日间手术模式下内镜辅助低温等离子腺样体消融术的临床探讨

目的 探讨日间手术模式下内镜辅助低温等离子腺样体消融术的可行性和安全性。方法 回顾分析2018年1—12月佛山市第一人民医院耳鼻咽喉头颈外科收治的108例腺样体肥大患者的临床资料，根据住院流程分为日间组65例和住院组43例。日间组于门诊完成各项检查，24 h内完成入院、手术、出院。比较两组患者手术情况（手术时间、出血量）、围手术期并发症（术后疼痛、发热、出血）和住院相关指标（术前等待时间、住院时间、住院总费用、西药费）。结果 日间组65例患者均顺利完成手术，日间组和住院组的手术时间分别为（6.9±2.3） min和（7.5±2.8） min，出血量分别为（5.2±3.6） mL和（5.5±2.4） mL，组间比较差异无统计学意义（P>0.05）。日间组3例出现术后发热、无术后出血、平均疼痛指数评分为（1.6±0.5）分；住院组6例出现术后发热、无术后出血、平均疼痛指数评分为（2.1±1.1）分，组间比较差异无统计学意义（P>0.05）。日间组和住院组临床疗效分别是96.9%（63/65）和95.3%（41/43），两组差异无统计学意义（P=0.935）。日间组术前等待时间和住院时间分别为（1.2±0.6） h和（10.5±2.8） h，较住院组术前等待时间（21.5±5.8） h和住院时间（76.2±12.5） h均明显缩短（P<0.001）。日间组住院总费用和西药费分别是（9 629.1±206.8）元和（650.4±54.3）元，亦较住院组住院总费用（11 672.7±1 016.2）元和西药费（779.5±103.9）元明显减少，差异具有统计学意义（P<0.05）。结论 日间手术模式下开展内镜辅助低温等离子腺样体消融术是安全、有效的，与住院手术相比可大大缩短术前等待时间和住院时间，降低住院费用，有助于减少医疗资源的消耗，加快病房运行效率。     

耳内镜与显微镜下Ⅰ型鼓室成形术的临床疗效分析

目的 探讨耳内镜与显微镜下Ⅰ型鼓室成形术治疗鼓膜穿孔患者的临床疗效。方法 收集2017年1月-2020年10月因慢性化脓性中耳炎行Ⅰ型鼓室成形术122例（122耳）,其中耳内镜下Ⅰ型鼓室成形术（ETT）62例;显微镜下Ⅰ型鼓室成形术（MTT）60例。所有患者术后均随访6个月以上,比较两组患者术中出血量、鼓索神经损伤率、手术时间、术后出院时间、住院费用,鼓膜愈合情况,对手术前与术后6个月的平均气导听阈（PTA）,气骨导差（ABG）进行分析,采用视觉模拟评分（VAS）评估患者术后24h疼痛反应。结果 ETT组具有术中出血量少、手术时间短、术后疼痛反应轻、出院时间缩短、住院总费用少等优越性,两组差异具有统计学意义（P<0.05）。ETT和MTT组中鼓膜愈合率分别为93.5%和90.0%,鼓索神经损伤率分别为6.5%和8.3%;ETT组术前PTA为（43.2±11.3）dB、AGB为（19.8±8.6）dB,MTT组术前PTA为（45.6±12.1）dB,AGB为（21.3±9.4）dB。术后6个月复查PTA两组均下降,ETT组为（33.7±8.3）dB,MTT组为（35.3±9.1）dB;复查ABG两组均下降,ETT组为（9.4±6.1）dB,MTT组为（10.7±6.4）dB。两组术式差异无统计学意义（P>0.05）。结论 与MTT相比,ETT能明显减轻术后疼痛、缩短手术时间、住院时间,减少总住院费。在术后穿孔修补、听力改善以及并发症等方面与传统手术MTT疗效相当,值得在中耳手术中推广使用。     

