经口鼻内镜下成人腺样体切除16例治疗体会

<正>我科经口鼻内镜下成人腺样体切除术16例,疗效满意,报告如下。1资料与方法1.1一般资料2010年8月—2012年3月,我科收治的腺样体肥大患者126例,其中成人16例。年龄18～34岁。男12例,女4例。病程4～10年。主要症状为张口呼吸,睡眠时打鼾,鼻阻塞,流涕。6例伴扁桃体肥大;12例伴鼻窦炎,迁延不愈;2例伴分泌性中耳炎,听力下降,气导平均     

鼻内镜下切除腺样体64例

鼻内镜最初仅用于鼻息肉及鼻窦炎的手术,1997年国外有学者首先报道了应用电动削刨器经鼻内镜切除腺样体。2002年以来,我们在鼻内镜直视下行腺样体切除64例,疗效满意。     

鼻内镜下电动负压切割器切除腺样体65例

腺样体肥大常见于儿童及青少年,但成人腺样体肥大也占一定比例。腺样体部位隐深,是儿童时期的重要免疫器官。临床上腺样体肥大常以鼻阻塞为主要症状,并常伴鼻窦炎。2002年5月～2004年10月,我们应用鼻内镜下电动负压切割器切除腺样体65例,术后听力、夜间打鼾、鼻塞、鼻漏等症状消失,腺样体无复发,疗效满意。现报告如下。     

鼻内镜下电动吸割器在小儿腺样体切除术中的应用

目的：探讨鼻内镜下电动吸割器在小儿腺样体切除术中的应用价值。方法：应用鼻内镜下电动吸割器,经口对26例小儿腺样体肥大病人进行腺样体切除术。结果：26例病人腺样体均切除干净,无残留,症状明显减轻或消失。结论：鼻内镜下电动吸割器经口行腺样体切除术具有视野清晰,病变切除彻底以及损伤小等优点,值得临床推广应用。     

鼻内镜下经口联合进路手术切除小儿腺样体肥大106例

小儿腺样体肥大指小儿在发育过程中因腺样体增长肥大影响全身健康或邻近器官者。最常见的并发症是合并扁桃体肥大致口咽部狭窄,以至引起鼻咽部堵塞而出现张口呼吸、打鼾,严重者出现睡眠呼吸暂停低通气综合征;耳咽管口阻塞致分泌性中耳炎及鼻腔后上部阻塞致小儿鼻窦炎;长期鼻寒和张口呼吸还可引起面骨发育障碍,致上颌骨变长、硬腭高拱,上切牙突小、牙列不整齐致咬合不良、下颌下垂、唇厚、上唇上翘、下唇悬挂,加上精神萎靡,面部表情愚钝,即所谓“腺样体面容”。     

内镜辅助切除腺样体治疗儿童慢性鼻窦炎和分泌性中耳炎27例

儿童睡眠呼吸疾病最重要的原因在于腺样体肥大，同时腺样体肥大也是慢性鼻窦炎和分泌性中耳炎的重要基础因素。我们对27例并发慢性鼻窦炎和（或）分泌物中耳炎的患儿采用内镜辅助经口腔腺样体切除术，观察慢性鼻窦炎和分泌性中耳炎的治疗效果。疗效满意，报告如下。     

鼻内镜表麻下低温等离子消融治疗儿童腺样体肥大疗效观察

目的:观察鼻内镜表麻下低温等离子消融治疗儿童腺样体肥大的疗效。方法:对44例7～12岁儿童腺样体肥大合并卡他性中耳炎、化脓性中耳炎、鼻窦炎的患儿采用鼻内镜表麻下低温等离子消融治疗。结果:术后3～12个月对37例追踪观察,34例鼾声、憋气消失,呼吸通畅,3例鼾声减弱,已无憋气现象。并发卡他性中耳炎17例22耳,20耳耳闷、耳塞症状消失,听力恢复正常,2例2耳上感时仍有耳闷,听力下降,并发鼻窦炎7例脓涕明显减少,仅上感时增多。结论:采用鼻内镜表麻下低温等离子消融治疗儿童腺样体肥大疗效显著,具有低温微创、安全性高、操作简单、恢复期短,不需住院,不破坏鼻咽部的正常粘膜和生理功能,无并发症、不出血等优点。     

鼻内镜下切割吸引器行腺样体切除术治疗儿童鼻窦炎的临床研究

目的 探讨鼻内镜下用切割吸引器行腺样体切除术治疗儿童鼻窦炎的临床疗效.方法 50例(双侧上颌窦),采用气管插管吸入加静脉复合全身麻醉,在直径4mm鼻内镜下用切割吸引器行腺样体切除术,8例同时行扁桃体切除术.结果 50例随访半年,治愈40例,鼻阻、流涕明显改善,X片示鼻窦未见异常.8例好转,鼻阻、流涕较术前改善,X片示与术前片相比较,炎症范围明显缩小.2例无效,术后症状无缓解,X片示与术前片相比较,炎症无明显变化.结论 鼻内镜下切割吸引器行腺样体切除术治疗儿童鼻窦炎,方法简单,疗效确切,无并发症,无副作用.     

