喉结核-基层门诊不容忽视的问题

目的分析总结喉结核临床误诊原因,以期减少基层门诊误诊误治。方法回顾性分析近3年我科门诊接诊的基层医院或社区医院经抗炎消肿等久治不愈疑似喉部其它疾病的13例的患者的临床资料,并总结其临床特征。结果13例患者经门诊大夫详细询问病史、动态喉镜检查、局部组织病理切检确诊为喉结核并转往专科医院综合治疗。结论喉结核患病率逐年上升,临床特点较以往变化较大,诊断困难,需基层临床大夫提高警惕,深入掌握其临床症状的变化特点有助于提高其诊断准确率。     

近年喉结核的临床病理特征

目的探讨近年喉结核的临床病理特征。方法回顾性分析48例喉结核患者的临床病理资料。结果患者以男性多见,男女之比为2.2∶1,中位年龄46.5岁。患者均因喉部症状就诊,声嘶为最常见症状,肺部症状及全身症状少。发病部位以声带最常见(64.6%),其次是会厌(31.3%)和室带(25.0%)。肉眼病变以肥厚性或外生性为主,溃疡性病变多发生在会厌和杓区。组织学病变以增生为主型多见(87.5%),坏死为主型及混合型少见。多数标本含菌量较少,菌体多分布于肉芽肿的类上皮细胞及多核巨细胞的胞质内。结论近年喉结核临床表现多不典型,其感染途径可能已发生改变。临床医师对非特异性喉部病变进行诊断时应考虑到喉结核的可能性,显微镜下应注意该病与喉部其他肉芽肿性疾病的鉴别。     

Laryngeal tuberculosis revisited.

Although a rare entity, laryngeal tuberculosis must be a diagnostic consideration--along with laryngeal carcinoma--whenever patients present with prolonged hoarseness or painful dysphagia. This form of tuberculosis was once thought to be especially virulent and more infectious than other forms; however, severity was probably the result of the frequent association with advanced cavitary disease. Laryngeal tuberculosis usually responds well to multiple-drug antituberculous therapy.     

THE SIGNIFICANCE OF THE EPITHELIAL CELLS AND SAPROPHYTES IN SPUTUM

1. Microscopical examination of sputum that has been washed with isotonic salt solution indicates its source. Sputum from above the vocal cords contains polygonal flat epithelial cells and numerous species of non-pathogenic microorganisms. Sputum from below the cords is clear of saprophytes, although it sometimes contains bronchoalveolar cuboidal cells. 2. The source of the sputum can be determined by the erythrocytes and the bacilli that are contained in it, and the site of the lesion can also be ascertained. 3. In every instance I found erythrocytes in the pulmonary sputum after severe pulmonary hemorrhage. 4. Six of the cases of laryngeal affection referred to in the presentpaper had had no subjective symptoms, but microscopical examination showed tubercle bacilli in the laryngeal sputum. All the six cases were examined by Dr. Tanaka and were found to have tuberculous lesions in the larynx. In the laryngeal sputum of most cases of laryngeal tuberculosis with symptoms, tubercle bacilli have been frequently demonstrated, while in some cases contaminated laryngeal sputum was obtained only after a long series of examinations. 5. Microscopical examination of the sputum plays a significant part in the diagnosis of tuberculosis.     

36例喉结核临床诊治分析

目的探讨喉结核临床表现及误诊原因。方法回顾性分析36例经组织病理确诊喉结核患者的临床资料。结果声音嘶哑、喉痛为喉结核主要症状;喉镜显示病变主要累及声带、室带、环后区;病变形态以肉芽样或结节样增殖性病变为主。经系统抗结核治疗1a,33例治愈,2例失访,1例复发。结论喉结核全身及局部症状不典型,喉镜检查、痰涂片及结核菌素纯蛋白衍化物试验等有助于诊断,确诊依据组织病理检查,规范抗结核药物治疗效果良好。     

喉罩通气全麻下经气管镜冷冻治疗支气管结核56例的护理体会

本文报告了喉罩通气全麻下经气管镜冷冻治疗支气管结核的临床资料和护理操作配合。56例患者经过术前准备,采用静脉全身麻醉后,在喉罩通气下行气管镜下冷冻局部治疗。56例患者护理配合好,经过平均(4±3)次的气管镜下冷冻治疗,总有效率为100％,无严重的并发症,取得了较好的疗效。喉罩通气全麻下经气管镜冷冻治疗支气管结核的疗效好,而护理配合则是保证患者完成喉罩通气全麻和支气管下检查的重要保证。     

Sudden upper airway obstruction in patients with hereditary angioedema.

