儿童腺样体肥大3种切除方式疗效分析

目的：比较传统经口腔腺样体刮除术、鼻内镜下经鼻腔腺样体切除术及鼻内镜下经口鼻腔双径路腺样体切除术的疗效。方法：回顾性分析202例接受腺样体肥大手术患儿的临床资料,比较3种术式术后患儿夜间打鼾、鼻塞、鼻漏及听力等症状的恢复和腺样体残留等情况。结果：传统经口腔腺样体刮除术后6例患儿存在腺样体残留,其他2种术式术后无腺样体残留。鼻内镜下经口鼻腔双径路腺样体切除术后患儿打鼾、鼻塞症状改善明显。结论：腺样体肥大的理想手术方法为鼻内镜下经口鼻腔双径路腺样体切除术。     

鼻内镜辅助腺样体切除术与常规腺样体刮除术的疗效比较

目的 比较鼻内镜辅助经口腺样体切除术与常规腺样体刮除术的疗效.方法 腺样体肥大患儿36例,其中19例接受鼻内镜辅助经口腺样体切除术,17例施行常规腺样体刮除术,比较两种术式的疗效.结果 常规腺样体刮除术治疗组中5例存在腺样体残留,鼻内镜辅助经口腺样体切除术组无1例有腺样体残留.结论 鼻内镜辅助经口腺样体切除术式是治疗腺样体肥大的最佳手术方法.     

鼻内镜下腺样体吸切术对咽鼓管周围组织的处理

目的总结鼻内镜下腺样体吸切术在处理咽鼓管咽口周围结构的临床经验。方法回顾分析26例腺样体肥大伴分泌性中耳炎的临床疗效。着重探讨对咽鼓管扁桃体和咽鼓管圆枕后方肥大淋巴组织的处理方法。结果鼻内镜下腺样体吸切术术后治愈率和好转率较常规腺样体刮除术高(P<0.05)。结论鼻内镜直视下用弯头外侧开口吸切头经口腔入路切除腺样体对于清除咽鼓管周围淋巴组织具有明显优势,对于改善咽鼓管通气功能甚为重要,而且降低了咽鼓管咽口损伤的可能。     

间接喉镜下刮除术和鼻内镜下切吸术治疗腺样体肥大的手术效果比较

目的比较间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术治疗腺样体肥大的效果。方法118例患者分为A组(64例)和B组(54例),全身麻醉,用导尿管悬吊软腭,分别行间接喉镜下腺样体刮除术或鼻内镜直视下腺样体切吸术。结果所有患者术后打鼾症状明显改善,显效率分别为A组93.8%(60/64),B组94.4%(51/54);78例伴有渗出性中耳炎或复发性中耳炎,术后A、B组平均听阈提高分别为16±4.2dB和15±5.8dB;伴有鼻窦炎的患者,术后症状改善率分别为A组78.3%(18/23),B组88.9%(24/27)。术中平均出血量分别为A组20m1,B组25m1;平均手术时间分别为A组9分钟,B组7分钟。所有患者均无术后并发症发生。A组的手术费用明显低于B组。结论间接喉镜下腺样体刮除术和鼻内镜直视下腺样体切吸术均为安全、有效术式,但间接喉镜下腺样体刮除术简单易行、经济实惠。     

腺样体与咽鼓管圆枕的毗邻关系及其与分泌性中耳炎的相关性

目的　观察腺样体肥大儿童的腺样体与咽鼓管圆枕的毗邻关系,探讨其与分泌性中耳炎的相关性。方法 144例腺样体肥大（或同时扁桃体肥大）70°鼻内镜下行等离子消融术患儿,术中观察并记录腺样体与咽鼓管圆枕的毗邻关系,并将其分为Ⅰ、Ⅱ、Ⅲ共3型;比较3组患儿分泌性中耳炎发病率、腺样体重度肥大（A/N比值是否大于0.7） 的发生率并计算有无统计学差异。结果　本组患儿分泌性中耳炎发病率23.6%;腺样体与咽鼓管圆枕的毗邻关系及合并分泌性中耳炎,Ⅰ型3例（9.1%,3/33）、Ⅱ型10例（16.9%,10/59）、Ⅲ型21例（40.4%,21/52）,Ⅰ型与Ⅱ型分泌性中耳炎发生率无显著性差异（χ 2=1.077,P =0.299）,Ⅰ型与Ⅲ型有显著性差异（χ 2=9.757,P =0.002）,Ⅱ型与Ⅲ型有显著性差异（χ 2 =7.542,P =0.006）;Ⅰ型和Ⅱ型组腺样体A/N＞0.7之和为34.9%,三型组A/N＞0.7为82.2%,Ⅰ型及Ⅱ型腺样体重度肥大率之和与Ⅲ型有显著性差异（χ 2=30.556,P =0.000）。结论　腺样体与咽鼓管圆枕毗邻关系及腺样体的肥大程度与分泌性中耳炎有显著相关性。     