老年性聋患者认知功能障碍初探

目的 分析老年性聋患者认知功能障碍情况,初步探讨老年性聋患者认知功能障碍的干预措施。方法 以2018年10月-2020年4月于空军特色医学中心行听力测试及言语识别能力调查的55例60岁及以上老年性聋患者为研究对象,其中男27例,女28例;年龄60~95岁。所有研究对象完成纯音听阈测试（PTA）、简易智能精神状态量表（MMSE）评估及普通话快速噪声下言语测试（M-Quick SIN）,分析不同年龄、不同听力损失程度和信噪比损失（SNR loss）程度下老年性聋患者的MMSE得分情况。结果 ①60~69岁组MMSE得分（27.89±1.82）分,高于70~79岁组（26.35±2.03）分和≥ 80岁组（25.19±2.07）分的得分,差异具有统计学意义（P<0.05）;70~79岁组和≥ 80岁组间MMSE量表得分的差异不具有统计学意义（P>0.05）;②不同听力损失组间MMSE量表得分的差异不具有统计学意义（P>0.05）;③轻度SNR loss组的MMSE量表得分（27.13±1.80）分高于重度SNR loss组（24.20±1.64）分（P<0.05）;轻度SNR loss组和中度SNR loss组、中度SNR loss组和重度SNR loss组间MMSE量表得分的差异不具有统计学意义（P>0.05）。结论 老年性聋患者认知功能障碍以SNR loss为主要特征,在听力损失早期进行干预是最佳时机。     

先天性耳廓畸形耳模矫正的疗效分析

目的 分析先天性耳廓畸形耳模矫正治疗的临床疗效。方法 回顾2019年1月—2021年12月在湖南省妇幼保健院耳鼻咽喉科门诊进行耳模矫正的201例（318耳）先天性耳廓畸形患儿，按患儿开始治疗的日龄将其分为3组：109例（181耳）<14 d的患儿为1组，75例（117耳）14～42 d的患儿为2组，17例（20耳）43～89 d的患儿为3组；分析3组患儿的治疗效果、治疗时长、并发症发生率等。结果 201例（318耳）先天性耳廓畸形患儿治疗的显效及治愈率为93.4%，佩戴时长平均（32.4±10.8） d，并发症发生率45.9%。3组的治疗显效及治愈率分别为96.7％、90.6％、80.0％，组间差异具有统计学意义（χ²=10.479，P=0.005）；3组的矫正时长分别为（30.2±10.4）、（35.2±10.8）、（35.5±9.7） d，组间差异具有统计学意义（F=8.940，P=0.000）；3组的并发症发生率分别为37.0％、59.8％和45.0％，差异具有统计学意义（χ²=14.900，P=0.001）。结论 先天性耳廓畸形患儿通过耳模矫正可获得良好的治疗效果，14 d内开始治疗有助于提高治疗效率，缩短治疗时长，降低并发症发生率。     

梅尔频率倒谱系数在声带息肉手术前后嗓音分析中的价值研究

目的 本研究拟通过提取患者嗓音中的梅尔频率倒谱系数(MFCC)指标,探讨其在声带息肉手术前后嗓音分析中的临床价值。方法 回顾性分析于2018年1月—2019年8月行声带息肉手术且术前及术后1个月均行嗓音评估的患者41例,男31例,女10例;平均年龄(42.9±11.4)岁。另选取无声嘶且无声带病变的正常受试者21例作为基线对照。使用基于Python编程语言的librosa语音处理包进行MFCC特征提取,分别提取每位患者的MFCC均值,MFCC方差与MFCC标准差,使用配对样本t检验比较声带息肉手术前后上述各MFCC特征的差异。结果 声带息肉患者术后MFCC均值1.25±1.01、MFCC方差561.34±154.98及MFCC标准差21.74±4.03比术前MFCC均值6.81±2.05、MFCC方差1 019.66±295.87及MFCC标准差34.37±6.63显著下降,差异具有统计学意义(t=18.596,P=0.000;t=10.338,P=0.000;t=11.852,P=0.000)。声带息肉组患者术后1个月其MFCC均值、MFCC方差及MFCC标准差与正常受试者相比差异均无统计学意义,表明绝大部分声带息肉患者术后嗓音得到良好的恢复。结论 本研究首次探索了MFCC在声带息肉手术前后嗓音分析中的价值, MFCC各特征可作为评估声带息肉术后嗓音恢复的指标。     

