腮腺良性肿瘤切除中胸锁乳突肌皮瓣的应用分析

目的 探讨腮腺良性肿瘤切除中胸锁乳突肌皮瓣的应用效果。 方法 选取腮腺良性肿瘤患者84例,以随机数字表法分成对照组和实验组,各42例。对照组接受常规腮腺切除术治疗,实验组常规切除腮腺病变后,采用胸锁乳突肌皮瓣转移填充术区凹陷行修复治疗。随访6~12个月,对比两组术后并发症发生率和肿瘤复发率。 结果 实验组术后并发症发生率14.29%,低于对照组的52.38%,差异有统计学意义(P<0.01)。两组肿瘤复发率差异无统计学意义(P>0.05)。 结论 在腮腺良性肿瘤切除中应用胸锁乳突肌皮瓣修复术区凹陷,可有效降低并发症风险,同时不影响手术效果,值得临床推广。     

糖尿病患者行白内障超声乳化术后视力及眼底的变化

目的 通过观察2型糖尿病患者行白内障超声乳化摘除及人工晶体植入术后视力及眼底的变化以评估糖尿病视网膜病变(DR)进展的相关危险因素。 方法 选取50例2型糖尿病伴非增殖型糖尿病视网膜病变(NPDR)且需单眼行白内障超声乳化及人工晶体植入术患者为研究对象,手术眼为手术组,非手术眼为非手术组。术后1、7 d及1、3个月,分别行最佳矫正视力(BCVA)及黄斑区光学相干断层扫描(OCT);术后3个月行FFA检查,分析DR进展的相关危险因素。 结果 手术组术后1 d~3个月视力明显改善(P<0.01),术后3个月BCVA呈下降趋势。手术组术后黄斑水肿发生率及DR进展率明显高于非手术组,差异有统计学意义(P<0.05或P<0.01)。Logistic回归分析结果显示,糖化血红蛋白(HbA1c)(OR=21.423)、糖尿病病程(OR=9.061)、NPDR程度(OR=2.486)为DR进展的危险因素。 结论 2型糖尿病NPDR患者行超声乳化及人工晶体植入术后BCVA明显改善,于术后3个月呈轻微下降趋势。糖尿病病程长、血糖控制差、术前DR加重是术后DR进展的危险因素。     

彩超引导低温等离子消融术在甲状腺良性结节的临床应用研究

目的 探讨彩超引导下低温等离子消融术对甲状腺良性结节治疗的临床价值。 方法 对36例接受彩超引导下低温等离子消融术的患者,观察术前及术后1、3、6个月甲状腺结节体积(V)、体积缩小率(VRR)及术前、术后1个月血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺素(TSH),评价低温等离子在治疗甲状腺良性结节的有效性及安全性。 结果 经过相关治疗,甲状腺良性结节术后体积逐步缩小,体积缩小率增大,差异有统计学意义［F(1.311,45.887)=378.369;P<0.001］;患者术前及术后1个月TSH水平比较,差异无统计学意义(P=0.123);术前及术后1个月FT3、FT4水平比较,术后1个月的FT3、FT4较前稍升高,差异有统计学意义(P<0.001;P=0.001)。治疗过程无声嘶、饮水进食呛咳等不良并发症。 结论 彩超引导下低温等离子消融术治疗甲状腺良性结节安全、有效。     

内镜经翼突入路切除中颅底恶性肿瘤30例临床分析

目的 探讨内镜经翼突入路切除中颅底恶性肿瘤的疗效。 方法 回顾分析30例经鼻内镜翼突入路切除累及中颅底恶性肿瘤患者相关资料,总结该手术相关技巧和经验,用Kaplan-Meier法进行生存分析,探讨肿瘤累及颈内动脉对预后影响。 结果 手术均为全身麻醉下进行。平均手术时间145 min,平均术中出血470 mL,术中脑脊液漏6例;术后颅内感染2例、脑脊液漏1例,均痊愈。病理分别为复发性鼻咽癌21例、腺样囊性癌3例、黏液表皮样癌2例、脊索瘤1例、癌肉瘤1例、鼻咽滤泡树突状细胞肉瘤1例和颅底淋巴上皮瘤样癌1例。30例颅底恶性肿瘤患者术后1年、2年、3年、5年生存率分别为92.9%、79.6%、48.6%和36.5%;复发性鼻咽癌中位生存期为29.00［35.00,23.00］个月,其他恶性肿瘤38.00［38.00,38.00］个月,生存曲线之间差异有统计学意义(χ2=4.248; P=0.039);颈内动脉累及和未累及患者中位数分别为16.00［23.00,14.00］个月和36.00［80.00,31.00］ 个月,生存曲线差异有统计学意义(χ2=9.421; P=0.002);而且颈内动脉受累是影响患者预后的危险因素,颈内动脉受累及患者的死亡风险是未受累患者的9.678倍(HR=9.678,P=0.011)。 结论 内镜翼突入路是部分中颅底恶性肿瘤外科治疗的合理方案,颈内动脉累及侵犯是影响疾病预后的危险因素。     

