复发性鼻息肉的鼻内镜治疗体会

目的探讨鼻内镜手术治疗复发性鼻息肉的临床疗效。方法回顾性分析36例复发性鼻息肉患者的鼻内镜手术及综合治疗临床资料。结果随访观察半年以上,36例复发性鼻息肉患者术后6～24个月,其中治愈27例(75.0%);好转5例(13.9%);无效4例(11.1%)。总有效率为88.9%。发生并发症3例,其中鼻腔粘连2例,鼻中隔高位偏曲1例。结论鼻息肉术后复发最常见的原因为术腔粘连以及病灶残留,其次为鼻中隔偏曲未矫正和不能按时进行鼻内镜复查,定期鼻内镜复查是提高复发性鼻息肉治疗效果的重要保证。对复发性鼻息肉应采用鼻内镜手术加综合治疗措施。     

多平面注射透明质酸鼻整形的临床研究

目的 通过在鼻梁不同部位不同层次注射透明质酸,以改善鼻部外观形态,达到满意的鼻整形效果.方法 在鼻骨部于骨膜下或骨膜上,软骨部于软骨膜上,鼻尖部于大翼软骨间注射透明质酸,以垫高鼻背和鼻尖.根据鼻部形态及求美者的审美要求确定注射剂量,遵循宁少勿多的原则,若不足可于首次注射后1周内补充注射,本组病例注射总量为1 ～1.5 ml.结果 2010年1月至2012年1月,共进行透明质酸注射鼻整形60例,未发现患者有特别的不良反应,未出现肿胀外观,术后随访10 ～ 13个月,效果均较满意,42例能维持9个月左右,最长12个月,1例在6个月消失.结论 透明质酸多层次注射隆鼻效果确实,可以达到更真实的鼻整形效果.     

鼻内窥镜修正术治疗复发性鼻息肉的体会

目的:探讨鼻内窥镜修正术治疗复发性鼻息肉的疗效及体会。方法:对28例复发性鼻息肉患者在我院行鼻内窥镜修正性手术治疗。术中采用Messerkl i nger技术,根据CT所见及术中情况相应处理。结果:随访6～12个月评定疗效,治愈11例,好转9例,无效8例,总有效率75%,并发眶周血肿1例。结论:鼻内窥镜修正术治疗复发性鼻息肉疗效好,对鼻息肉病效果欠佳,中鼻甲残根和后鼻孔上穹窿为手术中的指南针,术前详细的CT扫描可减少并发症的发生。     

鼻内镜手术联合糖皮质激素治疗鼻息肉效果观察

目的观察鼻内镜手术联合糖皮质激素治疗鼻息肉的效果。方法随机将92例择期行鼻内镜手术的鼻息肉患者分为2组,各46例。观察组联合应用糖皮质激素,对照组不使用糖皮质激素。比较2组的疗效、嗜酸性粒细胞及血清炎性因子水平和复发率。结果观察组的疗效、嗜酸性粒细胞及血清炎性因子水平和复发率均优于对照组,差异有统计学意义(P0.05)。结论鼻内镜手术联合糖皮质激素治疗鼻息肉,可提升疗效,减轻炎症反应,降低复发率。     

鼻内镜手术治疗慢性鼻-鼻窦炎伴鼻息肉效果分析

目的探讨鼻内镜手术治疗慢性鼻-鼻窦炎伴鼻息肉的临床效果。方法对58例慢性鼻-鼻窦炎伴鼻息肉患者实施鼻内窥镜手术治疗,术后规范实施清理鼻腔和鼻内糖皮质激素、黏液溶解促排剂及抗生素等联合治疗并随访。结果患者均成功完成手术,术后症状消失时间为(3.24±0.38)d,术中及术后未发生大出血、鼻中隔穿孔、脑脊液鼻漏等严重并发症。术后住院时间(5.82±1.46)d。患者出院后均获随访6~10个月。其中治愈46例,好转8例,无效4例。总有效率为93.10%。随访期间无复发病例。结论鼻内镜手术治疗慢性鼻-鼻窦炎伴鼻息肉,患者痛苦小,安全性和治疗有效率高,术后恢复快且可明显提高患者生活质量。     

鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉效果观察

目的观察鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉的效果。方法选取2013-01—2017-01间扶沟县人民医院收治的96例慢性鼻-鼻窦炎鼻息肉患者,均给予鼻内镜手术治疗。术后随访12～24个月,观察手术效果。结果本组治愈84例,好转10例,无效2例。术后随访12～24个月,其中3例患者出现鼻腔粘连,给予鼻内镜分离粘连及治疗后痊愈。未发生脑脊液鼻漏等其他并发症及复发病例。结论鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉,并发症少,疗效确切。但术者需不断提高鼻内镜手术的操作技巧、规范进行术后处理和随访,以提高患者的生活质量。     

鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉的效果分析

目的观察鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉的效果。方法对78例经药物治疗无效的慢性鼻-鼻窦炎鼻息肉患者在鼻内镜下实施Messerklinge手术,对治疗效果进行回顾性分析。结果本组治疗总有效率为96.15%。术后出现3例鼻腔干燥感,采用薄荷油滴鼻后症状消失。未发生眶周淤血及出血、鼻腔粘连、上颌窦口狭窄或闭锁等并发症。结论鼻内镜手术治疗慢性鼻-鼻窦炎鼻息肉,总有效率高,并发症发生率低。     

