等离子低温射频治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的探讨扁桃体、腺样体等离子低温射频切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的临床疗效。方法分析2005年8月～2007年5月,对43例患有OSAHS儿童在全身麻醉下,采用低温等离子手术系统Evac70刀头施行扁桃体切除术联合腺样体根治性切除术。结果手术时间10～20min,平均16min;术中出血1～10ml,平均3ml。与术前比较,术后6个月行PSG监测呼吸暂停低通气指数（apnea hypopnea index,AHI）明显降低[（14.6±4.6）次/hvs（4.2±2.7）次/h,t=8.563,P=0.000];阻塞性呼吸暂停指数（obstructive apnea index,OAI）明显降低[（6.9±3.5）次/hvs（3.3±1.4）次/h,t=5.443,P=0.000];最低血氧饱和度显著提高[（85.7±4.4）%vs（99.7±0.2）%,t=-6.687,P=0.000]。结论扁桃体、腺样体等离子低温射频切除术是治疗儿童OSAHS一种有效的治疗方法,具有手术时间短,术中出血少,疗效好等优点。     

鼻内镜下低温等离子射频切除儿童腺样体肥大

目的探讨鼻内镜下低温等离子射频切除儿童腺样体肥大的疗效。方法回顾性分析2008年6月～2009年12月诊治的80例儿童腺样体肥大患者的临床资料,全部患者均在鼻内镜下实施低温等离子射频切除术,术后观察疗效。结果所有患者腺样体均完整切除,术中出血量为1-10mL,平均约4．5mL,术后无出血及鼻咽粘连、分泌性性中耳炎等并发症,患者痛苦小,恢复快。随访6个月～1．5年,患者鼻窦炎、睡眠阻塞、中耳炎等明显好转,电子鼻咽镜检查无腺样体增生和残留。结论鼻内镜下低温等离子射频切除儿童肥大腺样体,具有安全、出血极少、易操作、疗效好等优点,在临床上是治疗儿童腺样体肥大的一种有效方法,值得推广。     

鼻内窥镜下低温等离子射频系统腺样体消融术结合扁桃体消融切除术对儿童OSAHS治疗的观察

目的探讨分析鼻内窥镜下低温等离子射频系统腺样体消融术结合扁桃体消融切除术对OSAHS患儿治疗的临床疗效。方法选取2014年4月至2016年4月在本院进行治疗的60例OSAHS患儿,随机分成观察组、对照组,每组各30例。对照组给予传统扁桃体剥离术和腺样体刮除术,观察组给予鼻内镜下低温等离子射频消融术切除扁桃体、腺样体治疗。对比两组患者临床疗效、手术指标及术后随访情况。结果观察组患儿治疗总有效率明显比对照组高,组间差异具有统计学意义(P<0.05);对照组患儿手术出血量明显比观察组多,观察组患儿手术时间、症状缓解时间和手术后疼痛时间明显比对照组短,组间差异具有统计学意义(P<0.05);两组患儿术后随访情况差异不具有统计学意义(P>0.05)。结论鼻内窥镜下低温等离子射频系统腺样体消融术结合扁桃体消融切除术对OSAHS患儿进行治疗,有较好的临床疗效,可以降低患者术中出血量,缩短手术时间,且患者术后恢复较快,因此,有较好的临床应用价值,值得推广。     

不同鼻内窥镜手术治疗腺样体肥大效果研究

目的比较鼻内窥镜下等离子低温射频消融术与动力系统腺样体切除术治疗腺样体肥大的效果和安全性。方法随机将58例腺样体肥大患者分为2组,各29例。均在鼻内窥镜下施术。对照组使用动力系统腺样体切除术,观察组使用等离子低温射频消融术。比较2组治疗效果。结果 2组治疗总有效率及手术时间差异无统计学意义(P0.05)。观察组术中出血量少于对照组,差异有统计学意义(P0.05)。结论鼻内窥镜下等离子低温射频消融术与动力系统腺样体切除术治疗腺样体肥大,均可获得较好的治疗效果。但等离子低温射频消融术可减少术中出血量。     

鼻内镜下用等离子射频消融治疗儿童腺样体肥大的疗效观察

目的:探讨电视监视鼻内镜下低温等离子射频消融术治疗儿童腺样体肥大的临床疗效.方法:对90例腺样体肥大患儿采用0°鼻内镜及等离子射频消融治疗系统进行治疗,观察其疗效及并发症.结果:90例术后1～3个月复查临床症状均消失,2例合并鼻窦炎保守治疗2个月后痊愈,随访1年均无复发及并发症.结论:该手术方法视野清晰,操作方便,术中损伤小,无并发症,具有很好的临床应用价值.     