颈源性纵隔脓肿手术切开概率增加的危险因素分析

目的 探讨颈源性纵隔脓肿手术机会增加、住院时间延长的危险因素,从而更好地判断颈源性纵隔脓肿手术治疗时机。 方法 回顾性分析2008年1月至2017年8月头颈部感染导致纵隔脓肿的61例患者临床资料,经Wilcoxon秩和检验得出影响住院时间的因素,采用Logistic回归模型筛选影响颈源性纵隔脓是否需要手术并延长住院时间的危险因素。 结果 纵隔脓肿死亡率为16.4%。糖尿病、手术治疗及脓肿最大直径≥3 cm是延长住院时间的因素(P分别为0.002、0.047、0.042)。性别、年龄、白细胞计数、发热、呼吸困难、即时手术与否与平均住院时间差异无统计学意义(P均>0.05)。糖尿病、呼吸困难及脓肿最大直径≥3 cm是增加手术治疗风险的临床危险因素(β分别为1.942、3.001、2.369,OR分别为2.565、20.099、10.979)。糖尿病患者药物治疗失败风险是无糖尿病患者的18.147倍(β=2.889,OR=18.147)。脓肿直径≥3 cm的患者药物治疗失败风险是脓肿直径<3 cm患者的57.303 倍(β=4.048,OR=57.303)。 结论 有糖尿病、存在呼吸困难及脓肿最大直径≥3 cm的患者需手术治疗风险增大,应积极手术干预;对无呼吸困难及脓肿最大直径<3 cm的患者,在经足量有效抗生素治疗下严密监控,可避免手术切开引流。     

改良白内障超声乳化术的临床研究

目的 对传统超声乳化术中的劈核技术进行改良,评估其安全性和术后效果。 方法 将年龄相关性白内障160眼随机分为劈核改进技术超声乳化术组及传统核分瓣超声乳化术组,每组80眼,记录手术时间、乳化时间、能量等数据,术后观察患者视力、角膜水肿程度、房水闪辉等指标。 结果 对术中数据进行Mann-Whitney U检验,两组间手术时间(P=0.000)、乳化时间(P=0.011)、能量(P=0.005)差异均有统计学意义。两组间最佳矫正视力(BCVA)术后1 d(P=0.003)、3 d(P=0.005)差异有统计学意义,角膜状态术后1 d(P=0.005)、3 d(P=0.004)、7 d(P=0.044)差异有统计学意义,房水闪辉术后1 d(P=0.004)、3 d(P=0.011)、7 d(P=0.026)差异亦有统计学意义。两组间术中并发症、术后其他并发症差异无统计学意义(P=0.560)。 结论 劈核改进技术超声乳化术较传统核分瓣超声乳化术对眼组织损伤更少,是一种安全有效的改良手术。     

气道内金属支架取出术方法学及其影响因素分析

目的 通过统计学处理分析影响气道内金属支架取出术方法学的影响因素,探讨气道内金属支架取出术的方法学。 方法 收集64例气道内金属支架取出术的病历资料,进行病例对照研究。所有患者按照支架取出使用的方法种类数量,分为支架取出方法种类≤3种组(n=40)和支架取出方法种类>3种组(n=24)。比较两组患者的人口学特征、气道内金属支架类型、气道内支架留置时间、支架相关并发症等影响因素。 结果 64例中有40例使用支架取出方法种类≤3种,24例使用支架取出方法种类>3种。两组患者的性别、年龄、置入支架时病因、支架留置体内时间、取出支架时支架结构完整性的差异无统计学意义。取出支架方法种类>3种组的支架覆膜情况、支架移位、支架相关肉芽组织或肿瘤组织形成程度评分、支架相关瘢痕组织形成程度评分,与取出支架方法种类≤3种组相比差异具有统计学意义。多因素分析发现,支架相关瘢痕组织形成程度评分(OR=1.354,95%CI:1.100~1.667,P=0.004)是影响气道内金属支架取出术方法学种类数量的影响因素。 结论 通过研究发现气道内金属支架相关瘢痕组织形成程度是支架取出方法学种类数量的影响因素,且影响关系为正相关。     

