腺淋巴瘤临床分析

腺淋巴瘤(adenolymphoma)也称为乳头状淋巴囊腺瘤(papillary cystadenomatosum或Warthin瘤).该病于1972年WHO涎腺肿瘤组织学分类中正式命名,是常见的涎腺良性肿瘤,绝大多数都发生在腮腺,极少数见于颌下腺.其发病率在腮腺肿瘤中仅次于腮腺混合瘤而居于第2位,约为14%～30%[1].该病以前主要收治于口腔颌面外科,随着耳鼻咽喉科治疗领域向耳鼻咽喉头颈外科发展,目前耳鼻咽喉科也逐渐开始腮腺疾病的治疗.本文收集了从2000年到2005年我院收治的48例腺淋巴瘤患者,并进行分析总结如下.     

夜夜鼾雷 一朝无声

42岁的孙先生，曾精力充沛，工作不知疲倦。可是，他当上乡镇领导没几年，就感觉白天工作打不起精神来，疲倦，看文件、开会和坐车没几分钟，就开始打盹了。老孙纳闷，每晚倒头就能睡，一觉七八个钟头，怎么还休息不过来呢？在妻子的催促下，老孙夫妻俩来到医院看病。     

阻塞性睡眠呼吸暂停低通气综合征手术的主观和客观疗效分析

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者主观和客观评价相关性,评价手术的主观和客观疗效.方法 41例OSAHS患者,根据阻塞部位采用单一或联合手术,术前和术后6个月分别做多道睡眠图(PSG)监测、OSAHS疾病特异性生活质量量表--魁北克睡眠问卷简体中文版和Epworth嗜睡量表评价.评价术前及术后改...     

魁北克睡眠问卷简体中文版的翻译及信度和效度评价

目的 翻译、修订形成魁北克睡眠问卷(Quebec sleep questionnaire,QSQ)简体中文版,并对其信度、效度进行评价.方法 引进特异性生活质量量表QSQ进行翻译及回译,修订为QSQ简体中文版,通过对141例[单纯鼾症22例,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)119例]患者的测量结果,分析量表的可行性、信度及效度;通过对55例[悬雍垂腭咽成形术(UPPP)治疗组35例,对照组20例]2个月后复诊患者对比研究,对量表反应度进行评价.结果 QSQ简体中文版可行性良好(回收率和调查完成率均为100%).量表各维度的内部一致性分析发现克朗巴赫α系数(Cronbach'sα)范围为0.65～0.90;各维度重测信度组内相关系数范围为0.82～0.91.呼吸暂停低通气指数(AHI)和最低血氧饱和度(LSaO2)不同程度组问比较,4个维度(白天嗜睡、白天症状、夜间症状、社会交往)差异均有统计学意义(P值均＜0.01或＜0.05).119例OSAHS患者的QSQ总分及全部5个维度分值均与Epworth嗜睡量表有相关性(P值均＜0.01),QSQ总分及3个维度(白天嗜睡、夜间症状、社会交往)分值与 AHI和LSaO2均有相关性(P值均＜0.05).UPPP治疗组术后与术前比较,QSQ的5个维度分值变化差异有统计学意义(P值均＜0.001),与对照组5个维度分值比较差异也有统计学意义(P值均＜0.01).结论 QSQ简体中文版有较好的信度、效度及反应度,可作为OSAHS特异性生活质量量表,用于评价疾病对OSAHS患者生活质量的影响及治疗效果.

Abstract：

Objective To develop a simplified Chinese version of the 32-item Quebec sleep questionnaire (QSQ) and to examine the reliability and validity.Methods A cross-sectional sample of 141 patients [22 simple snorers and 119 obstructive sleep apnea hypopnea syndrome (OSAHS)] and a longitudinal sample of 55 patients[35 in uvulopalatopharyngoplasty (UPPP) group and 20 in control group]completed the simplified Chinese version of QSQ for assessment of its feasibility,reliability,validity and responsiveness.Results QSQ had good feasibility.All internal consistency coefficients exceeded 0.65.Intraclass correlation coefficients of five domains for test-retest reliability ranged from 0.82 - 0.91.There were significant differences in four domains (daytime sleepiness,diurnal symptoms,nocturnal symptoms and social interactions) among patients with different severity of apnea hypopnea index (AHI) and lowest saturation of arterial oxygen (LSaO2,P ＜ 0.01 or ＜ 0.05＝.Correlations between QSQ scores and five domains and Epworth sleepiness scale (ESS) were statistically significant (P ＜0.01＝.Correlations between QSQ scores and three domains (daytime sleepiness,nocturnal symptoms and social interactions) and polysomnography (PSG) indices (AHI and LSaO2) were statistically significant (P ＜ 0.05＝.There were significant differences in scores of five domains of patients between at baseline and after UPPP.There were significant differences in change scores of five domains between patients who were treated and those who were not.Conclusion The simplified Chinese version of QSQ offers good reliability,validity and responsiveness and can be used as a OSAHS-specific instrument to assess impact of illness and treatment effectiveness in OSAHS patients.     

