鼻内镜联合支撑喉镜下电动切削器切除声带息肉

目的评价鼻内镜联合支撑喉镜下电动切削器切除声带息肉的疗效。方法对107例声带息肉病人采用鼻内镜联合支撑喉镜,以电动切削器在电视监视器下手术切除。结果随访3个月,治愈99例(92.5%);好转7例(6.5%);无效1例(0.9%)。结论鼻内镜联合支撑喉镜下电动切削器切除声带息肉,操作简单、快捷、安全、高效,技术要求不高,容易开展,值得推广。     

支撑喉镜结合鼻内窥镜下切除广基声带息肉

目的探讨支撑喉镜结合鼻内窥镜电视监视系统下切除广基声带息肉的优越性。方法对40例广基型声带息肉患者采用支撑喉镜与鼻内窥镜电视监视系统联合应用行手术治疗。结果一次手术治愈37例,3例声嘶改善,治愈率92.5%;随访3~6个月无复发。结论应用支撑喉镜在鼻内窥镜电视监视系统监视下治疗广基型声带息肉视野清晰、微创,手术疗效好,而且有利于示教。     

支撑喉镜下喉电动切削系统与喉钳夹术

目的比较不同方法切除声带息肉的疗效,探讨声带息肉手术方式的选择。方法回顾性分析2009年1月～2010年12月收治的声带息肉患者165例,其中使用支撑喉镜下喉电动切削系统手术治疗75例,支撑喉镜下喉钳夹手术90例,术后1个月复查纤维喉镜,以声带运动、边缘光滑、发音质量为指标进行评价,比较两组的疗效。结果支撑喉镜下喉电动切削系统手术治疗的总有效率为9 6%,支撑喉镜下喉钳夹术治疗的总有效率为8 8.9%,两者差异无统计学意义（P〉0.0 5）,但两组对广基息肉的治愈率分别为97.5%、77.5%,差异具有统计学意义（P〈0.05）。结论在治疗广基息肉方面,喉电动切削系统优于支撑喉镜下喉钳夹手术。     

支撑喉镜联合喉内镜及电动切削器治疗喉良性病变

目的评价支撑喉镜联合喉内镜监视系统及电动切削器治疗喉良性病变的疗效。方法对60例喉良性病变患者在支撑喉镜及监视摄像系统下应用电动切削器进行手术治疗。结果60例患者术后随访1年,4例广基型声带息肉因术后用声不当及2例喉乳头状瘤在3个月内复发,行再次手术,其余患者随访1年无复发。结论支撑喉镜联合喉内镜和电视监视摄像系统使喉部图像及手术视野尤其Reinke’s间隙更为清晰,病灶可以彻底切除,同时应用电动切削系统能更加简单、快捷、准确切除声带病变,并能保护好声带正常组织。     

支撑喉镜下微型电动切削器在声带息肉中的应用

声带息肉是喉科常见病,多发病。手术方法很多,如间接喉镜、直接喉镜、支撑喉镜及纤维喉镜等。各种术式有其利弊,应根据息肉的大小、位置、范围及蒂部情况决定术式[1,2]。对于巨大型及广基型声带息肉或弥漫性肿胀遍及整个声带的息肉样变者,适合用支撑喉镜下手术。我科2000年1月~2004年9月采用支撑喉镜下微型电动切削器切除声带息肉116例,现报道如下。1资料及方法1.1临床资料声带息肉116例,男56例,女60例;年龄18~67岁,平均34.3岁,病程1个月至8年,双侧65例,单侧51例,均以声嘶为主,声带息肉基底较广,息肉直径大于3 mm。1.2仪器及设备国产支撑喉…     

影响声带息肉手术因素的分析

目的：分析影响声带息肉手术的因素,以提高手术成功率和手术效果。方法：将2792例声带息肉手术患者分为间接喉镜下切除息肉组（A组）、纤维喉镜下切除息肉组（B组）和支撑喉镜下切除息肉组（c组）,并对影响手术的因素进行分析。结果：A组、B组和C组的手术失败率分别为6．46％、4．12％、1．53％;并发症发生率分别为0．19％,0,1．16％;影响各组手术的因素中,患者的个体状况分别为61．77％,6．67％,85．71％;息肉类型分别为27．94％,60．00％。0;手术者经验分别为30．88％,46．67％,0;手术器械分别为8．82％,13．33％,14．29％;麻醉分别为16．18％,33．33％,0。结论：除B组外患者的个体状况是导致各组声带息肉切除术失败的主要原因,麻醉则是支撑喉镜手术并发症的主要原因。     

内镜监视支撑喉镜下电动切削器切除声带息肉76例

2006年6～12月,我院采用内镜监视支撑喉镜下电动切削器切除声带息肉76例,效果较好,报告如下. 1 资料与方法 1.1 临床资料 患者76例,男43例,女33例;年龄21～68岁,平均39.2岁;病程2个月～7年.双侧声带息肉25例,单侧51例,均以发声嘶哑为主要症状.     