Hereditary angioedema (HAE) is clinically characterized by recurrent and self-limiting skin, intestinal, and life-threatening laryngeal edema. This study describes the age at which laryngeal edema first occurred, the time between onset and full development, and the effectiveness of therapy and prophylaxis in 123 HAE patients. 61 (49.7%) patients experienced a total of 596 laryngeal edema episodes. The ratio of laryngeal edema episodes to skin swellings and abdominal pain attacks was approximately 1:70:54 in patients who had laryngeal edema. The mean (SD) age at the first laryngeal edema was 26.2 (15.3) years. Nearly 80% of the laryngeal edemas occurred between age 11 and 45. The mean interval between onset and maximum development of laryngeal edema was 8.3 hours. A total of 354 laryngeal edemas cleared spontaneously without treatment and 208 laryngeal edemas were successfully treated with C1 inhibitor concentrate. Despite long-term prophylactic treatment with danazol, 6 patients developed subsequent laryngeal edemas. Laryngeal edema may occur at any age, although young adults are at greatest risk. In adults, the interval between onset of symptoms and acute risk of asphyxiation is usually long enough to allow for use of appropriate emergency procedures. It is essential to instruct patients and their relatives about the first signs of laryngeal edemas and the necessary procedures to follow.     

The roles of the laryngeal mask airway in emergency medicine

The laryngeal mask airway has a well established place in routine anaesthetic practice. Its potential role in emergency medicine is hampered by its failure to protect the airway from aspiration and to form a high pressure seal for controlled ventilation but supported by its ease of placement. This review discusses the uses of the laryngeal mask airway in the emergency situation. The laryngeal mask airway has a role as an alternative to the face mask in resuscitation. It has roles as an alternative airway when intubation has failed and as an aid to difficult intubation. In the prehospital setting, an additional specific indication for its use may be when access to a patient is limited making tracheal intubation impossible. Two recent modifications of the laryngeal mask airway are described. The intubating laryngeal mask airway is specifically designed for the difficult airway and the disposable laryngeal mask airway (Unique?) is undergoing trials in the UK for use by paramedical staff. The potential use of the intubating laryngeal mask airway in the emergency setting is discussed.     

Complications laryngées aiguës de l’intubation translaryngée : revue de la littérature

The frequency of laryngeal lesions after translaryngeal intubation differs in published studies. The pathophysiology of these lesions includes mucosal ischemia and other unclear factors. Post-extubation dyspnea uncommonly results from laryngeal edema; edema may result from lesions of laryngeal mucosa. Some physicians use corticosteroids to prevent this event. This preventive treatment has been evaluated in prospective studies conducted in both animals and humans. In adults without previous recent intubation or laryngeal disease, the prophylactic use of corticosteroids to prevent post-extubation laryngeal dyspnea is not warranted. In this review, the pathophysiology of acute laryngeal complications of translaryngeal intubation in adults, the preventive measures and the results of prospective studies assessing the use of corticosteroids are discussed.     

食管引流型喉罩的临床应用进展

食管引流型喉罩又称为双管喉罩,目前临床上广泛应用的食管引流型喉罩包括Proseal喉罩、在Proseal喉罩基础上进一步发展的Supreme喉罩、无套囊的I-gel喉罩和SLIPA喉罩。相比普通喉罩,食管引流型喉罩对通气罩进行了改进,并增加了对胃肠道起到密封和引流作用的引流管。作为第3代喉罩,其密闭性更强,可调整性更高,防误吸能力更好。随着食管引流型喉罩的有效性和安全性的大大提高,其临床应用在短期内迅速发展,并日益受到麻醉医生的青睐。      