Epworth嗜睡量表简体中文版信度和效度评价

目的 探讨Epworth嗜睡量表(Epworth sleepiness scale,ESS)简体中文版的信度和效度.方法以585例疑似阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者及103例确诊并进行手术的OSAHS患者为研究对象,多道睡眠图(PSG)监测前填写ESS量表简体中文版,进行手术的患者术后6个月以上再次进行了PSG监测和填写ESS量表.从585例患者中选取2010年7至8月间的51例患者重新进行ESS量表评分(时间至少间隔1周).结果 ESS量表简体中文版总的Cronbach'α系数为0.814;ESS总分重测信度为0.679,表中各项条目信度为0.473～0.698(P<0.01);分半信度R=0.817(P<0.01).ESS量表效度分析中,区分效度用呼吸暂停低通气指数(AHI)指标来区分单纯鼾症和轻、中及重度OSAHS患者,单纯鼾症与不同病情程度的OSAHS患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).用最低血氧饱和度(LSaO2)指标来区分正常血氧饱和度、轻、中及重度低血氧饱和度患者,正常血氧饱和度与不同程度低氧血症患者ESS量表总评分及各个项目评分差异有统计学意义(P<0.05).因素分析中有4个公因子,累积贡献率达74.270%,每项条目负荷大于0.4;各因子分值与ESS量表总分进行相关分析发现除开车等红绿灯或遇堵车停几分钟时与其他各因子的相关性较低外,其他因子之间及ESS总分之间相关性均较高(P<0.01).量表评估与临床诊断的一致率较差(Kappa值为0.099,P<0.01),预测效度差(r=0.138,P<0.01).手术前后ESS总分由15.0[10;20]分降到4[1;6]分(M[P25;P75]),手术治疗有效、无效患者在手术前后ESS总分的差异均有统计学意义(Z=-7.528,P<0.01;Z=-4.382,P<0.01).结论 Epworth嗜睡量表简体中文版具有较好的信度和效度,可以作为白天嗜睡程度自我评估工具.

Abstract：

Objective To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). Methods Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. Results The total Cronbach's Alpha of ESS was 0. 814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698 ( P ＜ 0.01 ). Split-half reliability was 0.817 ( P ＜ 0.01 ). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients( P ＜ 0.05 ), and this was also true in different degrees of lowest saturation of arterial oxygen ( LSaO2 ) patients and normal LSaO2 patients(P＜0.05). The factor analysis of construct validity showed that 4 factors were extracted.The cumulative proportion was 74.270%. The loading was higher than 0. 4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item.The ESS had low consistency with clinical diagnosis(κ =0.099,P ＜0.01 ) and the predictive validity was not good (r =0.138, P ＜0.01 ). As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] ( M[P25 ;P75] ) ,and improved to 4[1 ;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation ( Z = - 7.528,P＜0.01) ,so was the patients who got ineffective results(Z= -4.382, P＜0.01) . Conclusions The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.     

阻塞性睡眠呼吸暂停低通气综合征舌后区手术

成人阻塞性睡眠呼吸暂停低通气综合征(obtructive sleep apnea hypopnea syndrome,OSAHS)多平面外科面临挑战之一是舌后区手术。文献中也称为喉咽部气道手术(hypopharyngeal airway surgery)。舌根松弛后坠、舌体和/或舌根肥厚、咽侧壁塌陷、会厌软化黏膜松弛、颌骨弓较窄或发育不完善等复杂的阻塞因素,使其手术种类远多于腭后区。     

趋化因子受体CXCR4与口腔鳞癌微血管密度及临床病理的关系

目的:探讨趋化因子受体CXCR4与肿瘤微血管密度(MVD)及临床病理之间的关系.方法:通过流式细胞仪、免疫组化检测CXCR4在口腔鳞癌组织中的表达,计数CD34标记的肿瘤内微血管密度,分析CXCR4、MVD与口腔鳞癌大小、病理分级和淋巴结转移关系.结果:57 例口腔鳞癌中,CXCR4阳性反应为32 例,总体阳性率为56.1%,与肿瘤的大小、病理分级、淋巴结转移密切相关.CD34标记的肿瘤微血管在癌巢周缘的肿瘤间质中分布密集,而在远离癌巢的间质中呈散在分布.MVD均值为22.386±8.974. MVD与口腔鳞癌大小、病理分级和淋巴结转移密切相关.Spearman秩相关分析表明,口腔鳞癌中CXCR4的表达与MVD表达呈显著正相关(rs=0.334, P<0.05).结论: CXCR4可能直接或间接参与肿瘤血管新生,进而促进口腔鳞癌的转移.