健康和病变人声带振动特性声门图

本文用多功能声门图仪测定了健康受试者(男46名,女34名)和不同喉病患者(男134名,女87名)声门图的波形及其特征参数。根据测出的正常声门图及其参数分布研究了恶性喉病变、声带麻痹、喉内关节病变、功能性声门发声障碍、声带息肉、声带小结、喉炎和早期喉病的临床声门图表现及其与声带振动模式变异之间的关系,并探讨了上述病变声门图的鉴别诊断指标和用声门图对喉病手术治疗、药物治疗和功能治疗的疗效进行定性和定量评价。研究结果证实:声门图方法能准确、定量、灵敏地反映声带振动模式及其变异;在喉病诊治中具有重要的应用价值。     

人乳头瘤病毒与呼吸道肿瘤关系的研究：Ⅰ.HPV与喉癌的关系

应用α－３２Ｐ－ｄＣＴＰ标记ＨＰＶ－１１及ＨＰＶ－１６ＤＮＡ为探针，以Ｓｌｏｔｂｌｏｔ及Ｓｏｕｔｈｅｒｎｂｌｏｔ两种核酸杂交技术，检测了取自青岛及北京两个地区的３７例喉鳞癌组织ＤＮＡ中ＨＰＶ－１１及ＨＰＶ－１６ＤＮＡ相关序列。结果表明，Ｓｌｏｔｂｌｏｔ杂交中，与ＨＰＶ－１１探针杂交阳性者占８６％（３２／３７），与ＨＰＶ－１６探针杂交阳性者占８１％（３０／３７）。在同一癌组织中，与两型探针同时呈现阳性者占８１％（３０／３７）。Ｓｏｕｔｈｅｒｎｂｌｏｔ杂交中，与所用探针ＤＮＡ的内切酶ＰｓｔⅠ酶切图谱比较，有４６％（１３／２８）与ＨＰＶ－１６ＤＮＡ的酶切图谱相同，可定为ＨＰＶ－１６型。当用ＨＰＶ－１１探针时无一例出现与ＨＰＶ－１１相同的图谱。提示喉癌的发生与ＨＰＶ－１６有关。     

Removal of laryngeal mask airway: airway complications in children,anaesthetized versus awake*

The laryngeal mask airway (LMA) must be inserted during deep anaesthesia. There are no guidelines concerning the removal of LMA, i.e., in awake or anaesthetized patients. The aim of this randomized prospective study was to compare the incidence of respiratory complications after LMA removal in anaesthetized or awake paediatric patients. Sixty children (ASA PS I or II), ranging from 4 months to 12 years of age, were studied. In patients breathing spontaneously, anaesthesia was induced and maintained with nitrous oxide, oxygen and halothane. Patients were randomly divided into two groups: group 1 removal of LMA in awake patients, or group 2 removal of LMA in anaesthetized patients, i.e., in patients receiving halothane at an alveolar concentration of 2 MAC adjusted for age and oxygen for 5 min. In both groups, patients received 100% oxygen after removal of LMA. After removal the incidence of respiratory complications was highest (P < 0.05) in group 1. Therefore, in healthy children undergoing elective surgery, the authors conclude that it is safer to perform the LMA removal in anaesthetized patients.     

Anaesthesia for Cockayne's syndrome. Contemporary solutions to an old problem

The management of a failed intubation in a nineteen-year-old patient suffering from Cockayne's syndrome is described. Use of a laryngeal mask prevented major anaesthetic morbidity. Tracheal intubation was subsequently facilitated by a fibreoptic bronchoscope passed through the laryngeal mask. Cockayne's syndrome is reviewed including recent important developments in its aetiology and pathogenesis.;     

聚合酶链反应检测尖锐湿疣皮损内人乳头瘤病毒

１３个皮损组织取自１３例尖锐湿疣（ＣＡ）患者，１３例基底细胞上皮瘤（ＢＣＣ）组织作为对照，用溴化钠液分离表真皮，从组织中提出的 ＤＮＡ和溴化钠液分别用聚合酶链反应检测 ＨＰＶ ＤＮＡ。１１例ＣＡ表皮中检出 ＨＰＶ ＤＮＡ，ＨＰＶ６有７例，ＨＰＶ１１有４例。３例ＣＡ真皮中发现有ＨＰＶ ＤＮＡ，ＨＰＶ６有２例，ＨＰＶ１１有１例。２例标本因溴化钠液被ＨＰＶ污染未作统计。在ＢＣＣ组织中未发现有ＨＰＶ ＤＮＡ。在某些ＣＡ真皮内含有 ＨＰＶ ＤＮＡ可以解释散发病例的复发性。     

Quality of life and voice following endoscopic resection or radiotherapy for early glottic cancer

Objectives: To assess whether proposed voice and quality of life (QoL) outcome measures were likely to be acceptable to patients previously treated for early glottic cancer by either radiotherapy or endoscopic resection, as well as looking for differences in QoL and voice between treatments. Design: Questionnaire‐based cohort study. Setting: Secondary care, three centres. Participants: All patients treated for T1a or in situ glottic carcinoma between 1997 and 2003. Fifty‐three patients were identified; those who had undergone salvage surgery or radiotherapy were excluded. A proportion refused to participate or could not be contacted and two patients had died of unrelated causes. Thirty‐six patients completed the trial with 18 from each treatment arm. Main outcome measures: Quality of voice as assessed by three questionnaires, Voice Handicap Index (VHI), Vocal Performance Questionnaire (VPQ), Voice Symptom Score (VoiSS) and perceptual analysis of voice by Grade, Roughness, Breathiness, Asthenia and Strained (GRBAS) assessment of vocal recordings. Quality of life as assessed by the Hospital Anxiety and Depression Scale (HADS), University of Washington Quality of Life Questionnaire (UW‐QoL), and the Functional Assessment of Cancer Therapy (FACT) questionnaire. Results: All patients included in the trial were able to complete the questionnaires; however, 19% required assistance of some kind. GRBAS assessment showed no difference between groups for any criteria. All QoL questionnaires gave equivalent good scores. All of the voice questionnaires showed no statistical difference between groups except for the emotional subscale of the VoiSS which showed a significantly better score for the radiotherapy arm (P = 0.04). Conclusion: All outcome measures were applicable and acceptable to the patient group. Overall QoL and voice appears similar despite treatment arm, apart from the emotional subscale of the VoiSS. A randomized controlled trial is required to further assess this question.     

替代神经吻合法治疗喉返神经麻痹的解剖学研究

通过对30例人喉神经、膈神经、颈袢的解剖观测及利用图象分析仪二维重建技术对相关神经的截面积、纤维数量的测量比较分析,结合有关实验研究资料,设计了在甲状软膏板后下方开窗,于甲杓肌神经起点处切断该神经,用颈袢主支与甲杓肌神经吻合,用膈神经与喉下神经吻合,同时重建声带的内收和外展功能,并探讨了其解剖和生理学基础,认为此手术方法治疗喉返神经麻痹比较理想和可行。     

Recommendations for the reporting of larynx specimens containing laryngeal neoplasms

The Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the surgical pathology reporting of common malignant tumors. The recommendations for carcinoma of the larynx are reported herein.     

The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation

The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.