Nd:YAG激光治疗Little's区出血

1998年7月至1998年12月我们用Nd:YAG激光治疗鼻中隔Little's区出血33例,取得一定的疗效,现报告如下.     

微波治疗儿童鼻腔利特尔区出血113例疗效观察

我院自 1999年 1月～ 2 0 0 3年 6月对 113例儿童鼻腔利特尔区出血患儿采用微波治疗 ,收到满意效果 ,现报告如下。1　资料与方法113例患儿中 ,男 76例 ,女 37例 ;年龄 3.5～ 14岁 ,平均 8.5岁。左侧出血 5 0例 ,右侧出血 4 3例 ,双侧出血 2 0例。病程 15d～ 2年。皆经检查排除全身和局部其他致出血病变。患儿取坐位 ,鼻腔放置含 1%地卡因和 1%麻黄素棉片作表面麻醉后 ,暴露鼻中隔易出血区黏膜 ,用耳鼻喉微波综合治疗仪 (M Ⅳ型 ) ,微波频率 24 5 0MHz ,输出功率 4 5W ,将环形辐射器紧贴治疗部位 ,踩脚踏开关输出微波 ,电凝出血灶至表面出…     

内窥镜下射频治疗鼻腔隐匿性出血

鼻出血为耳鼻咽喉科常见的病症,但原因不一,位置复杂。隐匿性出血用常规的方法检查无法发现出血点,一般用填塞、用药止血,均效果不佳,难以奏效。从1999年以来,我们应用鼻内窥镜探查鼻腔隐匿处出血点,并用射频进行止血,创面加用表皮生长因子敷贴,有确切的疗效。现报告如     

鼻内窥镜下应用Nd:YAG激光治疗鼻深部出血

目的探讨鼻内窥镜下治疗鼻深部出血的临床效果.方法鼻深部出血43例于鼻内窥镜下找到出血点后,用YAG激光治疗,并观察疗效.结果43例中,37例治疗后止血,5例治疗后第1天少许渗血,此后未再出血,1例无效,填塞出血部位后止血,治愈率为97.67%(42/43).随诊3月余,尿毒症1例治疗后半月又出血,再次治疗后未再复发,其余41例无复发.结论在鼻内窥镜下寻找出血点并应用YAG激光治疗,视野清楚,定位准确,治疗方便,创伤及痛苦小,疗效好,是治疗鼻深部出血的有效方法.     

Nd：YAG激光治愈鼻出血56例

1996年3月～1998年3月,我科对56例反复性鼻出血患者采用Nd：YAG激光治疗,取得良好效果,现报告如下。1临床资料56例中,男37例,女19例。年龄12～72岁,平均42岁。病程1个月～4年,平均3个月。出血次数不等,多者每日2～3次,少者每年3～4次。出血量由反复涕中带血至10Oml～20Oml,其中2例发生出血性休克,但以少量反复出血者为多。因鼻中隔黎氏区粘膜糜烂,血管扩张而反复出血者50例;其中40岁以下者29例。鼻——鼻咽静脉丛血管扩张出血者6例,年龄为58～72岁,平均65岁,6例病人均有高血压病史。2治疗方法大出血者以l％麻黄素棉片收…     

低温等离子射频消融和Nd:YAG激光治疗慢性肥厚性鼻炎的疗效比较

目的观察等离子射频和激光治疗慢性肥厚性鼻炎的疗效及术后并发症。方法分析66例慢性肥厚性鼻炎患者接受等离子射频和激光治疗,其中30例行等离子射频治疗,36例行激光治疗。术后随访6个月,分别于术前及术后6个月应用VAS评分评价鼻塞的主观感觉,并观察术后鼻腔干燥、出血、粘连等并发症。结果等离子组患者术前鼻塞VAS评分为8.43±0.77,激光组为8.38±0.84;术后6个月等离子组为3.60±0.67,激光组为3.31±0.79。等离子组和激光组术前与术后比较均有统计学意义(P<0.01),两组间疗效比较差异无统计学意义(P>0.05)。等离子组并发鼻腔干燥2例,激光组12例,两组间并发症比较有统计学意义(P<0.01)。结论低温等离子射频消融和激光是治疗慢性肥厚性鼻炎的有效方法,均具有安全可靠、微创、无切口、操作简便、术后出血少等优点。但激光治疗术后所致黏膜损伤更重,易并发鼻腔干燥。     

经鼻内窥镜射频治疗下鼻道出血

目的总结下鼻道出血的特点及鼻内窥镜结合射频治疗下鼻道出血的疗效.方法回顾研究接受经鼻内窥镜射频治疗下鼻道出血81例的临床资料.结果下鼻道出血多发生在41～50岁,81例中1次治疗有效 76例(93.8%),1例行血管造影超选择性动脉栓塞后治愈.术后随访3月无复发,无并发症 .结论下鼻道出血部位隐蔽,不易发现,经鼻内窥镜结合射频是治疗下鼻道出血的首选方法.     