低温等离子扁桃体消融切除术联合腺样体消融术治疗小儿鼾症疗效观察

目的分析低温等离子扁桃体消融切除术联合腺样体消融术治疗小儿鼾症的临床疗效。方法将70例鼾症患儿随机分为2组,各35例。对照组采用扁桃体去除及腺样体切除术,观察组采用低温等离子扁桃体消融切除术联合腺样体消融术,比较2组治疗有效率及手术前后睡眠状况。结果术前2组患儿的睡眠水平差异无统计学意义(P0.05)。观察组手术时间、术中出血量及疼痛评分均低于对照组,治疗有效率高于对照组,差异均有统计学意义(P0.05)。术后6个月,观察组QSQ评分高于对照组,ESS评分低于对照组,差异有统计学意义(P0.05)。结论低温等离子扁桃体消融切除术联合腺样体消融术治疗小儿鼾症,疗效显著,可有效改善患儿的呼吸道狭窄及堵塞,提高睡眠质量,有助于患儿的生长发育。     

鼻窦内窥镜下低温等离子治疗腺样体肥大56例报道

目的探讨鼻窦内窥镜下低温等离子腺样体切除术对小儿腺样体肥大的治疗效果。方法对56例腺样体肥大患儿行鼻内镜下低温等离子腺样体切除术,观察其疗效。结果合并扁桃体肥大患儿术后1~4周,鼻塞、打鼾、张口呼吸症状明显缓解;30例合并分泌性中耳炎患儿术后随访半年,其中完全治愈23例,占76%;好转5例,占16%;无效2例,占8%,总有效率93.3%。结论治疗患儿腺样体肥大,鼻窦内窥镜下低温等离子腺样体切除术能在直视下进行,增加了手术的安全性和准确性,手术疗效显著。     

儿童扁桃体及腺样体术前表面细菌培养结果与术后发热相关性分析

目的:分析因阻塞性睡眠呼吸暂停低通气综合征(OSAHS)而需要行手术的患儿,术前腺样体及扁桃体表面的细菌培养结果与术后发热的关系.方法:随机抽取诊断为OSAHS并拟行腺样体及扁桃体手术的患儿60例,于术前采用咽拭子法,取扁桃体、腺样体表面分泌物进行细菌培养,采用低温等离子消融系统实施腺样体切除+扁桃体部分切除手术,观察并记录其术后体温的变化.将术前细菌培养阳性组与阴性组患者术后发热情况进行比较.结果:细菌培养结果以正常菌群为主,扁桃体及腺样体检出率分别为96.7％(58/60例)及78.3％(47/60例);条件致病菌以金黄色葡萄球菌、肺炎链球菌为主,其在扁桃体的检出率分别为28.3％(17/60例)和11.7％(7/60例),在腺样体的检出率分别为26.7％(16/60例)和16.7％(10/60例);术前细菌培养阳性组与阴性组比较,两组术后发热率差异无统计学意义(P=0.052).结论:儿童扁桃体及腺样体术前细菌培养阳性与术后发热无关.     

低温等离子消融切除术治疗儿童扁桃体、腺样体肥大的效果

目的探讨低温等离子消融切除术治疗儿童扁桃体、腺样体肥大的效果。方法将74例儿童扁桃体腺样体肥大患者随机分为2组,每组37例。观察组使用低温等离子消融切除扁桃体、腺样体,对照组实施扁桃体剥离术及腺样体刮除术。结果观察组手术时间、鼻腔恢复利通气时间短于对照组,术后并发症发生率低于对照组,差异有统计学意义(P0.05)。结论低温等离子消融切除术治疗儿童扁桃体、腺样体肥大,创伤小、并发症发生率低、术后恢复快。     

低温等离子双扁桃体加腺样体切除术治疗儿童OSAHS的疗效研究

目的研究全麻下低温等离子技术在儿童双扁桃体加腺样体切除术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中的运用效果。方法回顾性分析2018年4月至2019年12月在本院接受手术治疗的100例OSAHS患儿作为研究对象。按照手术方法将所有患儿分为研究组与对照组各50例。对照组给予传统手术治疗;研究组患者给予全麻下低温等离子切除术对双扁桃体加腺样体进行切除治疗。比较两组的手术时间、术中出血量、白膜脱落时间、术后24小时数字疼痛分级法(VAS)评分、治疗效果与术后并发症发生率。结果研究组患者的手术时间、白膜脱落时间明显短于对照组,术中出血量明显少于对照组,术后24小时数字疼痛分级法(VAS)明显低于对照组(P0.05)。研究组治疗总有效率明显高于对照组(P0.05)。两组患儿的术后并发症发生率相比(P0.05)。结论全麻下低温等离子技术在双扁桃体加腺样体切除术治疗儿童OSAHS中治疗效果显著,并发症少,值得推广应用。     

