻内镜下彻底切除,患者完整随访4~12个月,无复发,无鼻腔干燥、面部麻木等并发症.1例患者术后1个月出现术眼的溢泪,经眼科会诊考虑泪总管阻塞,给予置管处理后缓解.结论 鼻内镜下泪前隐窝入路手术治疗上颌窦良性病变可保留鼻腔正常结构、减小手术创伤、彻底清理上颌窦腔内病变,降低手术复发率,是切除上颌窦良性病灶的一种可靠的微创入路和方法.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.