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窦炎鼻息肉113例疗效观察

目的分析鼻内镜手术治疗慢性鼻窦炎鼻息肉的效果。方法对113例慢性鼻窦炎鼻息肉患者均给予鼻内镜手术治疗,回顾性分析患者的临床资料。结果本组均成功完成手术。术中出血量(58.58±9.11)m L,总有效率为95.57%。术后随访6~13个月,末次随访患者头痛、面部疼痛、鼻塞、嗅觉障碍等症状评分较术前均显著降低,差异有统计学意义(P0.05)。结论采用鼻内镜手术治疗慢性鼻窦炎鼻息肉,症状改善明显,复发率低。     

鼻内镜手术治疗慢性鼻窦炎及鼻息肉252例疗效观察

目的:观察鼻内镜手术治疗慢性鼻窦炎、鼻息肉的临床疗效.方法:对252例慢性鼻窦炎、鼻息肉患者行鼻内窥镜下手术局麻或全麻下采用Messerklinger术式,术后随访1年.结果:治愈186例(73.8%),好转56例(22.2%),无效10例(2.7%).总有效率96.0%.无效病例中多为中鼻道瘢痕粘连、筛窦区瘢痕粘连、窦口闭塞、上颌窦开口闭塞、中鼻道引流不畅.手术并发症7例其中上颌窦开口狭窄或闭锁4例、眶内淤血1例、鼻腔粘连2例.结论:鼻内窥镜下鼻窦炎、鼻息肉手术治疗具有良好的疗效,术前准备充分,熟练的麻醉技术,术者丰富的操作经验,术中正确处理中、下鼻甲及鼻中隔,术后定期随访可提高治愈率,减少并发症.     

慢性鼻-鼻窦炎鼻内镜术后反复流脓涕原因分析

目的探讨慢性鼻-鼻窦炎经鼻内镜术后反复流脓涕的原因,从中吸取经验和教训,进一步提高该病的治愈率。方法回顾分析慢性鼻-鼻窦炎经鼻内镜手术的临床资料,随访术后疗效并进行统计。结果本组104例(201侧),出现反复流脓涕的患者24例,其中上颌窦粘膜息肉样变8例(12侧,6.0%),上颌窦自然口狭窄6例(7侧,3.5%),中鼻甲与鼻腔外侧壁粘连5例(8侧,4.0%),鼻中隔高位偏曲3例(3侧,1.5%),下鼻甲肥大2例(4侧,2.0%),鼻腔鼻窦粘膜纤毛功能不良1例(2侧,1.0%)。结论反复流脓涕的原因主要是由于上颌窦积脓所致,而正确处理中鼻甲和上颌窦自然口是预防此类情况发生的关键所在。     

鼻内镜手术治疗慢性鼻窦炎伴鼻息肉的临床效果观察

目的探讨鼻内镜手术治疗慢性鼻窦炎伴鼻息肉的临床效果。方法对60例慢性鼻窦炎伴鼻息肉患者采用鼻内镜手术治疗,回顾性分析患者的临床资料。结果本组患者均顺利完成手术,总有效率96.67%(58/60)。术中、术后出现鼻腔粘连1例,眶纸板损伤1例。经积极处理后缓解,余未出现大出血等其他严重并发症。随访12个月,未见复发病例。结论鼻内镜下手术治疗慢性鼻窦炎伴鼻息肉,疗效肯定。做好术前准备、熟练掌握镜下操作技能及术后合理综合治疗,是提高慢性鼻窦炎伴鼻息肉治愈率,减少并发症的关键。     

鼻内镜手术治疗慢性鼻窦炎鼻息肉临床分析

目的探讨鼻内镜手术治疗慢性鼻窦炎、鼻息肉的效果。方法对102例慢性鼻窦炎、鼻息肉患者采取鼻内镜手术治疗,对患者的临床资料进行回顾性分析。结果随访1～2年,痊愈74例,好转19例,无效9例,总有效率91.18%。并发框内淤血5例,占4.90%,鼻腔粘连7例,占6.86%。结论鼻内镜手术治疗慢性鼻窦炎及鼻息肉效果良好。术前准备充分,熟练和准确手术操作,术后对患者进行定期随访,可有效降低并发症发生率。     

