悬雍垂腭咽成形术167例疗效分析

1995～ 1 998年 ,我科行悬雍垂腭咽成形术(ＵＰＰＰ) 1 0 3例 ,手术效果不甚满意。 1 999年我科将激光技术引进ＵＰＰＰ术中 ,并对ＵＰＰＰ术式进行了一些改进 ,手术效果明显提高 ,并发症亦大大减轻 ,现报告如下。1　资料与方法1 .1　临床资料1 995～ 2 0 0 0年住院的阻塞性睡眠呼吸暂停综合征 (ＯＳＡＳ)患者 1 67例 ,男 1 5 9例 ,女 8例 ;年龄 3～ 73岁 ,平均 43岁。有原发性高血压病史 5 2例 ,糖尿病史 38例。经临床症状分析、耳鼻咽喉检查、多导睡眠仪监测、上呼吸道Ｘ线摄像确诊为ＯＳＡＳ ,主要阻塞部位在口咽部 ,ＡＨＩ 42 .3± 1 6.…     

全麻行悬雍垂腭咽成形术死亡一例

UPPP术是治疗OSA的常用术式,造成死亡的主要原因为气道阻塞。为避免死亡悲剧的发生,对于重症者,尤其是拟行全麻者,建议于全麻手术前先行气管切开,保持呼吸道通畅,此不失为一种简便易行的有效方法。     

腭咽成形术与悬雍垂腭咽成形术的疗效对比

目的：探讨悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP)与腭咽成形术（palatopharyngoplasty,PPP)治疗阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS)的疗效比较及保护悬雍垂的意义。方法：分别对PPP（保留悬雍垂12例）及UPPP（不保留悬雍垂10例）的中层得于术前及术后3－6个月进行多导睡眠（PSG）监测，比较两组病人的疗效。结果：两组术式的疗效无显著差异。结论：PPP手术中保留悬雍垂不影响疗效，保留悬雍垂生理功能，有一定临床意义。     

腭咽成形术与悬雍垂腭咽成形术的疗效对比

目的 :探讨悬雍垂腭咽成形术 (uvulopalatopharyngoplasty,UPPP)与腭咽成形术 (palatopharyngoplasty,PPP)治疗阻塞性睡眠呼吸暂停综合征 (obstructive sleep apnea syndrome,OSAS)的疗效比较及保留悬雍垂的意义。方法 :分别对 PPP(保留悬雍垂 12例 )及 UPPP(不保留悬雍垂 10例 )的患者于术前及术后 3～ 6个月进行多导睡眠 (PSG)监测 ,比较两组病人的疗效。结果 :两组术式的疗效无显著差异。结论 :PPP手术中保留悬雍垂不影响疗效 ,保留悬雍垂生理功能 ,有一定临床意义     

悬雍垂腭咽成形术(腭咽成形术)手术探讨

随着对阻塞性睡眠呼吸暂停综合征（OSAS）致病机理的研究和认识,进入SO年代,手术治疗已由过去的阻塞旁路（改道）手术一气管切开术进展为有针对性的根据阻塞平面进行的成形手术。1964年Ikematsu在日本耳鼻喉科杂志撰文报告了打鼾与非鼾者口咽部相对径线测量研究结果,发现gi％打鼾者咽腔狭窄、软肥及悬雍垂长,其中部分患者经切除部分跨弓及软聘后得到治愈,此为最早的咽碑成形术报道。至1981年Fu沁a根据Ikematzu观点,采用悬雍垂腾咽成形术（UPPP）治疗OSAS,此后引起临床广泛兴趣。Simmons于1983年改良UPPP,不保留悬雍垂,称…     

悬雍垂腭咽成形术后曲马多镇痛作用

目的观察曲马多用于悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)后静脉自控镇痛的效果和安全性。方法40例患者随机分为镇痛组和对照组,观察VAS评分、病人自控静脉镇痛技术(patient-controlledintravenousanalgesia,PCIA)泵按压次数、不良反应和杜冷丁的平均用量及使用率。结果镇痛组在术后所观察的时间段内,均取得良好的镇痛效果,安静状态下VAS评分均小于3分,与对照组相比有显著性差异,P<0.05。镇痛组PCIA泵按压次数从术后4小时起逐渐减少,而对照组患者PCIA泵按压次数至12小时后才有所减少,各时间段两组对比均有显著性差异。镇痛组2例术后肌注杜冷丁各50mg,对照组20例患者术后均要求肌注杜冷丁,8例各50mg,12例100mg,均显著高于镇痛组,P<0.01。结论曲马多用于UPPP术后静脉自控镇痛,可以提供较完善和安全的止痛效果。     