自制电凝吸引器在腺样体手术中的应用

腺样体肥大是一种常见病和多发病,手术方法趋向于全麻,在鼻内镜直视下用吸割器或低温等离子手术,术后效果很好,但在基层医院由于吸割器、低温等离子器械昂贵尚未普及,手术是在鼻内镜下刮匙刮除。由于器械缺陷,后鼻孔及圆枕后方腺体极易残留,可能导致术后症状改善不佳或术后出血难以止血。根据我科在实际工作中遇到的情况和现有的医疗条件,在上级老师的帮助下,自制电凝吸引器应用于腺样体手术中,并且很好的解决了腺样体残留和术中术后出血的情况。     

儿童腺样体刮除术后复发原因及治疗

腺样体肥大过去多采用经口腺样体刮除术,易残留致复发。我科自1997～2001年收治术后复发需再次手术患儿15例,在鼻内镜下用切割钻切除腺样体,效果满意,报告如下。     

儿童腺样体肥大不同术式体会

我科自2004年4月-2007年5月收治腺样体肥大患儿120例，分别采用腺样体刮除术、鼻内镜下腺样体微波消融术、鼻内镜下腺样体切割术、耳内镜下经口腺样体切除术各30例。比较4组患儿临床资料如下。     

鼻内镜下两种手术径路治疗儿童腺样体肥大的疗效比较

目的比较鼻内镜下经口和经鼻两种手术径路在儿童腺样体肥大切除术中的疗效。方法将80例腺样体肥大患儿随机分为经口组和经鼻组各40例,对两组患儿打鼾、鼻塞、耳闭等症状改善情况、术后并发症及随访6个月复发情况进行回顾性比较分析。结果两组患儿症状均全部消失或得到显著改善,经口组术后腺样体切割干净,无腺样体残留,仅2例术后出现轻微软腭损伤,随访无复发;经鼻组术后出现不同程度的软腭损伤、圆枕损伤、咽鼓管损伤、继发出血、腺样体残留或鼻腔粘连,2例再次手术。结论鼻内镜下经口腺样体切除术术后并发症少、复发率低、疗效可靠,优于经鼻腺样体切除术。     

儿童局麻鼻内镜下腺样体刮除手术效果

目的 探讨局麻鼻内镜下腺样体刮除术的可行性和安全性.方法 486例患儿在局麻鼻内镜下行腺样体刮除术.采用1％的卡因鼻腔、鼻咽、口咽表面麻醉,鼻腔内填塞的卡因肾上腺素棉片表面麻醉.鼻内窥镜经鼻腔进入,腺样体刮匙经口腔进入,监视器直视下刮匙到达腺样体上部,自上向下后一次刮除.观察有否残留、出血、周边损伤,术毕.结果 ①手术...     

分泌性中耳炎和慢性鼻-鼻窦炎患儿咽鼓管咽口形态及功能的观察与分析

目的：观察分泌性中耳炎及慢性鼻-鼻窦炎患儿咽鼓管咽口及其周围形态的改变并检测其功能,为临床治疗提供客观依据。方法：将150例患儿分为分泌性中耳炎组（50例）、慢性鼻-鼻窦炎组（50例）及对照组（50例,无分泌性中耳炎及慢性鼻-鼻窦炎的声嘶患儿）,在电子鼻咽喉镜直视下观察各组咽鼓管咽口及其周围形态的改变,用声导纳仪检测各组患儿的咽鼓管功能状态,并进行统计学分析。结果：①分泌性中耳炎组咽鼓管咽口的形态学改变高达94%,慢性鼻-鼻窦炎组则为80%,2组差异无统计学意义（P〉0.05）,但与对照组比较均差异有统计学意义（均P〈0.05）。②分泌性中耳炎组70%存在咽鼓管功能障碍,慢性鼻-鼻窦炎组26%存在咽鼓管功能障碍,2组比较差异有统计学意义（P〈0.05）,且2组与对照组（2%）比较均差异有统计学意义（均P〈0.05）。结论：分泌性中耳炎及慢性鼻-鼻窦炎患儿存在咽鼓管功能障碍、咽鼓管咽口及其周围形态的改变;咽鼓管功能障碍在分泌性中耳炎的发病中占主导作用,与慢性鼻-鼻窦炎比较,咽鼓管功能障碍较咽鼓管咽口的形态改变更有差异性。     