鼻内镜手术治疗慢性鼻-鼻窦炎200例临床观察

目的观察鼻内镜手术治疗慢性鼻-鼻窦炎的效果。方法随机将400例慢性鼻-鼻窦炎患者分为2组,各200例。对照组采取传统开放手术,观察组采取鼻内镜手术。比较2组治疗效果。结果观察组显效率及总有效率均高于对照组,差异有统计学意义(P0.05)。术后6个月观察组患者的鼻分泌物、鼻塞、头痛、嗅觉障碍评分低于对照组,差异有统计学意义(P0.05)。观察组复发率及并发症发生率均低于对照组,差异有统计学意义(P0.05)。结论鼻内镜手术治疗慢性鼻-鼻窦炎,可有效改善鼻分泌物、鼻塞、头痛、嗅觉障碍等症状,还可降低术后复发率,并发症较少,疗效显著。     

鼻息肉及慢性鼻窦炎鼻内窥镜手术后复发原因及分析

目的:探讨鼻内窥镜手术治疗鼻息肉慢性鼻窦炎术后复发的原因,从而提高手术疗效。方法:对2004～2010年我院收治的复发性鼻息肉鼻窦炎42例患者资料进行回顾性分析。结果:中鼻甲处理不当与周围结构粘连14例,上颌窦窦口阻塞9例,病灶清除不彻底10例,钩突尾端残留未切干净3例,鼻中隔高位偏曲未同期矫正致术后复发6例。结论:鼻内窥镜手术前详细的CT阅片,缜密的手术方案,术中熟练掌握鼻内窥镜手术的鼻腔解剖,尤其是鼻腔外侧壁的解剖学特点,熟练的手术技巧和方法,术后定期鼻内窥镜随访换药,精细的清理术腔,鼻腔冲洗,是保证手术成功,提高手术疗效,减少手术复发的关键。     

慢性鼻-鼻窦炎患者细菌生物膜表达与细菌培养的相关性研究

目的 探讨细菌生物膜在慢性鼻-鼻窦炎（chronic rhinosinusitis,CRS）患者鼻黏膜中的表达与细菌培养的相关性.方法 获取90例CRS患者的手术黏膜样本,并以5例鼻中隔偏曲患者及10名健康志愿者的钩突黏膜样本作为对照.所有样本均行细菌培养及扫描电子显微镜检查,细菌生物膜表达与细菌培养的相关性分析采用Pearson检验.结果 90例实验组患者中,64例观察到细菌生物膜,阳性率为71.1%,其中60例（66.7%）患者细菌培养阳性.实验共检出61株细菌,其中检出率最高的为表皮葡萄球菌,占41.0%（25/61）.对照组及其余26例实验组患者均未观察到细菌生物膜,也未培养出需氧或厌氧菌.细菌培养与细菌生物膜间的Pearson相关系数为0.901（P=0.000）.结论 CRS患者鼻黏膜中细菌生物膜表达与细菌培养阳性结果高度相关.     

小儿鼻窦炎的综合治疗

目的探讨儿童双侧扁桃体切除术和（或）鼻内镜下腺样体切除术联合上颌窦穿刺冲洗术及术后置管引流术治疗小儿鼻窦炎疗效。方法回顾性分析笔者所在医院2008年2月～2010年11月行双侧扁桃体切除术和（或）鼻内镜下腺样体切除术联合上颌窦穿刺冲洗术和（或）术后置管引流术治疗小儿鼻窦炎,术后随访6个月以上以观察其疗效。结果扁桃体切除术和（或）经鼻内镜下腺样体切除术并上颌窦穿刺冲洗术及术后置管引流术后患儿流脓涕、鼻塞、中鼻道分泌物、打鼾改善率分别是82.35%（28例）、66.35%（23例）、79.41%（27例）、97.06%（33例）。总积分下降率为77.29%。34例患者中,23例显效,10例有效,1例无效。结论扁桃体切除术和（或）经鼻内镜下腺样体切除术联合上颌窦穿刺冲洗术及术后置管引流是治疗合并慢性扁桃体（或肿大）和（或）腺样体肥大之小儿慢性鼻窦炎的安全、有效方法。     