经鼻内窥镜下腺样体切除术

经鼻内窥镜下结合鼻腔切割吸引器行腺样体切除术３４例,其中单纯腺样体肥大４例,腺样体肥磊＋扁桃体肥大６例,腺样体肥磊＋渗出性中耳炎１０例,腺样体肥大＋扁桃体肥大＋渗出性中耳炎１４例,手术不仅适用于儿童,用于成人。本文对鼻内镜下腺样体切除术的优缺点进行了讨论。     

鼻内镜下腺样体刮除与等离子低温消融配合治疗腺样体肥大52例

腺样体肥大是儿童较常见的引起分泌性中耳炎、鼻窦炎的主要病因,长期不治还可导致颌面部发育障碍及身体生长发育迟缓[1]。近年来,随着鼻内镜的广泛应用,部分成年人的腺样体肥大也越来越多地被发现,成为引起阻塞性睡眠呼吸暂停低通气综合征的主要病因,因此,一经确诊,应尽早施行腺样体切除术。传统的治疗方法是经口盲刮，并发症较多，存在许多弊端。我科从2005—08至2006—08对52例腺样体肥大患者采取鼻内镜下刮除与等离子低温消融配合治疗腺样体肥大，取得满意疗效。     

鼻内镜下不同激光治疗鼻出血的临床效果及生活质量对比

 目的 通过对比鼻内镜下CO₂激光与Nd∶YAG激光治疗鼻出血的临床效果及生活质量,为鼻出血患者的治疗提供参考。方法 以2016-03至2017-02收治的240例鼻出血患者为研究对象,按照患者的入院顺序将其分为对照组和观察组,两组各120例。对照组采用CO₂激光治疗,观察组采用Nd∶YAG激光治疗。术后随访3个月,观察两组患者的各项手术指标、近期疗效及预后情况,并采用生活质量综合评分(GQOLI-74)评价患者的生活质量。结果 观察组手术时间及止血时间均短于对照组,术中出血量少于对照组,鼻出血次数少于对照组,术后首次出血时间长于对照组,生活质量评分高于对照组,上述指标差异均有统计学意义(P<0.05);观察组止血成功率98.3％高于对照组81.7％,术后3个月发生主观嗅觉减弱率0.8％低于对照组10.0％,差异有统计学意义(P<0.05)。结论 与鼻内镜下CO₂激光治疗相比,鼻内镜下Nd∶YAG激光治疗鼻出血患者,能够改善手术指标,提高近期疗效,改善预后及生活质量。     

经鼻内窥镜鼻中隔矫正术后两种鼻腔填塞方法的比较

目的 :探讨Merocel高膨胀填塞材料在经鼻内窥镜鼻中隔矫正术后的临床应用价值。方法 :6 0例经鼻内窥镜鼻中隔矫正术的患者随机分为两组 :Merocel组和凡士林油纱条组各 30例 ,手术后分别用Merocel高膨胀填塞材料和凡士林油纱条填塞鼻腔。比较两组患者的术后反应及并发症。结果 :Merocel组术后外鼻肿胀及头胀痛较对照组轻微 ,术后鼻腔出血量两组无显著性差异 ,抽取填塞物后 ,鼻内窥镜检查发现Merocel组鼻粘膜肿胀明显较轻 ,创面渗血及鼻腔伪膜少于对照组。鼻中隔血肿Merocel组 3例 ,凡士林油纱条组 1例 (P >0 .0 5 )。结论 :经鼻内窥镜鼻中隔矫正术后采用Merocel高膨胀填塞材料鼻腔填塞可以明显减轻患者的痛苦 ,是安全、可靠、有效的 ,可以取代传统的凡士林油纱条填塞     

腮腺肿瘤不同切口及路径的手术效果比较

目的比较传统"S"形切口皮瓣转移修复术与改良"S"形切口腮腺筋膜缝合术治疗腮腺肿瘤的临床效果。方法将我科2011年3月—2012年3月期间收治的74例腮腺肿瘤患者按随机数字表法分为观察组42例和对照组32例。对照组患者采用"S"形切口及皮瓣转移修复术,观察组患者采用改良"S"形切口及腮腺筋膜缝合术治疗,术后随访1年,记录并比较两组患者并发症发生率及患者对术后切口外观的满意度情况。结果(1)观察组患者并发症发生率为31.0%,明显低于对照组的56.3%,两组比较差异有统计学意义(P<0.05);其中观察组患者的暂时性面瘫、耳颞神经综合征(Frey's综合征)的发生率显著低于对照组(P<0.05)。(2)两组患者对手术切口外观的满意度构成比无统计学差异(P>0.05),但观察组术后整体满意度达到10分的患者比例(38.1%)明显高于对照组(15.6%),差异有统计学意义(P<0.05)。结论改良"S"形切口及腮腺筋膜缝合术治疗腮腺肿瘤较之"S"形切口皮瓣转移修复术并发症发生率低,患者满意度高。     

Conventional endoscopy versus virtual laryngoscopy in assessment of laryngeal lesions

Background

Virtual laryngoscopy is a non invasive computed tomography based technique that allows dynamic intra-luminal laryngeal evaluation resembling direct laryngoscopy.