隧道皮瓣修复外鼻肿瘤切除术后缺损

目的 探讨隧道皮瓣修复外鼻肿瘤切除术后缺损的意义。 方法 回顾分析2012年6月至2014年6月收治的27例外鼻肿瘤的临床资料,均行手术切除并根据肿瘤位于外鼻的部位和侵犯深度的不同,设计不同的隧道皮瓣修复缺损。 结果 27例患者皮瓣均一期修复成活,2个月后外观自然、皮色相近,患者接受度高,随访3个月~2年,1例鳞状细胞癌复发,再次手术切除,术后放疗。 结论 隧道皮瓣修复外鼻肿瘤切除术后缺损,皮瓣成活率高,术后外观自然,患者易于接受。     

慢性鼻-鼻窦炎伴鼻息肉患者组织嗜酸性粒细胞与嗅觉功能障碍的相关性研究

目的 探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者术后组织嗜酸性粒细胞与嗅觉功能障碍的相关性。 方法 回顾性选择2016年7月至2018年7月CRSwNP行鼻内镜鼻窦手术(ESS)治疗的120例患者。通过视觉模拟评分(VAS)和Lund-Kennedy评分了解患者病情;术后取筛窦黏膜组织进行嗜酸性粒细胞计数。通过Sniffin'Sticks测试和化学感觉事件相关电位(CSERP)来评估嗅觉功能。Spearman相关分析用以了解嗜酸性粒细胞计数与Sniffin'Sticks测试和CSERP参数之间的关系及VAS评分和CSERP的相关性。 结果 调整协变量(年龄、性别、饮酒、吸烟、过敏性鼻炎、哮喘、术后时间和Lund-Kennedy评分)后的相关性分析结果与未调整协变量的结果一致。组织嗜酸性粒细胞计数与阈值评分相关(r=-0.460,P=0.012);组织嗜酸性粒细胞计数与苯乙醇(N1:r=0.471,P=0.010; P2:r=-0.487,P=0.007)及乙醇(N1:r=-0.516,P=0.008; P2:r=-0.590,P=0.002)刺激产生的CSERP峰值潜伏期N1和P2相关;但与CSERP振幅均无明显相关(P>0.05)。苯乙醇刺激产生的阈值评分和CSERP峰值潜伏期N1之间存在明显负相关(r=-0.560,P<0.001)。乙醇刺激产生的CSERP潜伏期与症状VAS评分存在明显负相关(r=-0.400,P=0.005)。 结论 CRSwNP患者鼻术后组织嗜酸性粒细胞增多与术后嗅觉功能障碍明显相关,且三叉神经的敏感性可能与组织嗜酸性粒细胞增多相关,鼻黏膜炎症可同时影响嗅神经及三叉神经的功能。     

儿童细菌性脑膜炎后听力损害危险因素的系统评价与Meta分析

目的 系统评价儿童细菌性脑膜炎后听力损害的危险因素。 方法 计算机检索PubMed、EMbase、Web of Science、CNKI、Sinomed、Wanfang data、VIP。检索时限为建库~2021年9月20日,收集国内外有关儿童细菌性脑膜炎后听力损害危险因素的相关研究,由两名研究者独立筛选文献、提取资料后,采用纽卡斯尔渥太华量表(NOS)评价研究质量,并采用Stata 16.0软件进行Meta分析。 结果 纳入12项研究(3项队列研究,9项病例对照研究),对2041例细菌性脑膜炎患儿进行了听力检查,其中出现听力损害(特指感音神经性聋)者301例。共对4种危险因素进行Meta分析,显示肺炎链球菌感染［OR=2.70,95%CI(1.89,3.87),P<0.001］、癫痫发作［OR=2.31,95%CI(1.29,4.14),P=0.005］是儿童细菌性脑膜炎后听力损害的危险因素;年龄≤1岁［OR=1.00,95%CI(0.34,2.97),P=0.998］、性别［OR=1.06,95%CI(0.70,1.58),P=0.794］与儿童细菌性脑膜炎后听力损害不相关。 结论 研究的结果表明致病菌为肺炎链球菌、病程中出现癫痫发作是儿童细菌性脑膜炎后听力损害的危险因素。对有上述危险因素的患儿,应格外重视其听力的变化并加强随访。     