Vitamin d3 deficiency increases sinus mucosa dendritic cells in pediatric chronic rhinosinusitis with nasal polyps

Objective Dendritic cells are professional antigen presenting cells, capable of initiating Th1 or Th2 responses, and have been implicated in the pathogenesis of a number of diseases, including sinusitis. Vitamin D(3) is a steroid hormone that acts on dendritic cells in a manner similar to corticosteroids. Investigators examined whether children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were vitamin D(3) deficient and the relationship of vitamin D(3) deficiency to dendritic cell infiltrate in the sinus mucosa. Setting Tertiary care university hospital. Study Design Retrospective, controlled study using samples collected from pediatric patients seen from August 2009 to July 2011. Subjects and Methods Plasma levels of 25-hydroxy vitamin D(3) were measured by enzyme-linked immunosorbent assay in children (≤18 years old) with AFRS, CRSwNP, or CRS without nasal polyposis (CRSsNP) and in controls undergoing surgery for adenotonsillar hypertrophy. Vitamin D(3) levels were confirmed using clinical diagnostic methods for those with CRSwNP or AFRS. Tissue samples were immunohistochemically stained for the dendritic cell marker CD209 and the costimulatory molecules CD80 and CD86. Results There was no difference in mean vitamin D(3) levels between control and CRSsNP, whereas mean CRSwNP and AFRS levels were both well below the minimum recommended level of 30 ng/mL and significantly lower than control and CRSsNP levels. CD209(+) dendritic cells inversely correlated with vitamin D(3) but not costimulatory molecule expression. Conclusions These studies identify that children with CRSwNP or AFRS are vitamin D(3) deficient, which may be linked to increased dendritic cell infiltrate. These results suggest a role for vitamin D(3) as a key player in the immunopathology of pediatric CRSwNP.     

鼻内镜手术治疗真菌性鼻窦炎19例

目的探讨鼻内镜手术冶疗真菌性鼻窦炎的疗效。方法2000年1月～2003年12月对19例真菌性鼻窦炎在鼻内镜下清理中鼻道息肉或肉芽，切除钩突，扩大各窦口，清除窦内病变。术中3％H2O2反复冲洗窦腔。中隔偏曲致病侧中鼻道狭窄影响窦口引流，一期行鼻中隔矫正术。结果术后5例症状缓解，14例症状消失。19例随访6～48个月，平均14个月，17例未复发，2例复发，再次行Caldwell-Luc手术，无一例并发症发生。结论鼻内镜手术治疗非侵袭型真菌性鼻窦炎有较好的临床疗效，但对严重上颌窦真菌病仍不能替代Caldwell-Lues手术。     

Effect of endoscopic sinus surgery on asthmatic patients with chronic rhinosinusitis.

There have been several reports on the effectiveness of endoscopic sinus surgery (ESS) in asthmatic patients with chronic rhinosinusitis. Whether ESS has a positive effect on the clinical course of asthma still remains controversial. There have been several subjective evaluations but few objective results. We performed a study to evaluate the effectiveness of ESS in 19 patients with asthma who underwent ESS for rhinosinusitis. The use of antiasthma medication and postoperative asthma symptoms was analyzed. Objective changes of pulmonary function tests were evaluated. There was a significant improvement in diurnal and nocturnal asthma symptoms. Improvements in asthma medication scores were also confirmed, and individual asthma symptoms (dyspnea, cough, wheezing, and sputum production) improved significantly. Despite a reduction in use of antiasthma medication after ESS, the parameters of the pulmonary function tests did not change. Both subjectively and objectively, it seems that ESS, when used to treat asthmatic patients with chronic rhinosinusitis, can play a significant role in the clinical improvement of asthma.     

