2011年全国鼻部感染与变态反应专题学术会议征稿通知

中华耳鼻咽喉头颈外科杂志编委会鼻科组和中华医学会耳鼻咽喉头颈外科分会鼻科学组、小儿学组拟定于2011年5月中旬在郑州市召开"2011年全国鼻部感染与变态反应专题学术会议"。本次会议的主题是慢性鼻-鼻窦炎及难治性鼻-鼻窦炎,讨论和制定我国"儿童慢性鼻-鼻窦炎诊疗指南"。本次会议征文内容包括:①《慢性鼻-鼻窦炎诊断和治疗指南》(2008年,南昌)临床应用体会;②成人及儿童慢性鼻-鼻窦炎鼻息肉的基础和临床研究;③慢性鼻-鼻窦炎鼻息肉临床诊治经验总结;④慢性鼻-鼻窦炎的感染与炎     

鼻中隔偏曲与慢性鼻-鼻窦炎相关性分析

目的 探讨鼻中隔偏曲与慢性鼻.鼻窦炎的关系.方法 对141例慢性鼻-鼻窦炎患者临床资料进行回顾性分析,同时选择136例我科无鼻病症状者作为对照组,比较鼻中隔偏曲发生情况.结果 141例慢性鼻.鼻窦炎患者中74例合并鼻中隔偏曲,占52.48%;其中鼻中隔偏曲并双侧慢性鼻-鼻窦炎56例,鼻中隔偏曲并偏曲侧慢性鼻-鼻窦炎10例,鼻中隔偏曲并偏曲对侧慢性鼻-鼻窦炎8例.136例对照组中鼻中隔偏曲者24例,占17.65%,两组之间差异有统计学意义(x2=3 6.74,P＜0.01).结论 鼻中隔偏曲是慢性鼻-鼻窦炎发病的相关因素之一.     

慢性鼻-鼻窦炎药物及外科治疗的新进展

成年人慢性鼻-鼻窦炎病因复杂，目前已知的相关因素包括：①细菌感染：急性鼻-鼻窦炎与细菌的关系基本上没有争议，但是细菌感染与慢性鼻-鼻窦炎的关系目前还不是十分明确，临床上应用抗生素的目的就是为了控制细菌感染；②真菌感染：现在知道，如果采用敏感的培养方法，几乎在所有的慢性鼻-鼻窦炎患者中都能发现真菌。但2005年的一项研究证实，应用抗真菌药物不能改善慢性鼻-鼻窦炎患者的症状和放射学体征；③变态反应：不少学者认为，变应性鼻炎与慢性鼻一鼻窦炎有相关性。大约53％的变应性鼻炎患者同时有慢性鼻-鼻窦炎，这是临床上采用抗变态反应治疗慢性鼻-鼻窦炎的理论依据；④黏液纤毛传输障碍：临床上通过盐水冲洗和应用黏液稀化促排剂，以改善慢性鼻．鼻窦炎患者的黏液纤毛传输功能；⑤解剖畸形：对于慢性鼻-鼻窦炎患者施行手术的目的就是要矫正鼻腔、鼻窦的解剖畸形，如鼻中隔偏曲、中鼻甲气化、下鼻甲肥大等。总之，临床上对慢性鼻-鼻窦炎的治疗针对的就是这些已知的相关因素。     

慢性鼻-鼻窦炎黏膜重塑研究进展

黏膜重塑在慢性鼻-鼻窦炎的发生、发展进程中起着十分重要的作用,其与难治性鼻窦炎的关系密切。慢性鼻-鼻窦炎的机制与病因复杂,现有研究表明不同亚型慢性鼻-鼻窦炎其黏膜重塑的特点不同,主要表现为组织免疫学特点及黏膜重塑相关细胞因子表达不同。本文就不同亚型慢性鼻-鼻窦炎黏膜重塑的特点以及炎症与黏膜重塑之间的关系做一综述。     

影响慢性鼻-鼻窦炎手术预后的相关因素分析

目的：探讨影响慢性鼻-鼻窦炎手术预后的相关因素。方法：回顾性分析210例经鼻内镜手术的慢性鼻-鼻窦炎患者的临床资料,通过Logistic回归模型分析影响慢性鼻-鼻窦炎患者手术预后的诸因素。结果：相关因素分析表明,患者年龄、长期应用鼻减充血剂、鼻窦手术复发、变应性鼻炎病史、鼻内镜术后的综合治疗是影响慢性鼻-鼻窦炎手术预后的独立因素。结论：评估慢性鼻-鼻窦炎手术预后的重要依据是患者年龄、是否长期应用鼻减充血剂、是否伴有变应性鼻炎病史、是否慢性鼻窦炎手术复发患者、是否坚持鼻内镜术后的综合治疗。要强调鼻内镜术后的综合治疗包括鼻内糖皮质激素的应用、术后随访和鼻腔清理、黏液稀化剂和抗生素的应用,可提高鼻内镜手术的治愈率。     