非接触式激光前列腺切除400例分析

目的：总结非接触式激光治疗前列腺增生症（ＢＰＨ）的疗效。方法;对４００例ＢＰＨ患者采用Ｎｄ：ＹＡＧ非接触式激光经尿道行前列腺切除术,术后随访３个月－４年。结果：治疗总有效率为８５．０％,无尿失禁,膀胱穿孔等严重并发症,治疗前后国际前列腺症状评分,最大尿流率,平均尿流率,残余尿量及前列腺重复等主客观参数测定值经统计学处理均有显著性差异。     

AG、Schfer和URA图在诊断膀胱出口梗阻中的应用

目的　评价ＡＧ、Ｓｃｈａｆｅｒ 和ＵＲＡ 图诊断前列腺增生症（ＢＰＨ） 膀胱出口梗阻（ＢＯＯ） 的价值。　方法　应用ＡＧ、Ｓｃｈ¨ａｆｅｒ 和ＵＲＡ 图对１６０ 例ＢＰＨ 患者的压力流率检查结果进行比较分析。　结果　ＡＧ、Ｓｃｈ¨ａｆｅｒ 和ＵＲＡ 图诊断ＢＯＯ 者分别为７３ ．７ ％ 、７３ ．７ ％ 和７６ ．２ ％ 。　结论　ＡＧ、Ｓｃｈ¨ａｆｅｒ和ＵＲＡ 图诊断ＢＯＯ 的结果差异无显著性。对于ＡＧ 图中可疑梗阻和Ｓｃｈ¨ａｆｅｒ 图中Ⅱ级或以下的患者，应进一步用ＵＲＡ 图和ＰＱ 图分析，有助于得出准确结论。     

Madigan手术103例报告

目的 提高良性前列腺增生症开放手术治疗效果。方法 采用耻骨后保留尿道前列腺增生部切除术治疗良性前列腺增生症患者１０３例。结果 １０３例均手术成功,随访１～５６个月,效果满意,并发症少。结论 耻骨后保留尿道前列腺增生部切除术为较理想的良性前列腺增生开放手术治疗方法。     

Participation of a Pure Neuronal Mechanism in the Control of Gonadal Functions

The present review summarizes the data on the existence of a neural connection between the gonads and the central nervous system. As an experimental model the development of compensatory ovarian hypertrophy following unilateral ovariectomy was studied. Unilateral ovariectomy or orchidectomy resulted in a higher cellular activity in the hypothalamic arcuate neurons contralateral to hemigonadectomy and an increased luteinizing hormone-releasing hormone content in the medio-basal hypothalamus ipsilateral to the removed gonad. Local treatment of the remaining ovary with 6-hydroxy-dopamine prevented the development of compensatory ovarian hypertrophy after unilateral ovariectomy. Hemitransection of the spinal cord contralateral to hemigonadectomy, different unilateral hypothalamic deafferentations of the medio-basal hypothalamus as well as unilateral lesion of the medial preoptic area or of the arcuate nucleus blocked the compensatory ovarian growth when the brain surgery was on the same side as ovariectomy. Furthermore, in hypophysectomized + unilaterally ovariectomized rats a less severe ovarian atrophy occurred than in animals solely with hypophysectomy. All these data favour the view that - besides the hormonal control - a pure neuronal mechanism is also involved in the regulation of gonadal functions.     

前列腺增生症的逼尿肌功能改变

为了研究前列腺增生症（ＢＰＨ）病人的逼尿肌功能改变，对４２例ＢＰＨ病人进行了尿动力学研究。结果表明：８例逼尿肌代偿（ＣＣＤ）、９例逼尿肌无力（ＡＣＤ）、１５例逼尿肌不稳定（ＤＩ），ＤＩ组病人术后出现明显的膀胱刺激症状及膀胱痉挛，服用异博定、普鲁苯辛、安定和泌尿灵四联药物后症状明显减轻。认为ＢＰＨ患者除膀胱逼尿肌发生代偿性改变外，还发生逼尿肌不稳定性收缩和逼尿肌收缩无力等改变。术前尿动力学检查可以指导临床治疗，对伴有ＤＩ者术前服用钙离子通道阻滞剂为主的四联药物，可以减轻膀胱刺激症状。     