咽鼓管咽口形态改变与分泌性中耳炎相关性研究

目的：研究成人咽鼓管咽口形态改变与分泌性中耳炎(SOM)之间的相关性。方法：对77例(115耳)正常人(对照组)和68例(97耳)SOM患者(SOM组)用鼻内镜观察其咽鼓管咽口的形态，将其分为三角形、缝隙形、椭圆形、喇叭形等4种类型并行统计学分析。结果：对照组三角形84侧，缝隙形4侧，喇叭形17侧，椭圆形10侧；SOM组三角形13侧，缝隙形68侧，椭圆形5侧，喇叭形11侧，两组咽鼓管咽口形态存在显著的差异。结论：咽鼓管咽口形态改变在SOM的发生、发展中有着不可忽视的相关性，为探索成人SOM的治疗提供了一个新的思路。     

腺样体铲除术对咽鼓管功能影响的研究

目的:观察鼻内镜下经口腔腺样体铲除术与传统腺样体铲除术对腺样体肥大患者咽鼓管功能的影响。方法:选取诊断为腺样体肥大且不伴中耳炎的住院患者为研究对象,分别采用鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术,在治疗前及治疗3个月后分别检测咽鼓管功能。结果:2组患者治疗前咽鼓管功能检查无统计学差异,治疗后与术前相比,2组均有统计学差异;治疗后2组之间差异也有统计学意义。结论:鼻内镜下经口腔腺样体铲除术和传统腺样体铲除术均可改善腺样体肥大患者的咽鼓管功能,且鼻内镜下经口腔腺样体铲除术对咽鼓管功能的改善优于传统腺样体铲除术。     

咽鼓管咽口及其周围形态学改变与分泌性中耳炎的相关性研究

目的:研究咽鼓管咽口及其周围形态学改变与分泌性中耳炎(SOM)的相关性。方法:72例(144耳)正常人为对照组,89例(151耳)SOM患者为SOM组。用纤维鼻咽镜观察对照组和SOM组咽鼓管咽口的形态及SOM组咽鼓管咽口周围形态改变。结果:①对照组和SOM组成人咽鼓管咽口形态中三角形及缝隙形的差异有统计学意义(均P<0.01);②对照组和SOM组儿童咽鼓管咽口形态差异无统计学意义;③成人SOM咽鼓管咽口周围形态改变与儿童不同。结论:①成人咽鼓管咽口形态改变在SOM的发生、发展中有着不可忽视的相关性,为探索成人SOM的治疗提供了一个新的思路。②在SOM组儿童中发现所有患儿咽鼓管咽口周围主要是鼻咽部炎症,次之是腺样体肥大和咽鼓管扁桃体肥大。③本研究采用纤维鼻咽镜直接观察咽鼓管咽口及鼻咽侧壁,对于明确SOM的病因和选择治疗方案具有重要意义。     

Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management

OBJECTIVE: A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification. METHODS: Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry. RESULTS: In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions). CONCLUSIONS: In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).     

Flexible endoscopy and radiologic evaluation of the eustachian tube in adults with eustachian tube dysfunction

This study was conducted on 20 adult patients presenting with eustachian tube dysfunction of about 6 months' duration. It included endoscopy of the pharyngeal end of the eustachian tube and contrast radiologic study. Both methods are now available because of technical progress and practical improvements. By these methods, physiologic movements of the soft palate, tubal torus, and tubal orifice can be observed and studied and anatomic variations and pathologic abnormalities can be detected. This study shows that eustachian tube dysfunction may be caused by salpingitis (acute or chronic) or adenoid or nasopharyngeal carcinoma. Scleroma affecting the lumen of the eustachian tube was reported in one case.     