鼻内镜治疗慢性鼻-鼻窦炎疗效及影响因素分析

目的探讨慢性鼻-鼻窦炎术后疗效及影响疗效的相关因素。方法回顾性分析200例经鼻内镜手术的慢性鼻一鼻窦炎患者的临床资料,通过t检验了解术后疗效,Logistic回归模型分析影响慢性鼻-鼻窦炎患者手术预后的诸因素。结果患者术后症状明显改善,相关因素分析表明慢性鼻-鼻窦炎患者是否伴有鼻息肉、是否长期应用鼻减充血剂、是否有前期鼻窦手术史、是否伴变应性鼻炎病史、是否坚持鼻内镜术后的综合治疗是影响慢性鼻-鼻窦炎手术预后的相关因素。结论功能性鼻内镜手术作为治疗慢性鼻-鼻窦炎、鼻息肉最有效的临床方法之一,能够明显地改善患者的症状,同时强调鼻内镜术后的综合治疗,包括术后随访和鼻腔清理,鼻内糖皮质激素、黏液稀化剂和抗生素的联合应用。     

IL-17在慢性鼻-鼻窦炎患者血浆中的表达及其意义

目的 本实验旨在研究IL-17在慢性鼻-鼻窦炎患者血浆中的表达情况,探讨其在慢性鼻-鼻窦炎发生发展中的影响机制。方法 收集伴有鼻息肉慢性鼻 鼻窦炎患者38例(CRSwNP)、不伴有鼻息肉慢性鼻-鼻窦炎(CRSsNP)患者32例（柠檬酸钠抗凝）及对照组来自于门诊体检健康者28例的空腹晨血,采用ELISA法检测血浆中IL-17的含量。结果 正常对照组血浆IL-17的浓度为 1.6100（1.2575~1.9830)pg／mL ;慢性鼻-鼻窦炎组为8．2483（4.8868~10.1075) pg／mL; CRSwNP组为8.2430(6.2778~10.3610) pg／mL ; CRSsNP组为8.2550（4.8783~10.1650) pg／mL。IL-17在正常人与慢性鼻-鼻窦炎患者血浆中表达差异有统计学意义（P＜0.05）,但在CRSwNP 组与CRSsNP组差异无统计学意义。结论 慢性鼻-鼻窦炎患者血浆中IL-17明显高于正常人,推测其在慢性鼻-鼻窦炎的发生发展中起重要作用。     

慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后症状与病理学指标相关分析

目的：评估病理学指标对预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效的价值。方法：通过对53例接受鼻内镜手术1年以上的慢性鼻-鼻窦炎伴鼻息肉患者的临床症状问卷调查,阅读这些患者的手术标本病理切片,统计相关病理指标,统计学分析慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜术后的主要症状及其与病理学指标之间的联系。结果：慢性鼻-鼻窦炎伴鼻息肉患者接受鼻内镜手术后最主要的症状有鼻塞、流脓涕、流清涕或打喷嚏,其中杯状细胞与打喷嚏、流脓涕症状,病理性腺体形成与头昏症状,组织水肿程度与后鼻滴漏症状相关（P〈0.05）。结论：病理学指标有助于预测慢性鼻-鼻窦炎伴鼻息肉患者鼻内镜术后疗效。     

2011年全国鼻部感染与变态反应专题学术会议征稿通知

中华耳鼻咽喉头颈外科杂志编委会鼻科组和中华医学会耳鼻咽喉头颈外科分会鼻科学组、小儿学组拟定于2011年5月中旬在郑州市召开＂2011年全国鼻部感染与变态反应专题学术会议＂。本次会议的主题是慢性鼻-鼻窦炎及难治性鼻-鼻窦炎,讨论和制定我国＂儿童慢性鼻-鼻窦炎诊疗指南＂。本次会议征文内容包括：①《慢性鼻-鼻窦炎诊断和治疗指南》（2008年,     