鼻声反射和鼻阻力测量在阻塞性睡眠呼吸暂停低通气综合征患者术后鼻功能评估中的应用

目的 探讨鼻声反射和鼻阻力测量在鼻腔扩容手术治疗鼻腔结构异常致阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者鼻功能评估中的应用。方法 选择经多导睡眠监测（PSG）确诊且经视觉模拟量表（VAS）评估具有鼻塞、鼻内镜及鼻窦CT检查证实结构异常的成年OSAHS患者36例作为研究对象。根据检查结果实施个体化的鼻内镜下鼻腔扩容手术。术前及术后6个月所有患者均进行VAS评估、鼻声反射测量和鼻阻力测量,比较手术前后测量结果。结果 患者术前VAS评估计分、鼻腔吸气总阻力、鼻腔呼气总阻力、鼻腔最小横截面积、鼻腔容积、最小横截面积至前鼻孔的距离分别为（6.97±1.27）分、（2.07±1.07）kPa/L·S^-1、（2.15±1.09）kPa/L·S^-1、（0.39±0.16）cm²、（2.20±0.97）cm³及（1.97±0.47）cm;术后6个月分别为（1.33±0.92）分、（1.69±1.03）kPa/L·S^-1、（1.90±1.02）kPa/L·S^-1、（0.51±0.17）cm²、（2.73±1.05）cm³及（2.19±0.46）cm。手术前后各指标差异均具有统计学意义（P均<0.05）。结论 鼻腔扩容术可以显著改善伴有鼻腔结构异常的OSAHS患者的鼻通气功能,鼻声反射和鼻阻力测量能客观评估鼻腔扩容手术治疗前后伴有鼻腔结构异常的OSAHS患者鼻通气功能的变化。     

手术预案汇报制度在耳鼻咽喉头颈外科住院医师规范化培训中的应用

目的 探讨手术预案汇报制度在耳鼻咽喉头颈外科住院医师规范化培训中的应用效果。方法 以2016—2020年在首都医科大学宣武医院耳鼻咽喉头颈外科进行住院医师规范化培训的15名住院医师为研究对象,分为实验组(8名)和对照组(7名)。对照组按照住院医师规范化培训大纲进行培训,实验组要求住院医师在完成培训大纲的基础上,制作并汇报手术预案,通过比较两组的出科考核成绩和年度考核成绩,分析手术预案汇报在教学中的效果。结果 实验组住院医师出科考核成绩为(92.44±2.41)分,而对照组为(88.79±2.67)分,差异具有统计学意义(t=-2.78,dF=13,P<0.05)。实验组住院医师年度考核成绩为(85.87±3.64)分,对照组为(80.29±2.98)分,差异具有统计学意义(t=-3.22,dF=13,P<0.05)。实验组8名住院医师共汇报预案397例,平均(49.62±17.20)例。结论 在耳鼻咽喉头颈外科住院医师规范化培训中,住院医师通过制作和汇报手术预案,巩固了基础理论知识、提高了临床思维能力,指导教师对预案中暴露出的问题进行针对性指导,提高了教学效果。     