鼻内窥镜引导下高频电刀联合支撑喉镜治疗广基声带息肉113例

1996年3月至2003年3月我科共收治广基声带息肉及声带息肉样变患者113例，全麻鼻内窥镜引导并高频电刀及支撑喉镜下行广基声带息肉及声带息肉样变切除，收到良好效果，报告如下。     

支撑喉镜下用鼻内窥镜行声带良性病变显微手术

自1997年我们在支撑喉镜下用鼻内窥镜行喉显微手术,治疗了11例声带良性病变患者,现报告如下:1 资料与方法1.1 临床资料:本组11例中,男8例,女3例,年龄20～57岁,声音嘶哑时间半年至4年.病变部位,声带前中1/3交界处8例,声带前1/3段1例,声带前联合声门下2例.其中5例为双侧病变.病理诊断:声带息肉8例,声带小结2例,肥厚性鳞状上皮增生1例.1.2 手术方法:采用鼻内窥镜(德国Storze公司产)、冷光源、电视摄录像及打印系统,在电视监视器、支撑喉镜下进行手术.插管全麻成功后,置入支撑喉镜调整至充分暴露双侧声带.将鼻内窥镜自支撑喉镜光源孔插入,在电视监视器下使用不同角度的偏角镜(0°、30°、70°)调整至声带病变组织清晰可见后固定.然后使用喉显微手术器械切除病变组织.术后给予抗生素及地塞米松治疗,禁声10天,一个月后,在纤维喉镜电     

支撑喉镜下电动切削器治疗声带息肉

声带息肉是耳鼻咽喉科常见病和多发病，手术为主要治疗方式。常规以镰状刀先切开，再用钳咬除并修整创面，亦可采用激光等治疗方法。但对多发性广基甚至全声带息肉样变者，如何准确掌握切除范围及术中出血对手术的干扰是棘手难题，术后。恢复时间长且效果欠佳。我院自2006年1月起采用支撑喉镜下电动切削器辅助手术切除多发性广基声带息肉65例，取得良好效果，报道如下。     

Comparative study on the morphology and the composition of the otoliths in the teleosts

Conclusion. Saccular otoliths of teleosts were mostly larger than utricular otoliths, which might relate to the three-dimensional movement. The large and heavy otolith may be better suited in saccules of the bottom and reef fishes. The quantities of iron in lagenar otoliths were found to be lower than those of birds. The function of the fish lagena remains to be elucidated by further studies. Objective. To evaluate the morphological characteristics and the chemical composition of the otoliths in fishes as related to behaviour and habitat. Materials and methods. We studied the morphology of the otoliths of 18 genera of fishes (81 samples) divided into 3 groups: saltwater fish (13 genera), freshwater fish except for the carp family (3 genera) and carp family fish (2 genera). The otoliths and the living environments were compared. The chemical composition was analysed using a synchrotron X-ray fluorescence analyser. Results. Bottom fishes generally have larger saccular otoliths, and migrating fishes have smaller saccular otoliths. In comparing the bottom/reef fishes and the migrating fishes in salt water, the former tended to have larger saccular otoliths. In saltwater bottom fishes the tendency was found that the thinner the head, the larger was the saccular otolith. We found significant quantities of iron, zinc and manganese in the lagenar otoliths.     

On the High Frequency Transfer of Mechanical Stimuli from the Surface of the Head to the Macular Neuroepithelium of the Mouse