唾液酸Lewis-X在慢性鼻-鼻窦炎鼻黏膜组织中的表达

目的:探讨唾液酸Lewis-X(SleX)在慢性鼻-鼻窦炎鼻黏膜组织中的表达.方法:利用SleX单克隆抗体,通过免疫组织化学技术对9例慢性鼻-鼻窦炎患者鼻黏膜组织及7例正常对照鼻黏膜组织进行染色,分析SleX在鼻黏膜组织中的表达.结果:SleX在鼻黏膜上皮细胞及中性粒细胞均有表达.SleX在慢性鼻-鼻窦炎鼻黏膜上皮细胞中的表达阳性率为88.9%,在正常鼻黏膜上皮细胞中的表达阳性率为14.3%,差异有统计学意义(P<0.05).结论:SleX在慢性鼻-鼻窦炎黏膜组织高表达,可能参与慢性鼻-鼻窦炎的发生.     

变应原气道激发在变应性鼻炎和哮喘研究中的作用研究进展

随着城市化进程，环境及生活方式的改变，我国变应性疾病发病率逐年升高。目前认为变应性鼻炎和哮喘的发病主要是在遗传基因、环境因素共同作用下导致，但具体发病机制复杂，尚未完全清楚。慢性气道炎症和气道高反应性是变应性鼻炎和哮喘的典型的病理生理特征。环境中变应原的暴露可诱发疾病症状发作，引起气道及全身炎症反应增加，并导致气道敏感性/反应性升高。人为给予变应性鼻炎或哮喘患者呼吸道变应原吸入刺激，可以模拟其变应原自然暴露所致疾病症状发作，研究其病理生理变化，尚可通过药物干预评估其对症状及炎症抑制程度评估药物治疗效果。同时变应性鼻炎和哮喘作为上下气道疾病，相互影响，通过一端变应原刺激研究气道另一端症状及炎症反应，探讨上下气道之间的联系。屋尘螨为我国,特别是南方地区最主要、最常见的变应原，与疾病关系密切。主要从屋尘螨变应原鼻激发和支气管激发方法学及其在鼻炎和哮喘的研究中的应用作一综述。     

An overview of the etiology of otosclerosis

Otosclerosis is the primary disease affecting the homeostasis of otic capsule and is among the most common causes of acquired hearing loss. Otosclerosis is considered as a multifactor disease, caused by both genetic and environmental factors. The aim of the present review is to summarize and analyze the bibliographic data, associated with the etiology of the disease. In some cases, the otosclerosis has an autosomal dominant mode of inheritance with incomplete penetrance. Genetic studies reveal the occurrence of at least nine chromosomal loci as candidate genes of the disease. The localized measles virus infection of the otic capsule has been postulated as a possible etiological theory. The role of hormonal factors, immune and bone-remodeling system in the etiopathogenesis of otosclerosis and the association of the disease with the disorders of the connective tissue are the issues of the present study. Despite the extensive research, many etiological factors and theories have been suggested and the process of development of the otosclerosis remains unclear.     

水杨酸钠作用后大鼠海马内葡萄糖和乳酸水平变化

目的探讨边缘系统海马在耳鸣发病机制中的作用。方法在水杨酸钠诱导建立的耳鸣动物模型基础上,利用微透析技术结合葡萄糖和乳酸双组分同时在线电化学检测方法 ,活体、实时、动态研究水杨酸钠作用后大鼠海马内葡萄糖及乳酸水平的变化。结果水杨酸钠引起大鼠海马葡萄糖和乳酸水平显著性地升高。在2h内葡萄糖和乳酸分别最高升到基线水平的(234±26)%和(188±14)%,在第4小时和第5小时恢复至基线水平。生理盐水对照组未引起任何明显变化。结论大鼠海马内葡萄糖和乳酸水平的显著性升高提示海马内神经元活动明显增高,这可能与水杨酸钠诱导的耳鸣产生有关,这些活体数据为边缘系统参与耳鸣的发生提供直接的实验证据。     

Current trends and applications in endoscopy for otology and neurotology

There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.     