鼻内镜手术治疗鼻窦炎鼻息肉的疗效与安全性观察

目的探讨鼻内镜手术治疗鼻窦炎鼻息肉的临床效果与安全性,总结临床经验以提高治疗水平。方法将2014-05—2016-05间收治的110例鼻窦炎鼻息肉患者随机分成2组,各55例。对照组行传统手术治疗,观察组实施鼻内镜手术治疗。结果观察组的治疗总有效率优于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论鼻内镜手术治疗鼻窦炎鼻息肉,疗效确切、并发症少。     

鼻再造术中衬里组织的修复方法

目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。     

An angiomatous nasal polyp: a very rare variant of sinochoanal nasal polyps

Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by dilated, large vascular spaces. A 27-year-old female patient presented with a three-month history of unilateral right-sided nasal obstruction and recurrent mild epistaxis. Paranasal computed tomography demonstrated a mass in the right maxillary sinus extending through the nasal cavity. It was resected with both endonasal endoscopic and Caldwell-Luc approaches. Histopathological examination identified an angiomatous nasal polyp. Follow-up of thirteen months showed no recurrence.     

Free radical damage in nasal polyp tissue.

OBJECTIVE: To investigate whether the free radical injury in nasal polyp tissue exists or not. STUDY DESIGN: A prospective study in patients with nasal polyps. METHODS: Polyp specimens were obtained from 19 patients. Control specimens were acquired from 16 patients who underwent partial turbinectomy with concha bullosa free of rhinitis, sinusitis, and allergy, confirmed by endoscopic nasal examination, coronal paranasal sinus CT scan, and prick test. MDA levels of nasal polyps and control specimens were measured by using the method of Knudsen et al. RESULTS: The mean MDA levels of nasal polyps and control specimens were 38.2 +/- 5.1 (33.3-52.2) and 33.9 +/- 1.6 (32.6-37.4), respectively. MDA levels in NP were significantly higher compared with control specimens (P < 0.01). CONCLUSION: High level of MDA in nasal polyp tissue that represents FR increase supports the existence of cell injury in nasal polyp tissue. FRs should be considered in the development and life cycles of NP which is thought to have multifactorial pathogenesis.     

Management of colorectal polyp cancers

INTRODUCTION

Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated.

METHODS

A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group.

RESULTS

Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors.

CONCLUSIONS

Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.     

Complex nasal reconstruction: a case study: reconstruction of full-thickness nasal defect

Reconstruction of complex full-thickness nasal defects requires the reconstitution of the mucous internal nasal lining, the cartilaginous framework, and the aesthetic contour of the cutaneous nasal covering. Goals of reconstruction include restoration of a functional nasal airway and redefinition of the contours of the nose as well as its relationship to the cheek and lip with the least amount of morbidity to the patient. This article details a multistaged approach to repairing such a defect using an ipsilateral septal mucoperichondrial flap, multiple cartilage grafts, a paramedian forehead flap, and a cheek flap in a woman who had undergone Mohs surgery.     

Microvascular reconstruction of nasal defects

Microvascular reconstruction of nasal defects is a complex procedure and must consider 3 nasal components: skin, osteocartilaginous framework, and intranasal lining. These layers can be reconstructed with various flaps and grafts. The commonly used flaps are the first dorsal metacarpal flap, dorsalis pedis flap, auricular helical rim flap, and radial forearm and prelaminated flaps. These flaps can be composed of skin and cartilage or skin and bone. The decision is based on the patient's needs taking into consideration the extent of the defect and presence or absence of nasal septum and columella.     

Aesthetic aspects of nasal reconstruction

Reconstructive nasal surgery aims not just to rebuild a nose or part of a nose, but to blend and tailor the new and old tissues in such a way as to create a nearly ideal shape that is likely to be an improvement on the original. The challenge of the reconstruction is enhanced by the complexity of the defect. Differences in color, texture, and thickness between the nasal remnants and the sources of skin available for the reconstruction impose aesthetic limits that are often difficult to overcome.     

The use of proximal nasal tissue in nasal reconstruction

Lesions and defects of the nasal tip and alar rim can be reconstructed using composite or full thickness grafts from the proximal alar crease region. The texture, surface effect, and color match much better than the conventional skin grafts from other body areas. The donor site is well hidden in the natural crease of the alar rim and the scars have always been acceptable. This method has been used in ten patients to date and the average dimensions of the grafts are 1.5 x .7 cm.     

Cartilage grafting in nasal reconstruction

Nasal reconstruction after resection for cutaneous malignancies poses a unique challenge to facial plastic surgeons. The nose, a unique 3-D structure, not only must remain functional but also be aesthetically pleasing to patients. A complete understanding of all the layers of the nose and knowledge of available cartilage grafting material is necessary. Autogenous material, namely septal, auricular, and costal cartilage, is the most favored material in a free cartilage graft or a composite cartilage graft. All types of material have advantages and disadvantages that should guide the most appropriate selection to maximize the functional and cosmetic outcomes for patients.