伴自身免疫性疾病突发性聋患者的临床特征及预后

目的 分析突发性聋(突聋)合并自身免疫性疾病患者的临床特点及预后.方法 以2014年1月至2019年5月诊治的511例(511耳)突聋患者为研究对象,其中,合并自身免疫性疾病(autoimmune disease,AID)(AID组)56例,不合并AID(非AID组)455例,比较两组患者的临床特征及预后;同时,将AI...     

以溃疡为主要表现的咽喉部病变临床诊治分析

目的 回顾分析10例以咽喉溃疡病变为主要表现患者的病历资料,为临床医师诊疗该类疾病提供参考。方法 对纳入的病例从临床表现、病变部位、溃疡特点、诊疗经过、病理诊断、预后情况进行分析,结合典型病例及文献复习阐述该类疾病的临床特点。结果 最后确诊喉结核6例(声门上区1例,声门区4例,声门下区1例),溃疡性咽喉炎2例、淋巴瘤1例、下咽癌1例。所有患者根据最后诊断接受相应治疗。结论 对咽喉部溃疡性病变,首先需明确诊断,除单纯溃疡外,应考虑到特异性感染、恶性肿瘤等疾病可能,明确诊断后才能精准施治,得到确切疗效。     

儿童咽喉反流性疾病研究进展

咽喉反流性疾病（1aryngopharyngeal reflux disease,LPRD）是指胃内容物反流至食管上括约肌以上部位,流至咽喉部,与呼吸道和消化道上部组织接触,引起一系列症状和体征的总称。据国外研究表明到耳鼻咽喉科就诊的门诊患者约10%患有LPRD。虽然最近几年,耳鼻咽喉科医师逐渐在重视LPRD的诊疗,但LPRD目前仍是一个不明确的疾病,我们对其真实的发病率及重要性知之甚少,尤其在儿童中LPRD的评估仍存在争议。目前仍有许多工作亟待开展。     

重庆地区耳鼻咽喉头颈外科门诊咽喉反流性疾病的流行病学调查

目的:探讨重庆地区耳鼻咽喉头颈外科门诊患者咽喉反流性疾病(LPRD)的患病情况及影响因素,为该病的临床诊断和治疗提供依据.方法:采用多中心横断面调查及系统抽样的方法,对2019年8月至11月重庆地区十五家医院耳鼻咽喉头颈外科门诊患者进行反流症状指数评分量表(RSI)评估,同时收集相关饮食习惯并分析其影响因素.结果:有效...     

咽喉反流性疾病临床分析

目的　通过埃索美拉唑诊断性治疗咽喉反流性疾病（laryngopharyngeal ref lux disease,LPRD）,观察治疗前后反流症状和体征的变化情况。方法　将疑似LPRD的50例患者诊断性质子泵抑制剂（proton pump inhibitor,PPI）治疗8周,治疗前后均行反流症状指数评分量表（reflux symptom index,RSI）和反流体征评分量表（reflux finding score,RFS）评分。结果　RSI评分中声嘶或发音障碍84%、持续清嗓87%、痰过多或涕倒流71%、吞咽食物、水或药片不利58%、饭后或躺下后咳嗽52%、呼吸不畅或反复窒息发作68%、烦人的咳嗽79%、咽喉异物感92%、烧心、胸痛、胃痛32%。RFS评分中假声带沟45%、喉室消失57%、喉黏膜红斑/充血94%、声带水肿85%、弥漫性喉水肿82%、后连合增生83%、肉芽肿10%、喉内黏稠黏液附着58%。治疗前后RSI总分差异有统计学意义（t =16.42,P <0.001）,治疗前后RFS总分差异有统计学意义（t =16.99,P <0.001）。结论　LPRD的主要症状是咽喉异物感、持续清嗓、声嘶或发音障碍。主要体征是喉黏膜红斑/充血、声带水肿、后连合增生。PPI对于咽喉反流性疾病的症状和体征改善明显。     

咽喉反流性疾病58例诊疗体会

目的:探讨咽喉反流性疾病的诊断与治疗.方法:对2008-01-2009-01在我科就诊,可疑有咽喉反流性疾病患者,进行反流症状指数量表(RSI)和反流检查积分量表(RFS)评估.RSI评分>13,RFS>7分者为阳性.双阳性患者共计58例,给予奥美拉唑口服3个月,再次接受RSI和RFS评分.结果:经治疗后,41例患者自觉症状明显缓解,治疗后仅RSI阳性者有41例,仅RFS阳性者37例,RSI和RFS均为阳性者37例.结论:RSI和RFS两个量表可作为临床上咽喉反流性疾病的诊断及疗效评估的方法,质子泵抑制剂对该病有明显疗效.     