腺样体肥大患儿上气道气流流场模型的建立与数值分析

目的对9例腺样体肥大患儿病态和模拟手术后以及1例健康儿童上气道结构进行三维重建,对气流流场进行数值模拟,总结患儿术前、术后气流流场特征并与健康儿童气流流场对比,评价腺样体切除术的术后疗效。方法根据9例腺样体肥大患儿和1名健康儿童的上气道CT影像,应用表面重建的方法对其进行三维重建,修改CT图片,去除患儿腺样体肥大部分的信息,再重建术后模型。用有限元法对上述重建模型上气道气流进行数值模拟,分析气流流场特征。结果病态模型中,鼻咽部气流形态紊乱,术后及健康儿童模型中,鼻咽部气流形态更为规律;所有重建模型从鼻尖至声门的总体压强降均明显降低(t=6.068,P=0.000),病态模型的压强变化梯度主要集中在鼻阈及腺样体与扁桃体交界区域,术后及健康儿童模型的压强变化梯度主要集中在鼻阈区;病态模型呼吸道的高流速区主要集中在鼻阈、中鼻道和鼻咽部,术后模型鼻咽部的高流速区减小或消失,基本接近健康儿童气流流速分布特征。结论数字化三维重建病态及模拟手术后模型能较好的反映临床病例的术前、术后上气道气流分布情况,可从三维立体角度考虑患儿上气道的阻塞因素,为临床治疗提供参考。     

Correction of the Glosso-Larynx and Resultant Positional Changes of the Hyoid Bone and Cranium

In ankyloglossia with deviation of the epiglottis and larynx (ADEL) the tongue is located forward and as a result the epiglottis is elevated and leans towards the mouth. The larynx is also raised and curves ventrally. Various symptoms have been observed as a result of this condition. Correction of the glosso-larynx (CGL) is the operation performed to treat ADEL. The CGL procedure and the results obtained with it are reported in this paper. In addition, we studied the following six parameters using head and neck X-rays before and after CGL (the changes in these parameters as a result of CGL are shown in parentheses): ( i ) the shortest vertical length between the hyoid bone and mandible (+10.3 mm); ( ii ) the vertical length between the hyoid bone and the tangent line of C2-4 (+4.6 mm); ( iii ) the shortest length between the hyoid bone and the chin (+2.9 mm); ( iv ) the angle between the hyoid bone and the tangent line of C2-4 (+3.3°); ( v ) the length of H-M, where H is the intersection of a tangent line of C2-4 and a vertical line from the hyoid bone and M is the intersection of a tangent line of C2-4 and the mandible (+7.4 mm); and ( vi ) the width of the narrowest part of the hypopharynx (+3.0 mm). The changes in all the measured parameters after CGL were significantly different ( p <0.05).     

Tinnitus evaluation: relationship between pitch matching and loudness,visual analog scale and tinnitus handicap inventory

IntroductionTinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching.ObjectiveTo analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching.MethodsThe study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.ResultsRegarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant.ConclusionThere was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.     

头颈部转移性透明细胞癌5例并文献复习

目的 探讨泌尿系统透明细胞癌转移至头颈的部位和治疗方法.方法 总结我院2011年至2018年收治的具有完整临床资料的5例头颈部转移性透明细胞癌,分析原发疾病、原发病治疗方法、转移时间、转移部位、转移灶治疗方法、预后等临床资料.结果 5例透明细胞癌原发灶位于肾脏4例、膀胱1例,原发灶均行根治性手术.转移时间为原发灶术后1...     

β-连环素及Notch1蛋白质在鼻内翻性乳头状瘤中的表达及意义

目的通过对鼻内翻性乳头状瘤（nasal inverted papilloma,NIP）组织中β-连环素（β-catenin）及Notch1表达水平的测定,探讨NIP中Wnt及Notch信号传导系统的调控作用。方法63例鼻内翻性乳头状瘤、30例鼻息肉、38例鼻腔鼻窦鳞状细胞癌（简称鳞癌）及11例正常鼻黏膜组织均采用免疫组织化学法检测β-catenin及Notch1蛋白质的表达水平。结果鼻息肉、鼻内翻性乳头状瘤和鼻腔鼻窦鳞癌中的β-catenin异常表达率分别为3.33%、58.73%和78.95%;正常鼻黏膜、鼻息肉、鼻内翻性乳头状瘤和鼻腔鼻窦鳞癌中Notch1阳性表达率分别为27.27%、36.67%、73.02%和92.11%,呈阶梯状升高且差异有统计学意义（P〈0.05）;β-catenin异位表达与鼻内翻性乳头状瘤不典型增生程度有一定的相关性（P〈0.05）,复发组中Notch1的水平明显高于初发组（P〈0.05）。结论Wnt/β-catenin和Notch信号途径的异常激活对NIP中起不同作用,β-catenin对NIP的发生发展及最终恶变成鳞癌可能起到了重要作用,术后Notch1水平升高可提示NIP复发。