粘膜管成形发音功能重建在晚期喉癌手术中的应用研究

 目的 用粘膜管成形法重建发音功能,应用于晚期喉癌手术中,术后达到良好的发音和吞咽效果,以提高喉癌患者的生存质量。方法 对失去部分喉切除机会的晚期喉癌患者用粘膜管成形法进行一期发音功能重建术,取得了较好的效果。共行手术31例,其中28例行近全喉切除,仅仅保留了残余披裂,摘除勺状软骨后,利用残余披裂粘膜和延续到气管的一条粘膜瓣缝合成一粘膜管而重建发音功能;3例行全喉切除,用其下咽粘膜缝合成一粘膜管与气管相延续。结果 29例患者均取得了良好的发音效果而无误咽。结论 粘膜管成形法重建发音功能可使晚期喉癌患者在喉切除后用自身材料一期重建发音功能而取得较理想的发音和吞咽功能。     

环状软骨-舌骨-会厌固定术治疗声门癌的3年随访观察

目的 回顾性研究喉环状软骨-舌骨-会厌固定术(CHEP)治疗声门癌围手术期并发症及3年生存率。方法 接受CHEP的14例声门癌,T1b 3例,T2 8例,T3 2例(含1例复发癌),T4 1例,总结其围手术期并发症,并用Kaplan-Meier法计算3年生存率。结果 术后14个月局部复发死亡1例,3年生存率为92.9%;2例发生咽漏或喉瘘(14.3%),2例长期带气管套管(14.3%)。结论 尽管多数是局部中晚期病例,但CHEP术后长期生存率高,是声门癌根治性切除及喉功能重建的理想选择,需要不断积累手术经验以减少并发症。     

全喉切除发音功能重建术20例

全喉切除术后，发音功能重建术主要有食管前壁制管接通气管法和气管食管间扣限法两种。1992年3月～1993年10月，我们采用食管前壁粘膜制作发音管接通气管法，手术20例。1临床资料1．1一般情况20例均为男性，年龄45～72岁，平均62岁。按UICC1978年临床分类标准，声门上型8例，声门型12例。TNM分期，T2N0M04例，T3N0M07例，T4N0M09例，喉部标本病理切片均为鳞状细胞癌，手术上下切缘无癌细胞浸润。20例中有2例误咽明显改做发育管封闭，其余18例音质、音量满意，恢复正常吞咽功能，随访至今20例均健在。1.2手术方法常规低位气管切开，插…     

垂直半喉切除术后双肌蒂瓣残喉修复术

目的探讨喉癌垂直半喉切除的术式和利用正常组织重建修复残喉,恢复喉功能的方法。方法对T1,T2声门型,会厌未侵及,无转移的53例喉癌行喉部分切除术,并用双肌蒂瓣进行残喉修复。结果 53例手术全部成功。51例14～25 d成功拔除气管套管,恢复自体喉呼吸,均能较清晰发音。2例未能拔管。无1例呛咳、误咽、咽漏等。结论 T1N0M0及部分T2N0M0病例,在垂直半喉切除术后,保留甲状软骨,利用患侧甲状软骨表面的胸骨舌骨肌形成双肌蒂瓣翻入喉内进行残喉修复,具有较好的实用价值和效果。     

喉切除保留会厌发音管重建术28例

晚期喉癌患者 ,传统手术方法行全喉切除术 ,虽然延长病人的生命 ,但术后不能说话 ,对生活、工作带来诸多不便 ,增加了病人精神负担 ,如何设法恢复喉功能 ,多年来 ,喉科医生作了不懈的努力 ,如人工喉、气管与咽腔吻合、气管食道造瘘等 ,方法很多。为了更好地解决发音与误咽这对矛盾。我科从 1 991年 2月～ 1 998年 2月对 2 8例晚期喉癌患者施行喉切除保留会厌发音管重建术 ,术后发音清晰 ,提高了患者生存质量 ,报告如下。1　临床资料2 8例中 ,男性 2 7例 ,女性 1例 ;年龄 44～ 71岁 ,平均年龄 5 8岁 ,病理检查 2 7例男性均为鳞状细胞癌 ,1例…     