Eustachian tube endoscopy in patients with chronic ear disease

OBJECTIVES/HYPOTHESIS: A paucity of research exists on trans-eustachian tube endoscopy to evaluate the status of the eustachian tube. Fuller examination of the role of the eustachian tube in chronic ear disease is needed, particularly because the eustachian tube has been implicated in the chronicity and pathogenesis of chronic ear disease. Therefore the purpose of this study was to evaluate the eustachian tube, based on observations from trans-eustachian tube endoscopy. STUDY DESIGN: Twenty-two adult patients with chronic ear disease gave informed consent to participate in a prospective, trans-eustachian tube endoscopic investigation. METHODS: Flexible, fiberoptic, nonarticulating (outside diameter of 0.5 mm) and articulating (outside diameter of 1.0 mm) endoscopes (coherent fused bundle of 3,000 pixels) were employed. The eustachian tube endoscopy was performed under general endotracheal anesthesia as the initial part of a larger, otological surgical procedure for chronic ear disease. The endoscope was passed from the middle ear (transtympanic approach) to the nasopharynx. RESULTS: The 0.5-mm endoscope passed entirely through the eustachian tube from the tympanic orifice into the pharyngeal orifice in 16% of the cases. Stenotic blockage occurred at the infundibulum in 37%, isthmus in 42%, and fossa of Rosenmuller in 5% of cases. The eustachian tube mucosa was abnormal in 64% of cases. The risk for abnormal eustachian tube mucosa was four times greater for persons with long-standing disease (> or = 20 y) than for persons without long-standing disease (<20 y). The mean therapeutic efficiency of ossicular reconstruction was higher for the subgroup with normal than for the subgroup with abnormal eustachian tube mucosa. CONCLUSIONS: The findings of trans-eustachian tube endoscopy provide objective evidence concerning eustachian tube status in persons with chronic ear disease and have implications for the timing of surgical intervention (ossicular reconstruction).     

儿童阻塞性睡眠呼吸暂停低通气综合征的手术治疗

目的：探讨手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征的临床特征及疗效分析。方法：经多导睡眠监测确诊的OSAHS儿童32例,采用全麻下扁桃体切除和经口内窥镜下腺样体切除术治疗,并随访观察手术疗效,分析扁桃体、腺样体肥大与睡眠呼吸低通气指数（AHI）的相关性,进行手术前后的睡眠监测有关参数的比较。结果：腺样体厚度与鼻咽通气道的比值(AN值) 和扁桃体厚度与咽腔宽度的比值 (TP值)与AHI成正相关;所有手术的患儿围手术期没有出现急性呼吸道阻塞及术后出血、感染的情况,随访12～24个月,睡眠打鼾、张口呼吸等症状得到明显改善,没有鼻咽粘连、腺样体残留、咽鼓管功能障碍等并发症;手术后睡眠呼吸暂停及低通气指数、最低血氧饱和度和最长呼吸暂停低通气时间均比手术前有显著好转。结论：扁桃体与腺样体肥大是儿童OSAHS的主要原因,切除肥大的扁桃体和（或）腺样体是治疗儿童OSAHS的有效办法,经口内窥镜下腺样体切除术,具有直视、彻底和避免损伤周围附近重要结构的优点。     

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy

OBJECTIVES: To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. DESIGN: Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. SETTING: Tertiary referral center. PATIENTS: One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. MAIN OUTCOME MEASURES: The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. RESULTS: Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. CONCLUSION: The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.     

儿童鼻窦炎对咽鼓管与中耳传音功能的影响

目的：探讨儿童鼻窦炎对咽鼓管与中耳传音功能的影响及程度,观察治疗鼻窦炎后,中耳传音功能障碍的恢复情况。方法：对儿童鼻窦炎100例和正常儿童50例行耳科检查、咽鼓管咽口观察、声阻抗检查、纯音测听,对比结果;对鼻窦炎合并耳病变的68例患者（128耳）行有针对性的治疗。结果：鼻窦炎患者中鼓膜异常率为64%、咽鼓管咽口异常率为62%、咽鼓管功能异常率为63.5%、鼓室导抗图异常率为62.5%,听力减退47.5%,与正常儿童组相比,差异有统计学意义（P＜0.01）。急性鼻窦炎、亚急性鼻窦炎与慢性鼻窦炎中耳病变的发生率和程度相比,差异有统计学意义（P＜0.05）。治疗鼻窦炎后,中耳传音功能障碍有明显改善。结论：儿童鼻窦炎引起咽鼓管功能的改变,中耳病变发生率较正常儿童显著增高;随病程的延长,发病率增高且程度加重。