咽喉反流性疾病与自主神经功能障碍的相关性研究

目的了解咽喉反流性疾病(laryngopharyngeal reflux disease,LPRD)患者的自主神经功能状态,探讨咽喉反流性疾病与自主神经功能障碍的相关性。方法对疑为LPRD的患者采用反流症状指数量表(reflux symptom index,RSI)和反流体征评分量表(reflux finding score,RFS)进行评分。对RSI>13分和RFS>7分的81例疑似LPRD患者进行心率变异性(heart rate variability,HRV)检查,并均予质子泵抑制剂诊断性治疗,有效者确诊为LPRD,最终纳入病例组,共53例;选择同期55例健康志愿者纳入对照组。根据自主神经功能评价时域指标(连续RR间期标准差、RR间期差值均方根)、频域指标(总功率、低频和高频功率、标准化低频和高频功率、低频功率占总功率比值、高频功率占总功率比值、低频功率与高频功率比值),进一步分析自主神经受累程度与RSI及RFS的关系。结果①病例组中代表迷走神经功能活性的连续RR间期差值的均方根、高频功率(0.15~0.40 Hz)、标准化的高频功率、高频功率占总功率的比值均较对照组明显降低,差异有统计学意义(P<0.05);②病例组中代表交感迷走平衡的低频功率与高频功率的比值较对照组明显升高,差异有统计学意义(P<0.05);③两组间平均连续RR间期标准差、总功率(0.00~0.40 Hz)、低频功率(0.04~0.15 Hz)、低频功率占总功率的比值差异无统计学意义(P>0.05);④RSI评分、RFS评分、病程均与高频功率的数值呈负性线性相关关系(r=-0.89、-0.77、-0.315,P<0.05);低频功率与高频功率比值与病程呈正性线性相关关系(r=0.315,P<0.05)。结论LPRD患者存在以迷走神经活性降低为主的自主神经功能障碍,LPRD的严重程度与自主神经功能障碍具有明显相关性,尤其与迷走神经功能活性呈负相关。     

质子泵抑制剂联合抗抑郁药治疗咽喉反流性疾病的疗效分析

目的　评价质子泵抑制剂（proton pump inhibitor,PPI）联合使用抗抑郁药对咽喉反流性疾病（laryngopharyngeal reflux disease,LPRD）患者的疗效。方法　收集2018年7月~2019年10月就诊于中国人民解放军联勤保障部队第九〇〇医院耳鼻咽喉头颈外科疑似LPRD合并抑郁症状患者62例,按随机数字表法分为研究组（单用艾司奥美拉唑治疗）和对照组（艾司奥美拉唑联合艾司西酞普兰治疗）,所有患者随访8周后再次进行反流症状指数评分量表（reflux symptom index,RSI）、反流体征评分量表（reflux finding score,RFS）及Zung抑郁自评量表（self-rating depression scale,SDS）评分。研究组失访9例,最终纳入26例;对照组失访5例,最终纳入22例。结果　治疗前组间RSI、RFS、SDS评分比较,差异无统计学意义（P ＞0.05）;治疗后组间RSI、SDS评分比较,差异有统计学意义（P＞0.05）;治疗前RSI与SDS评分呈正性相关（r =0.529,P <0.01）,RFS与SDS评分无相关性（r =0.170, P <0.12 6）;治疗后研究组RSI与SDS评分呈正相关（r =0.354,P <0.05）,而对照组无相关性（r =－0.021,P <0.884）。结论　在LPRD合并抑郁状态的患者中,反流症状评分越重抑郁评分越高;针对LPRD合并抑郁症状的患者,联合使用抗抑郁药物较单纯使用抑酸药效果更佳。     

质子泵抑制剂试验性治疗咽喉反流性疾病187例临床分析

咽喉反流性疾病的症状多种多样,无特异性.当患者有持续性清嗓、慢性声嘶、咽异物感、慢性咳嗽、吞咽困难及痰液增多等症状时,临床医师应该考虑反流性咽喉疾病的存在.     