保留喉功能下咽癌手术

随着医学的发展和科学技术的进步 ,各种修复材料在头颈外科的广泛应用 ,取得了满意的下咽癌保留喉功能手术的治疗效果。作者对 2 3例保留喉功能和 2 0例不保留喉功能的下咽癌手术患者进行了对比分析 ,现报道如下。1　材料与方法　　我科自 1 980年 1 2月～ 1 994年 5月共收治下咽癌 43例 ,其中 2 3例保留喉功能者为观察组 ,2 0例未保留喉功能者为对照组。全部病例病理证实为鳞癌。根据 1 987年ＵＩＣＣ下咽癌肿瘤分期标准对全部病例进行分期。本组病例进行了全部随访 ,大多数病例随访 5年以上。1 .1　喉功能保留组一般资料 :2 3例中男 2 1例…     

喉环上切除颈阔肌皮瓣喉重建术

目的：使中、晚期喉癌患者术后保留良好的发音功能。方法：自2000年做喉环上切除喉重建术6例，临床分期Ⅱ期2例，Ⅲ期3例，Ⅳ期1例。手术特点为保留环状软骨，以颈阔肌皮瓣修复喉腔。结果：全部病例术后发音良好，误咽不重，2例拔除套管经喉呼吸，随访至今无一例局部复发或淋巴结及远处转移。结论：该术式在恢复喉功能方面效果良好，值得推广。     

CT扫描在喉及下咽癌术后评价中的应用价值

目的探讨CT扫描在评价喉及下咽癌术后状况中的应用价值。材料与方法回顾性分析了45例（术后1～120月共作了69次CT扫描）经喉镜、活检或手术病理证实的喉及下咽癌术后正常和异常的CT表现。结果10例患者呈喉及下咽癌术后正常改变,8例水肿或瘢痕形成,2例术后滞溜囊肿。25例有术后肿瘤复发或/和转移,包括局部肿瘤复发18例、颈部淋巴结转移13例及远处转移2例。结论CT扫描能很好地显示喉及下咽癌术后的正常和异常改变,判断有无肿瘤复发及其侵犯范围,为临床治疗提供重要的帮助。     

喉癌和会厌癌切除功能重建30例手术体会

近年来,我们对功能性喉癌30例进行手术治疗,在保留和重建发音、呼吸和吞咽功能方面,疗效满意。1　临床资料1.1　一般情况　本组30例,男28例,女2例;年龄24～72岁。病理分类全部为鳞状上皮细胞癌。病变部位及术式:(1)对声门上型喉癌(T3)行次全喉切除,术中保留一侧的正常杓状软骨及其毗邻结构缝制成具有括约功能的发音管3例。(2)对会厌癌行喉水平切除,在舌根制作带蒂舌瓣重建会厌3例;利用会厌舌面根部残留的正常粘膜与舌会厌谷的粘膜缝合成门槛样皱襞重建会厌1例,用颈部双肌蒂岛状皮瓣重建会厌1例。(3)对喉癌行垂直半喉切除,保留部分甲状软骨…     

CT扫描在喉及下咽癌术后评价中的应用价值

目的 探讨CT扫描在评价喉及下咽癌术后状况中的应用价值。材料与方法 回顾性分析45例（术后1－120个月共作了69次CT扫描）经喉镜、活检或手术病理证实的喉及下咽癌术后正常和异常的CT表现。结果 10例患者呈喉及下咽癌术后正常改变,8例水肿或瘢痕形成,2例术后滞留囊肿。25例有术后肿瘤复发和／或转移,包括局部肿瘤复发18例、颈部淋巴结转移13例及远处转移2例。结论 CT扫描能很好地显示喉及下咽癌术后的正常和异常改变,判断有无肿瘤复发及其侵犯范围,为临床治疗提供重要的帮助。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.