悬雍垂腭咽成形术后鼻咽部并发症

悬雍垂腭咽成形术(UPPP)治疗阻塞性睡眠呼吸暂停和打鼾日渐增多。术后立即出现的并发症有出血、切口感染、水肿等可引起上呼吸道阻塞。据报道暂时性腭咽功能障碍者约20～50％,其表现为饮食返流。这种情况常在术后几周内由于咽括约肌的代偿作用而消失。持久性腭咽功能障碍者尚未见诸报道。本文报     

悬雍垂腭咽成形术适应证选择

目的探讨悬雍垂腭咽成形术(uvulopalatopha-nyngoplasty,UPPP)的最佳手术适应证。方法经多导睡眠监测(polysomnography,PSG)确诊为阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的216例中重度患者,根据年龄、体重指数、睡眠呼吸暂停低通气指数(apnea hypopneaindex,AHI)、血氧、最低血氧饱和度(LSaO2)、阻塞平面、阻塞类型等项检查中筛选出其中31例患者行UPPP手术治疗。结果本组近期有效率为93.5%,远期有效率为80.6%。结论UPPP手术疗效与手术前的适应证选择密切相关,提高UPPP疗效的关键在于选择合适病例。     

软腭前移悬雍垂腭咽成形术

目的 研究联合应用改良悬雍垂腭咽成形术(H-uvulopalatopharyngoplasty,H-UPPP)及硬腭截短软腭前移手术,治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrom,OSAHS)的疗效,探索存在骨性鼻咽腔狭窄OSAHS患者的治疗方法.方法 32例OSAHS患者,年龄27～54岁,平均(-x±s,以下同)为(39.1±7.8)岁,均为男性,体重指数22.9～36.7 kg/m2,平均(29.0±3.6) kg/m2.术前睡眠呼吸暂停低通气指数(apnea and hypopnea index,AHI)11.7～113.7 次/h,平均(61.8±21.9)次/h,最低血氧饱和度0.10～0.85,平均0.64±0.13.术前纤维鼻咽喉镜检查,全部患者均存在腭咽部狭窄,合并舌根平面阻塞14例.X线头影测量:SNA角72.9°～87.0°,平均(80.7±4.1)°;SNB角69.5°～85.0°,平均(76.8±4.5)°;PAS 0.5～2.1 cm,平均(1.2±0.5)cm;MP-H 1.2～3.5 cm,平均(2.2±0.7)cm;PNS 2.4～3.5 cm,平均(2.8±0.4)cm.全部患者行软腭前移联合H-UPPP手术.14例合并舌后隙轻度狭窄者,同期行颏前徙术.结果 术后6个月复查多道睡眠监测,32例患者中总有效27例,其中显效22例(占总例数的68.8%),包括AHI＜5次/h者8例(占总例数的25.0%);无效5例(15.6%).手术后Epworth嗜睡程度评分由术前9.2±4.5下降至4.7±2.8,OSAHS初筛量度评分由术前56.0±15.3下降至17.5±11.5,差异均有统计学意义(t值分别为4.058和11.45,P值均＜0.01).结论 硬腭截短软腭前移手术是针对存在骨性鼻咽腔狭窄的OSAHS患者有效的治疗方法,联合应用软腭前移手术与H-UPPP,可以提高其显效率及治愈率,即单纯腭咽平面阻塞的患者有望手术治愈.     

Fatal pulmonary embolism developing after tympanoplasty: a case report and incidence of pulmonary embolism at Toyooka Hospital

We report a case of fatal pulmonary embolism (PE) developing after tympanoplasty. A 69-year-old woman underwent type III tympanoplasty for a middle ear cholesteatoma under general anesthesia. Operating time was 3 hours 27 minutes and anesthesia lasted 5 hours 9 minutes. The next morning, 14 hours 5 minutes after returning to the recovery room, the patient lost consciousness while getting out of bed. Although consciousness recovered transiently, she went into shock with cardiopulmonary arrest. Heart beat was regained after resuscitation with artificial respiration and cardiac massage, but her blood pressure was unstable. Echocardiography revealed right ventricular overload and pulmonary hypertension. Because PE was suspected, thrombolytic therapy was conducted to stabilize hemodynamics. Enhanced computed tomography (CT) of the chest showed bilateral pulmonary thromboembolism. The patient died of hypoxic encephalopathy 23 days after PE onset. We have seen 40 cases of PE at our hospital in the last 70 months. Five patients developed PE after surgery with a postoperative occurrence rate of 0.03% (5/16, 277), and 3 of them died. Enhanced CT in 19 of 21 cases (90.5%) before or just after the start of therapy for PE was useful in establishing the diagnosis. Although PE is rare in the field of otolaryngology and head and neck surgery, it may develop rapidly after any type of surgery resulting in a fatal outcome. It is thus important to establish diagnosis early and prevent such serious complications.     