中西医结合治疗痰热蕴结型咽喉反流性疾病的临床研究

目的观察中西医结合法治疗痰热蕴结型咽喉反流性疾病的临床疗效。方法选取2018年9月至2019年9月就诊于辽宁中医药大学附属医院耳鼻咽喉科的痰热蕴结型咽喉反流患者60例为研究对象,随机分为对照组和治疗组各30例。对照组采用口服埃索美拉唑镁肠溶片治疗,治疗组在对照组的基础上加服中药汤剂治疗,组成:瓜蒌子15 g、甘草10 g、蜜麻黄10 g、麦冬15 g、生石膏30 g、炒枳壳15 g、炒紫苏子15 g、川贝母2 g、清半夏15 g加减,疗程均为2个月。分别于治疗前和治疗后对患者进行电子喉镜检查,并且观察反流症状指数RSI和反流体征评分RFS量表评分变化,从而进行疗效评价。结果两组治疗均能改善患者症状,但观察组方案优于对照组。结论中西医结合法治疗痰热蕴结型咽喉反流患者疗效显著,大大的改善患者的症状,值得推广。     

接触式内镜在鼻腔和咽部疾病诊断中的应用

目的探讨接触式内镜在鼻腔及咽部多种疾病中的辅助诊断作用。方法应用接触式内镜观察慢性鼻-鼻窦炎38例,鼻息肉19例,变应性鼻炎15例,慢性鼻咽炎26例,鼻咽癌21例,咽部乳头状瘤5例。结果接触式内镜能够显示鼻腔和鼻咽部不同病变的黏膜微血管及表层细胞的形态分布特点,包括细胞形状、排列、边界、染色情况以及核的大小、核浆比例等。微血管的异常包括不规则扩张、收缩或血栓形成、血管间距拉大、血流缓慢或中断、管壁脆弱易出血等。表层细胞的主要病理改变包括鳞状上皮化生、非典型增生和鳞状细胞癌。结论接触式内镜作为一种新的无创、动态的检查方法,在临床上对鼻腔及咽部的多种疾病具有一定的辅助诊断作用。     

Endoscopic stapling diverticulotomy for pharyngeal pouch

Fifteen endoscopic stapling diverticulotomy procedures were performed on 14 patients. Our preliminary results show the technique to be fast, effective and safe. Most patients resumed oral intake within 6 h post-operatively and were discharged from hospital within 24 h. The technique has many advantages over both the external diverticulectomy and the traditional Dohlman's procedure. The short operating time and short hospital stay are an advantage. Our follow-up period was between 1 and 12 months. Long-term results require evaluation.     

Oral and pharyngeal adenosquamous carcinoma

Summary Four cases of adenosquamous carcinoma from the oral and pharyngeal cavities were analyzed by light microscopy and immunohistochemistry. Lymph node metastases were present in three cases. One patient died 2 years after treatment. All four carcinomas presented a mixture of squamous and glandular mucus-secreting neoplastic elements. Immunostaining for high-molecular-weight cytokeratins (KL1) was constantly positive in both squamous and glandular tumor cells. Antibodies against low-molecular-weight cytokeratins (K19) and carcinoembryonic antigen were positive only in the glandular component. The histological aspect and the immunohistochemical phenotype of these tumors is similar to the ordinary squamous cell carcinoma and adenocarcinoma, respectively. Offprint requests to: F. Martinez-Madrigal     

扁桃体啄治法治疗咽部疾病的临床与实验研究

目的 探讨扁桃体啄治法的治病机理与疗效。方法 对１４５例咽部疾患的病人,随机分为治疗组与对照组进行１～２个疗程观察,并对治疗组５０例进行了唾液免疫球蛋白治疗前后的测定。结果 慢性扁桃体炎治疗组有效率９８％,与对照组比较Ｐ〈０．０１;慢性咽炎治疗组有效率９４％,与对照组比较Ｐ〈０．０５。唾液免疫球蛋白治疗后明显高于治疗前。结论 本法临床疗效显著,是新型的中医外治法。     

Botulinum neurotoxin for pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration

OBJECTIVES/HYPOTHESIS: The purpose of the study was to evaluate the effectiveness of Botulinum neurotoxin (Botox) for elimination of pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration. STUDY DESIGN: A retrospective review was made of 62 patients between 1991 and 2002 who had Botox as the initial treatment for pharyngeal constrictor muscle spasm. METHODS: One hundred units of Botox properly diluted in 3 mL saline was instilled unilaterally under electromyographic guidance after fluoroscopic identification and marking of the contracted pharyngeal constrictor muscles. The patients were divided into three groups based on their response to the first Botox injection: group I, complete relaxation of the pharyngeal constrictors resulting in fluent voice, intratracheal phonation pressure of 20 to 40 cm H2O, and the ability to say 15 to 20 uninterrupted syllables; group II, hypertonic or incomplete relaxation of the pharyngeal constrictors resulting in intratracheal phonation pressure of 45 to 70 cm H2O and the ability to say 7 or 8 syllables; and group III, failure to produce relaxation of the pharyngeal constrictors. RESULTS: After the first injection of Botox, 49 (79%) patients were in group I or II (41 in group I and 8 in group II) and group III consisted of 13 patients. Thirty-four patients (55%) had group I (28) or II (6) responses for greater than 6 months. A second Botox injection enabled 6 of the 13 failures to move into group I. In all, 8 pharyngeal constrictor muscle myotomies (13%) were ultimately required in the 62 patients. The group I speaker for the longest period has enjoyed 11 years of fluency and successful daily use of a tracheostoma valve after two Botox injections. CONCLUSION: Botox relaxation of the pharyngeal constrictor muscles has proven to be effective, has replaced secondary pharyngeal myotomy for the initial treatment of pharyngeal muscle spasm, and is the only treatment in patients who are not candidates for elective surgery. Radiographic assessment, electromyographically monitored injection, and the number of Botox units appear to be important to successful outcomes.     

咽异感症与精神焦虑及抑郁症状相关性研究

目的探讨咽异感症患者发病与精神焦虑和抑郁症状的相关性,分析咽异感症男、女患者之间量表评分差异以及不同病程患者间量表评分的差异。方法选择50例咽异感症患者为研究组,健康体检者40例为对照组。分别用焦虑自评量表（self-rating anxiety scale,SAS）、汉密尔顿焦虑量表（Hamilton anxiety scale,HAMA）、抑郁自评量表（self-rating depression scale,SDS）、汉密尔顿抑郁量表（Hamilton depression scale,HAMD）进行症状量化评分检查,将两组量表得分进行比较。按性别以及患病时间进行分组,组间量表得分进行比较。结果 研究组量表评分均高于对照组,研究组SAS总分、HAMA平均秩次、SDS总分、HAMD平均秩次分别为47.5±12.7、65.28、48.2±9.5、58.09;对照组相应量表评分分别为31.6±4.6、20.78、32.7±4.6、29.76,差异均具有显著性（P均〈0.05）。不同性别咽异感症之间量表评分差异无统计学意义（P均〉0.05）。按患病时间不同分组,病程5年以下组与病程5～10年组、病程10年以上组SAS、HAMA、SDS、HAMD总分差异均有统计学意义（P均〈0.05）。结论咽异感症患者中精神焦虑及抑郁症状发生率较健康者高,应重视患者的心理情况,尤其是病程较久的患者中精神焦虑及抑郁症状发生更严重;咽异感症患者焦虑、抑郁症状评分结果 与性别无关。     

Lateral pharyngeal flap with a double pedicle for repair of unilateral velopharyngeal insufficiency

ObjectivesConventional pharyngeal flap surgery, which closes the median portion of the velopharynx, has been performed for dysarthria patients with velopharyngeal insufficiency (VPI). However, for VPI due to unilateral pharyngeal paralysis, median closing disrupts pharyngeal contraction of the unaffected side and allows pharyngeal pressure to escape through the nose at the lateral portion of the affected side during speech and swallowing. The purpose of this study was to evaluate the effectiveness of lateral pharyngeal flap (LPF) surgery for unilateral VPI.MethodsSeven patients with unilateral VPI (five males and two females with an average age of 54 years) underwent LPF surgery combined with other transoral surgeries for dysphagia. The LPF surgical technique was as follows: after the laterocaudal-based pedicle flap of the soft palate and cranial-based pedicle flap of the posterior pharyngeal wall on the affected side were transorally elevated, each mucosal pedicle flap was sutured together. Functional oral intake scale (FOIS) scores and swallowing pressure before and after surgery were compared.ResultsUnilateral velopharyngeal closure preserved nasal breathing after LPF surgery in all patients. Rhinolalia aperta improved postoperatively in all patients except one. The mean FOIS scores were 2.3 preoperatively and 3.7, 5.3, and 5.9 at 2 weeks, 1 month, and 6 months postoperatively, respectively. The mean pressures significantly increased at the velopharynx (from 49 ± 30 mmHg to 92 ± 45 mmHg) and oropharynx (from 48 ± 18 mmHg to 66 ± 15 mmHg) six months after the surgery.ConclusionLPF surgery leaving the unaffected side intact can be an effective surgical procedure for patients with unilateral VPI.