电子喉镜在小儿喉部疾病诊断中的应用

[摘要] 目的 探讨电子喉镜在小儿喉部疾病诊断中的应用价值。 方法 采用Pentax VNL-1130 型电子喉镜对深圳市儿童医院2005年1月至2006年7月间1381例有喉部症状的患儿进行喉部检查。男926 例，女455例，年龄0～17岁，其中0～1岁164例，平均年龄4.8岁。结果 1381例患儿顺利接受检查并得出诊断，发现小儿常见喉部疾病为慢性喉炎（698例）、声带小结（384例）和声带息肉（143例），先天性喉喘鸣（63例）和急性喉炎（56例）是婴儿常见喉部疾病；此外还发现一些以往很容易误诊的罕见疾病，其中声带麻痹16例，先天性喉蹼4例，喉咽异物3例，喉乳头状瘤3例，会厌囊肿3例，喉裂3例，急性会厌炎2例，环杓关节炎1例，声门下狭窄1 例，喉损伤性肉芽肿1例。结论 慢性喉炎和声带小结/息肉是小儿常见的喉部疾病。电子喉镜是小儿喉部疾病诊断的一种新的有用的工具。     

喉外伤18例临床分析

目的:总结喉外伤的救治方法以提高其疗效。方法:回顾性分析2003年1月-2013年12月收治的喉外伤患者18例的临床资料。结果:15例开放性喉外伤均行颈部探查术,并行喉整复术及低位气管切开术;3例闭合性喉外伤中2例行气管切开术。17例接受气管切开的患者中16例成功拔管,1例术后拔管困难。结论:在喉外伤的综合救治中,应以抢救患者生命为原则,并尽可能保留、恢复喉功能和防止并发症。     

喉癌细胞线粒体去极化和凋亡研究

目的线粒体膜电位的缺失是线粒体凋亡途径的早期事件。我们用线粒体膜电位去极化剂(valinomycin)处理3个喉癌细胞系,研究它们的凋亡反应和细胞色素C释放的能力。方法 3个喉癌细胞系和对照细胞系HL-60经过valinomycin处理后,用细胞膜电位探针JC-1染色和凋亡特异性探针annexinV染色,用流式细胞仪分别测量它们的线粒体膜电位和凋亡率。Western印记用来检测细胞浆内的细胞色素C的释放。结果在经过24小时的处理后所有细胞均显示完全的线粒体去极化,只有对照细胞HL-60出现凋亡和细胞色素C释放,而喉癌细胞系没有出现。结论喉癌细胞系表现出线粒体膜电位去极化诱导的凋亡途径的缺陷,线粒体膜电位去极化而没有细胞色素C的释放。线粒体凋亡途径的缺陷是喉癌的一个特点。     

Video-assisted endoscopic laryngosurgery using a direct laryngoscope and a long rigid endoscope

Endolaryngeal microscopic laryngosurgery (microlaryngosurgery) using a direct laryngoscope is the preferred surgical method for treating laryngeal lesions under general anesthesia. However, this method does not provide a wide-angle view of the larynx and does not allow detailed observations of the ventricle and subglottis of the laryngeal cavity, resulting in blind areas. Video-assisted endoscopic laryngosurgery using a direct laryngoscope and a long transurethral rigid endoscope was therefore utilized to allow clear observations and complete resection of laryngeal lesions in these blind areas. This endoscopic surgical technique is introduced, and clinical cases are presented.     

Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review

Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor or respiratory difficulty or both. Ultimately, postextubation laryngeal edema may result in respiratory failure with subsequent reintubation. Risk factors for postextubation laryngeal edema include female gender, large tube size, and prolonged intubation. Although patients at low risk for postextubation respiratory insufficiency due to laryngeal edema can be identified by the cuff leak test or laryngeal ultrasound, no reliable test for the identification of high-risk patients is currently available. If applied in a timely manner, intravenous or nebulized corticosteroids can prevent postextubation laryngeal edema; however, the inability to identify high-risk patients prevents the targeted pretreatment of these patients. Therefore, the decision to start corticosteroids should be made on an individual basis and on the basis of the outcome of the cuff leak test and additional risk factors. The preferential treatment of postextubation laryngeal edema consists of intravenous or nebulized corticosteroids combined with nebulized epinephrine, although no data on the optimal treatment algorithm are available. In the presence of respiratory failure, reintubation should be performed without delay. Application of noninvasive ventilation or inhalation of a helium/oxygen mixture is not indicated since it does not improve outcome and increases the delay to intubation.     