Objective

The aim of this prospective study is to evaluate the accuracy, clinical value and limitation of VL in the diagnosis of laryngeal masses in comparison to conventional laryngoscopy.

Patients and methods

Forty-two (42) patients with different laryngeal lesions (VL) was performed through advantage window navigation system (GE) using volume rendering reconstruction fly and through technique to navigate the laryngeal lumen.

Results

Forty-two patients with different laryngeal pathology were examined, hoarseness of voice in 27 patients 67.5%, stridor in 17 cases 42.5%, followed by chronic cough in 11 patients 27.5%, the laryngeal lesions was 18 carcinoma 45%, 13 subglottic stenosis 32.5%, 6 polyps 15%, 2 nodules 5% and 1 papilloma 2.5%, direct laryngoscopy was performed for 40 patients and all cases were pathologically proved.

Conclusion

VL is an additive tool in conjunction with the direct laryngoscopy and easily reaches the lower limit of the lesion compared to direct laryngoscopy.     

Comparison between gastric radiology and fiber endoscopy (author's transl)]

This paper summarizes the experience from 1969 to 1972 of a mixed team of radiologists and endoscopists at the Northern Marseilles University Hospital Centre. The patients were unselected and the team were not given all the information. After recalling the clinical and radiological conditions, together with the endoscopic conditions of the examination, the authors define the criteria which they chose to orient patients towards fiber endoscopy, i.e. either frankly abnormal radiology, or a radiological examination classed as normal in 563 cases, but which the team considered doubtful. They then report their results. Under these conditions, the results seem to be less unfavourable for radiology than would have been thought, for only 7% of the results were made by endoscopy alone (96 cases out of 1,500). In both benign and malignant ulcer, fiber endoscopy simply confirmed the radiological diagnosis and, in 54% of all the examinations, fiber endoscopy confirmed the normal character of radiology. However, in deciding whether carcinoma or benign ulcer, i.e. 11% of the cases of carcinoma and 14% of the cases of benign ulcer, radiology completely omitted the diagnosis of the lesion which might seem unacceptable. They conclude by asking radiologists to improve their technique of lesion detection and concentrate their examination on the smallest visible lesion in areas considered diffcult to explore radiologically. They are more and more circumspect about giving a full etiological diagnosis of lesions by radiology, especially in gastric ulceration where fiber endoscopy and direct biopsy seems more and more advisable.     

全膝关节置换术两种入路效果比较

 目的  比较经股内侧肌入路与内侧髌旁入路行全膝关节置换术的临床疗效。 方法 25例行同期双侧全膝关节置换术,每例患者随机一侧采用经股内侧肌入路,另一侧采用内侧髌旁入路,观察两组手术时间、术后引流量、术后6周关节活动度、直腿抬高恢复时间,术后第1、2、3、6天对每例患者双侧膝关节进行视觉模拟疼痛评分（visual analog scale,VAS）。 结果 经股内侧肌入路组在直腿抬高恢复时间［（2.2±0.8） d vs （4.4±1.4）d］、VAS评分方面明显优于内侧髌旁入路组( P <0．05 ),两组在术后引流量、手术时间、术后6周膝关节活动度方面差异无统计学意义( P >0．05)。 结论 经股内侧肌入路行全膝关节置换术与髌旁入路相比,可以减轻术后的疼痛,减少直腿抬高恢复时间,较早恢复膝关节功能,值得临床推广和应用。     

CT仿真内镜对鼻腔及鼻窦临床应用价值的研究

目的：探讨CT仿真内镜对鼻腔及鼻窦病变的显示能力和临床应用价值。方法：搜集健康志愿者6例及临床疑为鼻部病变的患者30例共71例鼻腔，分别进行CT仿真内镜及硬管内镜检查，将两种方法所得显示结果进行对比研究，并利用Wilconxon Wtest和x^2进行统计分析。结果：对鼻腔解剖结构和病变的显示，VE与RE有良好的一致性，VE可完整显示大部分未受侵犯的结构及大的病变；VE较RE能更清楚完整地显示鼻窦肿瘤、囊肿和息肉，本组显示例数均多于RE。结论：VE具有操作简便、无生、多入路方式及多观察方向的特点。对鼻腔病变的诊断上，VE可作为一种补充手段；对鼻窦病变的诊断，VE有一定优势，可作为一种主要手段运用于临床。     