一期手术清除胆脂瘤并发迷路瘘的疗效分析

目的 探索一期手术清除胆脂瘤并发迷路瘘的手术方法,评估一期手术清除胆脂瘤基质后的远期听力变化和手术疗效。方法 选取2014年8月—2019年8月收治的41例胆脂瘤并发迷路瘘患者,术前仔细询问症状,均行瘘管试验、耳内镜检查、纯音测听检查和高分辨率颞骨薄层CT检查提示有胆脂瘤并发迷路瘘。41例迷路瘘管覆盖的胆脂瘤基质进行一期完全切除。分析术后听力改善情况与瘘管大小的关系,评估各种诊断检查的准确性。结果 根据术前检查结合术中探查发现,12例为外耳道胆脂瘤并发迷路瘘,29例为中耳胆脂瘤并发迷路瘘。所有患者术后3个月复查骨导阈值（BC）（42.1±12.8）dB与术前BC（35.5±11.6）dB比较无显著性差异（P>0.05）。术后5例患者骨导听力下降>10 dB,其中3例为术前平均气导阈值（AC）>90 dB。术前检查听力明显下降的5例患者,术中探查发现瘘管明显大于无听力损失的患者（P<0.05）。随访12～72个月,无复发病例。结论 虽然大迷路瘘全部切除胆脂瘤基质风险较大,但为了减少胆脂瘤复发及术后听力继续下降,选择一期完全切除胆脂瘤基质是治疗迷路瘘安全有效的方法。     

组织蛋白酶B在鼻咽癌患者组织和血清中的表达及临床意义

目的 通过测定组织蛋白酶B （Capthesin B）在鼻咽癌组织和血清标本中的表达量,探讨Capthesin B作为评估鼻咽癌患者治疗预后的可行性。方法 收集长沙金域医学检验中心2019年8月—2020年2月50例鼻咽癌组织和癌旁正常组织标本,免疫组织化学（IHC）检测组织标本Capthesin B表达,比较分析蛋白表达差异。收集湖南省肿瘤医院2019年7月—2020年3月106例鼻咽癌患者治疗前、治疗后及40例健康体检者的血清标本,ELISA试验检测血清Capthesin B浓度,并比较分析3组间的血清Capthesin B浓度。结果 IHC结果显示,鼻咽癌组织Capthesin B阳性率显著高于癌旁正常组织（P< 0.001）。ELISA结果表明,鼻咽癌患者血清Capthesin B 1.23（0.64,2.27） ng/mL显著高于健康体检组的（0.98 ±0.49） ng/mL （P< 0.05）,鼻咽癌患者治疗后血清Capthesin B 0.69（0.39,1.42） ng/mL显著低于治疗前的1.23（0.64,2.27） ng/mL （P<0.001）。TNM分期III、IV患者血清Capthesin B （2.09 ±1.50） ng/mL显著高于I、II期患者的1.14（0.60,2.12） ng/mL,提示Capthesin B水平与TNM分期显著相关（P<0.05）。鼻咽癌颈淋巴结转移组血清Capthesin B （2.63±1.67） ng/mL显著高于未转移组的1.10（0.59,2.14） ng/mL （P<0.01）,提示Capthesin B与转移相关。工作特征（ROC）曲线下面积（AUC）为0.670（P<0.001）,提示血清Capthesin B可作为鼻咽癌疗效预测的参考指标。结论 鼻咽癌组织Capthesin B高表达和患者血清Capthesin B浓度明显升高,治疗后其浓度降低,提示Capthesin B与鼻咽癌发生发展密切相关。Capthesin B与肿瘤淋巴结转移及TNM分期呈正相关,提示Capthesin B可作为鼻咽癌治疗预后的参考指标。     

可视麻醉喉镜下低温等离子消融术治疗15例先天性会厌囊肿疗效观察

目的 探讨可视麻醉喉镜下低温等离子消融术治疗婴幼儿先天性会厌囊肿的临床疗效及特点。方法 选取苏州大学附属儿童医院2017年2月-2020年1月接受手术治疗的先天性会厌囊肿婴幼儿15例,对手术时间、术中出血量、创面反应进行统计分析,并观察随访半年以上。结果 15例先天性会厌囊肿患儿手术均获得成功,手术时间（22.67±7.99）min;术中出血量（3.47±1.60）mL;术后会厌创面轻度水肿3例,中度水肿2例;术后半年无1例复发。结论 可视麻醉喉镜下低温等离子消融术治疗先天性会厌囊肿具有可行性,为先天性会厌囊肿患儿提供了一种微创、安全有效的治疗方法,疗效明确,值得临床推广。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.