Particularidades del abordaje transcanal endoscópico de los tumores benignos de oído medio en adultos

Background and objectiveMinimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarize its key points through a case series.Materials and methodsRetrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry.ResultsSix patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (± 21.9). Four tumours were in the left ear and 2 in the right ear. These included 4 tympanic paragangliomas (3 type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months.ConclusionsThe present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.     

范金茹教授治疗颈性眩晕经验举隅

范金茹教授为首批全国优秀中医临床人才,在诊治眩晕类疾病方面积累了丰富经验。颈性眩晕多表现为眩晕、头颈部疼痛、恶心、呕吐、耳鸣等,严重影响了人们的生活质量。范师认为颈性眩晕为本虚标实之证,病位在头颈,肝肾亏虚为本,病性因素多为痰瘀。强调分急性期、缓解期治疗,注重气之升降--引痰饮血瘀下行而出,津气上行以荣脑。自拟颈痹眩晕方,为升降散合泽泻汤加减而成,组方精当,临床运用每获良效。     

半夏白术天麻汤治疗眩晕高血压病举隅

高血压病是我国发病率较高的疾病之一,西医治疗以长期服用降压药物为主要治疗方式,但常因依从性差的原因导致血压控制不佳,而用中医辨证治疗对于首次发现高血压的患者,可明显有效地降低高血压的发病率。高血压病在中医学中属"眩晕",在临床中常常会用半夏白术天麻汤来治疗眩晕,本文通过跟师医案及临床收集介绍半夏白术天麻汤治疗高血压眩晕临证方药的运用。     

温阳通脉方联合抗抑郁药及认知行为干预对恐惧性姿势性眩晕患者的临床研究

目的:探讨温阳通脉方联合抗抑郁药及认知行为干预治疗恐惧性姿势性眩晕(PPV)的临床疗效。方法:选取2015年6月至2017年6月新乡医学院第一附属医院收治的PPV患者78例作为研究对象,随机分为对照组和观察组,每组39例,对照组采用抗抑郁药及认知行为干预治疗,观察组在对照组基础上给予温阳通脉汤加减治疗,连续治疗4周,随访6个月。治疗前后采用国际眩晕评分量表(DHI)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定患者的临床症状及心理状态改善情况,检测并比较2组治疗前后凝血功能指标变化,统计2组临床疗效及随访期间复发情况。结果:治疗后,观察组临床总有效率89. 74%,明显高于对照组的69. 23%(P 0. 05)。治疗后2组躯体症状评分、心理因子评分、社会功能评分、DHI总分、HAMD评分及HAMA评分均较治疗前明显下降(P 0. 01),且观察组各项评分均低于对照组(P 0. 05或P 0. 01)。治疗后对照组各项凝血功能指标无明显变化(P 0. 05),观察组PT、APTT明显延长,且长于对照组,FIB及D-D水平明显降低,且低于对照组(P 0. 01)。随访期间,观察组、对照组复发率分别为12. 82%、17. 95%,2组间复发率差异无统计学意义(P 0. 05)结论:PPV患者在抗抑郁药及认知行为干预的基础上应用温阳通脉方治疗效果显著,不仅有效降低患者各种负面情绪,同时改善了血液高凝状态及眩晕症状,具有一定的临床推广价值。     

针刀松解寰枕筋膜治疗颈源性眩晕的疗效研究

目的:研究针刀松解寰枕筋膜治疗颈源性眩晕的疗效。方法:选取2017年1月至2018年1月佛山市健翔医院收治的颈源性眩晕患者96例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组48例。对照组患者给予3次/周针灸、局部按摩治疗,观察组患者给予1次/周的针刀松解寰枕筋膜治疗,均治疗3周。依照《颈性眩晕评估量表(ESCV)》分析2组患者治疗前后颈性眩晕评分变化、椎动脉血流动力学变化,比较2组患者血清中内皮源性超极化因子(EDHF)的含量和一氧化氮(NO)水平,统计2组患者的治疗有效率、眩晕症状缓解时间及生命质量变化。结果:观察组患者治疗后总有效率为97.92%高于对照组的81.25%(P<0.05),眩晕有效缓解时间明显缩短,眩晕评分显著高于对照组(P<0.05);观察组患者治疗后椎动脉的平均血流、收缩期血流、舒张期血流速度、血清中NO及EDHF水平明显上升,血管搏动指数显著下降(P<0.05);生命质量评分显著升高(P<0.05)。结论:针刀松解寰枕筋膜能够通过改善颈源性眩晕患者的椎动脉血流动力学,有效治疗患者的颈源性眩晕。