鼻翼及鼻尖肥大的美容整复

目的:探讨矫正鼻翼鼻尖肥大的最佳手术方法。方法:依鼻翼、鼻尖肥大的特点,采取横向缩小鼻翼法,并注重鼻翼外侧脚的移位。鼻尖整形行开放式手术入路,重塑鼻翼软骨,并把切除下的鼻翼组织块去表皮后置到鼻假体上。结果:30例鼻翼鼻尖肥大患者均取得了良好的手术效果。结论:鼻翼、鼻尖肥大要整体诊治,才能取得良好的手术效果。     

前列腺增生症各区细胞增殖与凋亡特征的研究

目的 探讨良性前列腺增生症（ＢＰＨ）各区细胞增殖和凋亡特征及其与ＢＰＨ发病的关系。方法 采用流式细胞术对３３例ＢＰＨ病人前列腺各区细胞表皮生长因子（ＥＧＦ）,表皮生长因子受体（ＥＧＦ－Ｒ）,碱性纤维细胞生长因子和转化生长因子－β１（ＴＧＦ－β１）表达,细胞ＤＮＡ含量和细胞凋亡情况进行定量对比分析。结果 ＥＧＦ和ＥＧＦ－Ｒ的标记率和表达量在移行区（ＴＺ）明显高于周边区（ＰＺ）和中央区（ＣＺ）。     

压力-流率测定在评估前列腺增生症手术适应证中的作用

对１２０例前列腺增生症（ＢＰＨ）患者进行了压力流率测定，以评估其在手术适应证中的作用。经Ｓｃｈｆｅｒ列线图和直线被动尿道阻力关系（ｌｉｎＰＵＲＲ）定量分析ＢＰＨ患者膀胱出口梗阻（ＢＯＯ）程度和逼尿肌收缩强度。结果表明：本组患者无ＢＯＯ和轻度ＢＯＯ者为２９．１％，逼尿肌收缩强度很弱者为７．５％，不适合前列腺手术者为３６．６％；ＢＯＯⅡ度者，ＩＰＳＳ＜７可等待性观察；ＢＯＯ＞Ⅲ度者，部分患者病情可进一步发展而需手术处理，尿流率和ＩＰＳＳ是有效的观察手段。逼尿肌收缩强度弱者，术后逼尿肌收缩功能可能改善；逼尿肌收缩强度很弱者，术后其功能难以改善     

Blood-pressure-independent wall thickening of intramyocardial arterioles in experimental uraemia: evidence for a permissive action of PTH

BACKGROUND.: Abnormalities in cardiovascular structures, e.g. LV hypertrophyand thickening of vessels (arteries, arterioles, veins) arehallmarks of renal failure. They are in part independent ofelevated blood pressure. Parathyroid hormone (PTH) has beenshown to affect cardiac function and has also been identifiedas a permissive factor in the genesis of cardiac fibrosis. PURPOSE OF THE STUDY.: The present study in rats with experimental renal failure wasdesigned to examine whether PTH was permissive for wall thickeningof intramyocardial arterioles as well. METHODS.: Male SD rats were sham operated or sub-totally nephrectomizedand maintained for 2 weeks. Subgroups of subtotally nephrectomized(SNX) rats were parathyroidectomized (PTX). Saline or rat 1,34 PTH was administered by osmotic minipump. Eucalcaemia wasmaintained in PTX animals by a high-calcium diet (3%). Serumcalcium was not statistically different between the groups.After perfusion fixation, intramyocardial arterioles were assessedusing stereological techniques (wall thickness; wall/lumen ratio;minimal lumen diameter; length density). RESULTS.: In random samples of the left ventricle, wall thickness of arterioleswas 2.2±0.25 µm in sham-op controls and 2.76±0.41in SNX (n=at least 8 animals per group). SNX-PTX animals+solventdid not differ significantly from sham-op controls (2.08±0.42µm), while SNX-PTX animals+PTH had values not significantlydifferent from SNX (2.59±0.54 µm). Differencesin wall thickness were not paralleled by differences in systolicblood pressure (sham-op 110±13.3 mmHg; SNX 138±8.4mmHg, SNX PTX+solvent 142±5.2 mmHg; SNX-PTX+PTH 148±5.7mmHg). PTH treated animals showed signs of marked vascular smooth-musclecell and endothelial-cell activation. CONCLUSIONS.: The data suggest that wall thickening of intramyocardial arteriolesin short-term experimental uraemia is dependent upon the presenceof PTH (permissive effect).     

Donor left ventricular hypertrophy increases risk for early graft failure

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007). Received: 12 February 1996 Received after resision: 27 June 1997 Accepted: 14 July 1997