Vestibular macular sensors are activated by a shearing motion between the otoconial membrane and underlying receptor epithelium. Shearing motion and sensory activation in response to an externally induced head motion do not occur instantaneously. The mechanically reactive elastic and inertial properties of the intervening tissue introduce temporal constraints on the transfer of the stimulus to sensors. Treating the otoconial sensory apparatus as an overdamped second-order mechanical system, we measured the governing long time constant (Τ_L) for stimulus transfer from the head surface to epithelium. This provided the basis to estimate the corresponding upper cutoff for the frequency response curve for mouse otoconial organs. A velocity step excitation was used as the forcing function. Hypothetically, the onset of the mechanical response to a step excitation follows an exponential rise having the form Vel_shear = U(1-e^−t/TL), where U is the applied shearing velocity step amplitude. The response time of the otoconial apparatus was estimated based on the activation threshold of macular neural responses to step stimuli having durations between 0.1 and 2.0 ms. Twenty adult C57BL/6 J mice were evaluated. Animals were anesthetized. The head was secured to a shaker platform using a non-invasive head clip or implanted skull screws. The shaker was driven to produce a theoretical forcing step velocity excitation at the otoconial organ. Vestibular sensory evoked potentials (VsEPs) were recorded to measure the threshold for macular neural activation. The duration of the applied step motion was reduced systematically from 2 to 0.1 ms and response threshold determined for each duration (nine durations). Hypothetically, the threshold of activation will increase according to the decrease in velocity transfer occurring at shorter step durations. The relationship between neural threshold and stimulus step duration was characterized. Activation threshold increased exponentially as velocity step duration decreased below 1.0 ms. The time constants associated with the exponential curve were Τ_L = 0.50 ms for the head clip coupling and T_L = 0.79 ms for skull screw preparation. These corresponded to upper −3 dB frequency cutoff points of approximately 318 and 201 Hz, respectively. T_L ranged from 224 to 379 across individual animals using the head clip coupling. The findings were consistent with a second-order mass-spring mechanical system. Threshold data were also fitted to underdamped models post hoc. The underdamped fits suggested natural resonance frequencies on the order of 278 to 448 Hz as well as the idea that macular systems in mammals are less damped than generally acknowledged. Although estimated indirectly, it is argued that these time constants reflect largely if not entirely the mechanics of transfer to the sensory apparatus. The estimated governing time constant of 0.50 ms for composite data predicts high frequency cutoffs of at least 318 Hz for the intact otoconial apparatus of the mouse.     

Observations on the stria vascularis of the guinea pig cochlea and the changes resulting from the administration of the diuretic furosemide

An electron microscope examination of the stria vascularis of guinea pigs and the structural changes occurring after administration of furosemide has been made. The use of ruthenium-red, which stains cell coats, has shown that the stria is impermeable to the passive diffusion of material from both the endolymph and the spiral ligament. The first changes after administration of furosemide are observed 4 hours after injection; small spaces develop between the cells. After 5–6 hours the spaces have enlarged but the tight junctions between marginal cells remain intact. The intermediate cells show signs of atrophy. In severely affected animals the intermediate cells have so shrunk that the spaces are very large and the marginal cells clearly resolved. These latter cells show no structural damage. In this severely affected tissue it is seen that the blood vessels are entirely surrounded by marginal cell extensions. It is suggested that the intermediate cells may have a regulatory function. The damage appears to be recoverable, since 6 hours after injection the spaces have decreased in size although some signs of intermediate cell atrophy are still apparent.     

Contact between the tectorial membrane and the cochlear sensory hairs in the human and the monkey

European Archives of Oto-Rhino-Laryngology - The surface structure of the organ of Corti and the overlying tectorial membrane were studied in human and monkey cochleas under a scanning electron...     

胃镜联合食管镜取出胃内异物1例

患者,男,49岁,因＂反复中上腹疼痛6年＂于2012年6月12日就诊于我院消化内科。患者有反复胃痛、胃部不适症状,长期按胃病治疗效果不佳。既往有吸毒史、丙型肝炎病史。6年前患者毒瘾发作时曾吞入牙刷,在当地医院复查未发现异物,未进一步诊治。     

膈神经与面神经吻合的解剖学研究

目的:探讨膈神经移位与面神经干吻合的解剖学基础。方法:解剖11具22侧成年尸体头颈部,观察并测量:①膈神经根与面神经总干腮腺区分叉处之间的距离;②膈神经干在颈部可利用长度;③面神经总干腮腺区分叉处游离至水平半规管下缘可利用长度,面神经总干腮腺区分叉处游离至水平半规管下缘较游离至茎乳孔处增加的面神经干可利用长度;④面神经总干腮腺区分叉处至水平半规管下方切断处膈神经干及面神经干神经移位后并列放置重合长度。结果:①膈神经根与面神经总干腮腺区分叉处之间的距离为(7.2±0.9)cm。②膈神经起点至锁骨下静脉上缘平面为(7.2±1.6)cm。③面神经总干腮腺区分叉处至水平半规管下方切断处的长度2.7~3.5 cm,较面神经干自茎乳孔下方切断增加1.0~1.5 cm。④神经移位后重合长度为0.4~1.8 cm。结论:在锁骨下静脉上缘平面切断20侧标本膈神经可与自乳突内切取的面神经干无张力吻合,两侧膈神经不能与自乳突内切取的面神经干无张力吻合。