Comparison of two approaches to structured physical activity surveys for adolescents

PURPOSE: To compare the test-retest reliability, convergent validity, and overall feasibility/ usability of activity-based (AB) and time-based (TB) approaches for obtaining self-reported moderate-to-vigorous physical activity (MVPA) from adolescents. METHODS: Adolescents (206 females and 114 males) completed two 3-d physical activity recalls using the AB and TB surveys, which contained identical lists of physical activities. The participants wore an MTI Actigraph accelerometer for the same period. RESULTS: The TB instrument took about 3 min longer to complete (P = 0.022). Overall 2-d test-retest correlations for MVPA were similar for the two surveys (r = 0.676 and 0.667), but the girls had higher reliability on the AB survey than the boys (girls: r = 0.713; boys: r = 0.568). The overall 3-d correlations for MVPA surveys and Actigraph counts varied by gender (girls: AB = 0.265 vs TB = 0.314; boys: AB = 0.340 vs TB = 0.277). Correlations for vigorous physical activity and Actigraph counts were higher for the AB than for the TB (r = 0.281 vs 0.162). As the interval between completing the surveys and the days being recalled increased, reliability and validity were lower, especially for the AB survey. CONCLUSION: For both genders, either approach is acceptable for obtaining MVPA information on a single day, but the TB approach appears to be slightly favored over the AB approach for obtaining multiple days of MVPA. A 3-d recall period appears to be too long for accurate recall of MVPA information from either instrument. For both genders, the surveys overestimated activity levels; thus, self-reports should be supplemented with objective data.     

两种入路进行掌侧钢板内固定治疗桡骨远端骨折疗效比较

目的比较两种入路掌侧钢板内固定治疗桡骨远端骨折的临床疗效。方法回顾性分析2012年3月—2015年6月江苏省沭阳县人民医院诊治的60例桡骨远端骨折患者,根据手术入路不同分为对照组和观察组。对照组29例采用Henry入路切开旋前方肌进行掌侧钢板内固定治疗,观察组31例采用外侧入路切开旋前方肌与肱桡肌之间的筋膜进行掌侧钢板内固定治疗。比较两组的手术时间、术中出血量、术后住院时间、骨折愈合时间及腕关节活动度。结果两组患者均获12~18个月随访,平均13.5个月。观察组患者手术时间、术中出血量、术后住院时间及骨折愈合时间均少于对照组(P0.05)。末次随访时两组腕关节活动度(背伸度、掌屈度、桡偏度、尺偏度、旋后度、旋前度)及Gartland-Werley评分相比,差异有统计学意义(P0.05)。两组疗效比较,观察组优良率96.8%,较对照组优良率89.7%,差异有统计学意义(P0.05)。结论采用外侧入路行掌侧钢板内固定治疗桡骨远端骨折可以有效保护旋前方肌的功能,具有手术风险小、手术时间短、术中出血量少等优点,临床疗效满意。     

剖宫产子宫瘢痕憩室两种自然腔道手术的疗效比较

 目的 探讨经宫腔镜子宫瘢痕憩室刨削术及经阴道子宫瘢痕憩室切除缝合术治疗子宫瘢痕憩室的疗效及临床应用价值。方法 选择2016-06至2019-06解放军总医院海南分院收治的剖宫产术后经期延长的患者共84例,均经B超联合宫腔镜检查确诊为子宫瘢痕憩室,其中31例采用宫腔镜瘢痕憩室刨削术治疗(宫腔镜组),53例采用经阴道子宫瘢痕憩室切除缝合术治疗(经阴道手术组)。结果 两种手术术后3个月的总有效率分别为宫腔镜组87.1%、经阴道手术组86.8%;宫腔镜组及经阴道手术组平均手术时间分别为(19.3±6.1)min及(33.3±7.1)min;宫腔镜组及经阴道手术组平均术中出血量分别为(11.5±3.7)ml及(48.2±10.7)ml;宫腔镜及经阴道组术后疼痛评分分别为(1.3±0.9)分及(3.3±1.1)分;住院费用分别为(4817±386)元及(11071±1041)元,术后住院天数分别为(1.4±0.7)d及(3.2±0.8)d。两种手术方式疗效差异无统计学意义,但手术时间、手术中出血量、术后疼痛程度、术后住院时间及费用方面宫腔镜手术具有明显优势。结论 两种经自然腔隙治疗子宫瘢痕憩室的手术方式均能取得较满意的临床治疗效果,其中宫腔镜手术较经阴道手术出血少、手术及住院时间短,治疗费用低,适合临床上开展应用于子宫瘢痕憩室的治疗。