游离组织瓣修复头颈部术后缺损并发组织瓣坏死的原因分析

目的探讨游离组织瓣修复头颈部术后缺损并发组织瓣坏死的原因,以期提高手术成功率。方法对63例应用游离组织瓣修复的头颈恶性肿瘤术后缺损的临床资料进行回顾性分析。结果术后出现血管危象11例,危象发生率17．46％。其中静脉危象9例,动脉危象2例,最终皮瓣坏死4例,坏死率6．35％。与术后并发症有关的术前因素包括年龄、糖尿病、高凝状态、长期吸烟史及长期适量饮酒史;术中因素包括血管蒂过长、吻合血管组数;术后因素包括术后引流及激素治疗。结论对拟行游离组织瓣修复头颈部术后缺损的患者,进行完善的术前评估,严格掌握手术适应证以及周全的术中、术后处理是减少手术并发症、提高成功率的关键。     

Risk factors of postoperative infection in head and neck surgery

Objectives

Patients undergoing head and neck oncological surgery are at great risk of developing complications following surgery. It is important to clarify risk factors contributing to operative wound infections.

Methods

Two hundred and nine cases with head and neck tumor (87 female, and 122 male, averaged 58.6 years old) were studied at Mie University Hospital within a 24-month interval, during 2002 and 2003.

Results

Twenty-one (10.0%) surgical site infections (SSIs) were recorded. Univariate analysis revealed that the following factors were significantly related to SSI: blood loss, previous chemotherapy, clean-contaminated surgery, tracheotomy, malignant tumor, advanced T-stage, flap reconstruction, and long operative time. Multivariate analysis showed that blood loss, previous chemotherapy, and the type of surgery contributed to SSI. Otherwise, the following factors did not show any significant correlations: age, body mass index, smoking, alcohol intake, diabetes, sex, previous radiotherapy, N-stage or ASA score.

Conclusions

In order to minimize postoperative wound infection, clinicians managing the head and neck tumor patients should have a thorough understanding of the risk factors leading to postoperative infections such as blood loss, previous chemotherapy, and clean-contaminated surgery.     

Deltopectoral flap revisited in the microvascular era: a single-institution 10-year experience

OBJECTIVES: In 1965, Bakamjian described the deltopectoral (DP) flap as a reconstructive option in head and neck surgery. It served as the premier flap for reconstructing complex head and neck defects until the late 1970s. Today, the DP flap is often overlooked; although its role has diminished, its use is still warranted in certain select clinical situations. METHODS: A retrospective patient chart review of 25 DP flap procedures performed at the University of Iowa Hospitals and Clinics and Iowa City Veterans Administration Hospital between January 1, 1991, and June 1, 2002, was undertaken. The data collected included patient demographics and assessment of DP flap survival and its ability to accomplish established preoperative reconstructive goals. RESULTS: The DP flap was used for the following situations: vascularized skin coverage of the neck, carotid arteries, and face (16 cases), including simultaneous coverage of other reconstructive flaps in 6 cases; controlled orocutaneous fistula development (3 cases) or fistula closure (5 cases); and pharyngoesophageal reconstruction (4 cases). In 3 cases the flap was used for more than one of the preoperative goals described above (n = 25). Minor flap-related complications that required local wound treatment developed in 5 cases (20.0%), but the flaps were successfully salvaged and no subsequent reconstructive procedure was required. In an additional 5 cases (20.0%), the flap failed in some measure to accomplish its preoperative goal, necessitating further surgical reconstruction. Sixteen patients (64%) had undergone previous or simultaneous reconstructive procedures that limited other available reconstructive options. CONCLUSIONS: The technical simplicity of the DP flap, coupled with its predictable vascular supply, has allowed it to maintain a niche role in contemporary reconstructive surgery. The DP flap provides an excellent method of reconstruction in select cases in which vascularized skin coverage of the neck is needed. The DP flap also provides a valuable salvage option in situations in which other reconstructive techniques are not possible.     

The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy

Pharyngocutaneous fistula after total laryngectomy remains a hardly inevitable complication. The predisposing factors are not clearly identified, but prior radiotherapy seems to increase the risk of fistulae. The purpose of this retrospective study was to determine the value of the pectoralis myofascial flap in pharyngeal reconstruction in post-radiotherapy total laryngectomy in order to decrease the risk of fistula formation. The charts of 60 consecutive patients who had undergone total laryngectomy or pharyngolaryngectomy after radiotherapy were analyzed. Twenty-one variables were recorded for each patient. The overall rate of fistula formation was 38% (23% when a pectoralis myofascial flap was used to cover the pharynx and 50% when no flap was used, P=0.06). The flap-related complications were exceptional. In the subgroup of patients with diabetes mellitus, a history of vascular disease or a poor nutritional status, the use of a flap reduced the fistula formation from 73 to 13% (P=0.018). The pectoralis myofascial flap covering the pharyngeal sutures in postradiotherapy laryngectomy is particularly useful in a selected group of patients (with diabetes mellitus, history of vascular disease or poor nutritional status).     