梗阻性黄疸时胆道的细菌学特点

本文收集１９８０年至１９９５年所作的肝外胆道患者细菌培养６４１例及其药敏试验结果资料，进行回顾性分析，并就胆道感染途径及常见细菌和其药物敏感性问题讨论。大肠杆菌仍是梗阻性黄疸合并感染时的常见致病菌，但条件致病菌、厌氧菌等感染增加。梗阻性黄疸合并感染时抗生素选用应遵循一定的原则，并应同时给以提高免疫力等综合治疗措施。     

Measurement of nasal dimensions and nasal indexes in patients with chronic dacryocystitis and its relationship to the sex of the patient

Chronic dacryocystitis is seen more commonly in females than males. This study was designed to determine why this should be the case. The nasal dimensions were measured and the nasal indexes in patients with chronic dacryocystitis (in both sexes) and in controls were calculated. Both of these values were smaller in females when compared with controls and males. It is concluded that besides other causes, the nasal dimensions in females were predisposing factors for their increased incidence of dacryocystitis. Received: 7 July 1997 / Accepted: 14 August 1997     

胆固醇息肉病人胆囊黏膜ABCG1表达的研究

目的:探讨ABCG1基因在胆囊黏膜中的表达与胆固醇息肉病的关系。方法:采集15例胆囊胆固醇息肉病病人和8例无息肉无结石之对照组的胆囊黏膜和胆汁。测定胆汁胆固醇、胆汁酸和磷脂含量;real-time PCR测定胆囊黏膜中ABCG1 mRNA的表达;Western印迹法检测胆囊黏膜ABCG1之蛋白表达。结果:胆固醇息肉组胆汁胆固醇饱和指数、ABCG1mRNA表达均较对照组升高(P<0.05);息肉组中胆囊黏膜ABCG1在蛋白水平较对照组同样存在高表达。结论:胆固醇息肉病人之胆囊黏膜ABCG1基因及蛋白高表达,可能在胆固醇息肉疾病的发生、发展中起一定作用。     

Histopathologic parameters as predictors of response to endoscopic sinus surgery in nonallergic patients with chronic rhinosinusitis.

OBJECTIVE: To estimate the predictable value of histopathologic parameters in chronic rhinosinusitis (CRS) for response to endoscopic sinus surgery (ESS). STUDY DESIGN: Symptomatology was rated in 100 patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were examined and scored for goblet cells, subepithelial thickening, mast cells, and eosinophils. Multiple regression analysis was performed to predict the total score of subjective symptoms before treatment by histopathologic parameters. The correlation between histopathologic parameters and postoperative symptoms was then evaluated. RESULTS: Goblet cells were the best predictor correlating with 5 symptoms. Subepithelial thickening correlated with 4 symptoms. Mast cell infiltration correlated with 3 symptoms. Eosinophilic infiltration correlated with only one symptom (P<0.05). CONCLUSION: Certain histopathologic parameters in CRS are predictive of favorable response to ESS. SIGNIFICANCE: Pathologic evaluation may help the ENT surgeon to predict the persistence of certain CRS symptoms after ESS, even in patients at low risk for surgical failure. EBM rating: C-4.     

Prevalence of allergy in patients with chronic rhinosinusitis.

OBJECTIVES: The purpose of this study was to provide further evidence that allergic rhinitis is an important factor in chronic and recurrent acute rhinosinusitis. Specifically, this study shows that perennial allergens play a more significant role than seasonal allergens. STUDY DESIGN AND SETTING: Census by chart review of patients with chronic and recurrent acute rhinosinusitis presenting to the Department of Otolaryngology at the MetroHealth Medical Center, Cleveland, OH. METHODS: All participants had allergy testing done either by RAST or intradermal skin endpoint titration utilizing a battery of seasonal and perennial antigens. RESULTS: Of the 48 voluntary participants analyzed in this study, 57.4% had a positive allergy test. Most patients in the study were sensitive to more than one allergen. Of the patients with a positive allergy test, 92% demonstrated sensitivity to one or more perennial allergens-most prominently, molds and dust mites. CONCLUSIONS: Perennial allergy has a statistically significant association with chronic and recurrent acute rhinosinusitis. SIGNIFICANCE: The diagnosis and management of perennial allergies may be beneficial when treating chronic sinus disease.