Use of the laryngeal mask prior to definitive intubation in a difficult airway: A case report

The laryngeal mask, a relatively new airway adjunct, consists of a large tube with an inflatable shallow mask at its distal end which forms a seal around the glottic opening. We describe a case of a difficult intubation in the emergency department of an obese patient with microagnathia, a short bull neck, and a nasopharyngeal hemorrhage in which a laryngeal mask was used to temporarily manage the airway prior to definitive intubation. In difficult airway cases where it is impossible to ventilate the patient by face mask or intubate the trachea, ventilation with the laryngeal mask may be an alternative to transtracheal jet ventilation or cricothyrotomy. The laryngeal mask may be useful in managing the difficult airway provided that the risks of an inadequate seal, obstruction, coughing and laryngospasm, and lack of protection from aspiration are recognized.     

Accuracy of laryngeal examination during upper gastrointestinal endoscopy for premalignancy screening: prospective study in patients with and without reflux symptoms

BACKGROUND AND STUDY AIMS: Gastroesophageal reflux disease may be associated with laryngeal damage caused by reflux material. The aim of this study was to investigate the accuracy of laryngeal examinations during routine upper gastrointestinal endoscopy as a method of screening for major laryngeal injury in a series of patients with reflux symptoms. PATIENTS AND METHODS: A total of 100 consecutive patients with reflux symptoms and 100 control individuals underwent upper gastrointestinal endoscopy with standard or high-resolution magnifying video endoscopes. Any laryngeal abnormalities were initially identified by the gastroenterologist before the scope was inserted into the esophagus. All of the examinations were recorded on video and subsequently reevaluated by an otorhinolaryngologist. All of the patients underwent standard laryngoscopy as a reference procedure. RESULTS: All of the patients completed the study. The sensitivity, specificity, negative predictive value, and positive predictive value of the preliminary laryngeal exploration for detecting laryngeal abnormalities (such as laryngitis and vocal leukoplakia) were 90%, 90%, 92%, and 89%, respectively. High-resolution magnifying endoscopy had a higher sensitivity and specificity than standard endoscopy for detecting laryngeal pathology. Two patients were found to have laryngeal leukoplakia. CONCLUSIONS: This study shows that preliminary diagnosis of laryngeal disorders can be accurately carried out by the gastroenterologist when patients are undergoing upper endoscopy for reflux symptoms. This approach could also be helpful for the timely diagnosis of major reflux-related laryngeal disease.     

喉返神经变异及损伤的预防

目的了解喉返神经变异的情况,预防甲状腺手术中变异喉返神经的损伤。方法分析甲状腺手术中发现变异喉返神经的情况并复习有关文献。结果823例甲状腺手术中暴露725条喉返神经,喉返神经不返1例,喉返神经发出分支呈分叉状入喉1例,有1例神经沿着气管壁弧形爬行后入喉,变异率为0.41%。结论喉返神经变异少见,手术中容易损伤,了解其变异情况有助于甲状腺手术时预防变异喉返神经的损伤。     

MTLC基因在喉癌组织中的低表达及其对喉癌Hep2细胞凋亡的影响

目的研究MTLC（c-myc target from laryngeal cancer cells）基因在喉癌组织中的表达规律及其在喉癌发生中的作用。方法用反转录一聚合酶链反应法检测MTLC mRNA在喉癌组织及配对对照组织中的表达水平；用基因转染分析MTLC基因过表达对Hep2细胞生长的影响。结果36份喉癌组织中有28份（77．8％）MTLC mRNA表达下调；与转染空质粒的对照细胞相比，表达MTLC的细胞生长明显受到抑制，凋亡细胞比例明显增高（喉癌组织为118／300，对照细胞为25／300）。结论MTLC基因在喉癌组织中表达下调，其过表达可抑制喉癌Hep2细胞生长并促进凋亡，提示MTLC可能在喉癌发生、发展过程中起重要作用。     

喉癌SCT成像技术及其临床应用

目的:探讨SCT成像技术及其在喉癌临床应用价值。材料与方法:对53例喉癌进行了二维(2D)、多层面重建(MPR)和仿真内窥镜(CTVE)的研究,均与手术和纤维内窥镜对比。结果:2D,MPR,CTVE均能明显显示喉癌的病变大小、部位、形态,与纤维喉镜基本相一致。结论:SCT在喉癌诊断中具有重要价值。