The latissimus dorsi flap in head and neck reconstructive surgery: a review of 121 procedures.

The results of a prospective study of 121 latissimus dorsi flaps performed during head and neck reconstructive surgery at the Royal Marsden Hospital are presented. Three-quarters of the flaps were pedicled and one-quarter were free. All the patients underwent surgery for malignant disease. The flap failure rate was 5%, other flap related complications occurred in 19% and the overall rate of complications was 26%. Previous radiotherapy, site of reconstruction, type of flap (free or pedicled) and age of the patient were not significant risk factors. Men were more likely to have a complication than women.     

Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck

BACKGROUND: Twenty-four hours of perioperative antibiotics provides effective prophylaxis for most head and neck cancer resections. Many reconstructive surgeons have been hesitant to apply this standard to free-flap reconstruction of the head and neck. This prospective clinical trial compared short-course and long-course clindamycin prophylaxis for wound infection in patients with head and neck cancer undergoing free-flap reconstruction. METHODS: Seventy-four patients were randomized to receive short-course (3 doses) or long-course (15 doses) clindamycin perioperatively. Wound infections, fistulas, and other postoperative complications were documented by faculty surgeons who were blinded as to treatment group. RESULTS: The differences in wound infections and other complications were statistically insignificant. No other independent predictors of wound complications emerged in this series of patients. CONCLUSIONS: Short-course clindamycin is as effective as long-course clindamycin in preventing wound infections after free-flap surgery for head and neck ablative defects.     

The latissimus dorsi flap in head and neck reconstructive surgery: a review of 121 procedures

The results of a prospective study of 121 latissimus dorsi flaps performed during head and neck reconstructive surgery at the Royal Marsden Hospital are presented. Three-quarters of the flaps were pedicled and one-quarter were free. All the patients underwent surgery for malignant disease. The flap failure rate was 5%, other flap related complications occurred in 19% and the overall rate of complications was 26%. Previous radiotherapy, site of reconstruction, type of flap (free or pedicled) and age of the patient were not significant risk factors. Men were more likely to have a complication than women.     

Predictors of perioperative complications in head and neck patients

BACKGROUND: Patients with significant medical problems requiring major otolaryngology procedures are at high risk for both medical and surgical complications. OBJECTIVE: To identify risk factors associated with perioperative complications in medically compromised patients undergoing major otolaryngology procedures. METHODS: Ninety-three consecutive patients with significant comorbid medical illnesses (eg, diabetes, hypertension) undergoing major head and neck surgical procedures were referred to a medical consultation center for preoperative assessment and medical management. Patient and surgical characteristics as well as perioperative complications were identified and recorded. Univariate and multivariate analyses were performed to determine which characteristics were associated with complications. RESULTS: Thirty-two patients (34%) had postoperative complications. Twenty-six patients (28%) had serious medical complications, and 18 (19%) had surgical complications. No deaths occurred in the study population. On univariate analysis, the factors associated with all complications included history of hepatitis, flap reconstruction, oncologic surgery, preoperative radiation therapy, preoperative gastrostomy placement, intraoperative transfusion, anesthesia time (> or =8 hours), and those with greater intraoperative fluid replacement and estimated blood losses. Only anesthesia time (> or =8 hours) remained independently significant on multivariate analysis. A history of hepatitis and prolonged anesthesia time were the only independent predictors of medical complications. The only independent predictor of surgical complications was the volume of intraoperative fluid administered. CONCLUSIONS: Prolonged anesthesia times of 8 hours or more, a history of hepatitis, and large-volume intraoperative fluid resuscitations predicted adverse outcomes. Special care must be taken in counseling these patients preoperatively and in caring for them during their operative and postoperative course.     

Complications following reconstruction with the pectoralis major myocutaneous flap: the effect of prior radiation therapy.

Over the past 5 years, 40 patients with head and neck cancer underwent pectoralis major myocutaneous flap (PMMF) reconstruction following radical ablative surgery. Twenty-three patients received prior radiation therapy (55 to 70.2 Gy), while 17 patients had no radiation preoperatively. Thirty-five percent of the irradiated patients had flap-related complications, compared to 47% of the nonirradiated patients (P = .52, not statistically significant [NSS]). There were no reoperations and no operative deaths in either group. There was 1 fistula in each group, both of which closed with conservative management. The PMMF for head and neck reconstruction is well tolerated following radiation therapy and has shown comparable morbidity in patients who have not undergone prior radiation.