Diverticulum hypopharyngis lateralis with a record of one case

Summary A case of lateral hypopharyngeal diverticula is reported. This type of diverticula is comparatively rare. The diagnosis can be made clinically and confirmed by x-ray examination and hypopharyngoscopy. A pharyngocoele is of differential importance as this may be present in many patients during Valsalva, but does not indicate treatment. The reported case is most probably caused by a developmental defect in the third branchial cleft.     

Diverticulum hypopharyngis lateralis with a record of one case.

A case of lateral hypopharyngeal diverticula is reported. This type of diverticula is comparatively rare. The diagnosis can be made clinically and confirmed by x-ray examination and hypopharyngoscopy. A pharyngocoele is of differential importance as this may be present in many patients during Valsalva, but does not indicate treatment. The reported case is most probably caused by a development defect in the third branchial cleft.     

Two cases of pulmonary embolism after head and neck surgery

Pulmonary embolism (PE) is a prominent cause of morbidity and mortality in surgical patients. Here, we report two cases of PE following head and neck surgery: (1) in case 1, the patient underwent endoscopic sinus surgery (ESS), and (2) in case 2, the patient was suspected PE after resection of the parotid gland and radical neck dissection. Prophylactic compression devices were used during the operation in both cases. In case 1, PE was diagnosed 3 days following surgery after the patient complained of dyspnea while walking. PE was successfully treated by intravenous administration of heparin. In case 2, PE was strongly suspected 13 days following surgery after the patient experienced syncope and chest pain and exhibited abnormal findings on a cardiac echogram. This patient died 18 h after the onset of cardiac symptoms. Despite prophylactic measures taken during surgery, the prognosis was poor for this patient due to numerous high-risk factors (e.g., advanced age, obesity, prolonged immobilization). Although the incidence of postoperative PE in our department during the last 7 years is very low (0.04%), the frequency of postoperative PE in Japan has steadily increased in recent years. PE still is one of the most significant complications leading to morbidity and mortality following surgery. Given the gaining prominence of PE, we conclude that otolaryngologists including those in Japan should be reminded of high-risk factors associated with PE and be made aware of prophylactic treatments newly aimed at reducing the frequency of PE.     

Rhinolithiasis. Review of one case

Rhinoliths are foreign bodies of the nose, which may be found during the course of a routine examination or whe the show, if undetected for a long time, symptoms of nasal obstruction, similar to the ones of sinusitis. They require a high level of suspicion to be diagnosed and surgical removal is the treatment of choice. We present the case of a woman diagnosed of rhinolithiasis and we carry out a literature review.     

头颈恶性肿瘤术后肺栓塞患者的诊疗分析

目的 总结头颈恶性肿瘤围手术期肺栓塞的临床相关因素及影响预后。方法 2010～2014年我院头颈外科恶性肿瘤手术2736例,术后发生肺栓塞10例,回顾性分析该 类患者临床诊治经过,总结其病因、临床表现、诊断及治疗。结果 肺栓塞在头颈恶性肿瘤患者围手术期发病率为0.37%（10/2736）。临床表现以喘憋、呼吸困难为主,无症状低氧血症3例。8例患者行肺动脉造影显示肺动脉及其分支充盈缺损。7例患者行抗凝等综合治疗后治愈出院,3例抢救无效死亡。抗凝治疗术腔渗血2例,予以局部探查加压包扎止血,未调整抗凝药物。结论 头颈恶性肿瘤围手术期肺栓塞死亡率高,提前预防和及时治疗是降低肺栓塞死亡率的关键。     

耳部恶性黑色素瘤一例

患者男性,49岁,因右耳闷、听力下降8月．反复血性耳液溢3月,于1999年9月18日收入我院。患者于8月前无诱因出现右侧耳闷,伴听力下降,不伴耳鸣、耳痛及耳脓溢。自服阿莫西林及头孢类抗生素,症状未见好转。于3月前出现右耳流脓,间歇性带有鲜血,并逐渐出现阵发性同侧颞部疼痛,耳呜,听力下降明显。