4种方法治疗鼻Little区出血的疗效比较

目的：比较ＣＯ２激光等４种方法治疗鼻Ｌｉｔｔｌｅ出血的疗效。方法：对８５１例鼻Ｌｉｔｔｌｅ区出血患者分别采用硬化剂粘膜下注射、冷冻、ＣＯ２激光和化学烧灼４种方法治疗。结果：硬化剂治疗有效率为９２．４％;ＣＯ２激光治疗为７５．８％;冷冻治疗为７６．４％;化学烧灼为７３．８％。结论：鼻Ｌｉｔｔｌｅ区出血可首选硬化剂粘膜下注射治疗,其疗效虽优于其他３种治疗方法（Ｐ〈０．０５）,但亦应根据具体病情选出其他     

鼻内镜下Nd:YAG激光与射频治疗常年性变应性鼻炎

常年性变应性鼻炎(perennial allergic rhinitis,PAR)的手术方法很多,临床已确认Nd：YAG激光与射频治疗PAR有效。本研究的目的主要是比较鼻内镜下Nd：YAG激光与射频治疗PAR的疗效及并发症,以期探讨提高治疗PAR疗效的方法。     

鼻内镜联合YAG激光治疗鼻腔后段出血的体会

鼻出血是耳鼻咽喉科常见急症之一,后段鼻出血以鼻中隔中后段及Woodruff's静脉丛出血为多见,其处理比较复杂.既往我们常采用前鼻孔或前后鼻孔填塞术,患者痛苦大、恢复慢.我科自2000年以来对50例严重鼻出血患者行鼻内镜检查合并镜下YAG激光治疗取得满意疗效.现报告如下.     

CO2激光与掺钕钇铝石榴石激光治疗声门型喉癌手术并发症的比较研究

目的 比较CO2和掺钕钇铝石榴石(Nd:YAG)两种激光治疗声门型喉癌的手术并发症的发生率,并探讨减少并发症的有效方法.方法 采用回顾性分析1999年1月1日至2008年12月31日在北京大学第一医院耳鼻咽喉头颈外科接受支撑喉镜下CO2和Nd:YAG激光治疗的83例患者的临床资料,比较两组并发症的发生率.CO2激光治疗组32例,其中原位癌2例,T1N0M021例,T2N0M0 8例,T3N0M0 1例,采用非接触式脉冲激光;Nd:YAG激光治疗组51例,原位癌3例,T1N0M0 36例,T1N2M0 3例,T2N0M0 9例,采用光纤接触式激光.结果 CO2激光并发症共4例(12.5%),其中喉软骨膜炎1例(3.1%),舌体麻木1例(3.1%),门齿松动1例(3.1%),皮下气肿1例(3.1%);Nd:YAG激光并发症27例(52.9%),其中术后出血2例(3.9%),呼吸困难5例(9.8%),喉软骨膜炎7例(13.7%),肺部感染4例(7.8%),舌体麻木2例(3.9%),咽颈瘘1例(2.0%),声带固定4例(7.8%),喉狭窄2例(3.9%).结论 Nd:YAG激光较CO2激光更易发生手术并发症,少数并发症需要紧急处理,通过适当预防措施可以减轻并发症,避免严重后果.     

金嗓散结丸结合YAG激光治疗声带息肉疗效观察

目的 观察YAG激光治疗声带息肉后结合应用金嗓散结丸的疗效。方法 213例患者随机分为两组，其中金嗓散结丸组107例，对照组106例。YAG激光治疗结束后1月、3月进行两次随访，比较两组疗效。结果 金嗓散结丸组总有效率为99．07％，对照组总有效率为98．11％，二者差异无显著性意义，但前者1月和3月随访治愈显效率分别为89．71％和94．38％，后者分别为75．47％和77．35％，二者相比差异具有显著性意义。结论 声带息肉的YAG激光治疗术后结合运用金嗓散结丸能减轻喉部炎症反应，促进声带创面和声带外观形态的恢复，并能较好的抑制或消除部分患者YAG激光治疗后引起的喉干、喉痛和喉部灼热感等不适症状。     

纤维喉镜下Nd:YAG激光治疗760例声带息肉和小结的疗效分析

目的 评价纤维喉镜下激光治疗声带息肉和声带小结疗效。方法 对随访2年以上的760例声带息肉（516例）和小结（224例）病人进行了总结、分析。结果 声带息肉和小结一次性治愈率分别为96％、99％，末彻底治愈的20例声带息肉病人、3例声小结病人经再次激光治疗后痊愈。结论 纤维喉镜下引导导激光是治疗声带息肉和小结的有效方法，具有痛苦小、反应轻、恢复快、复发率低的优点。     

喉显微手术及中西医结合治疗喉癌前病变临床观察

目的对比观察喉癌前病变显微手术及中西医结合疗法的疗效. 方法 33例喉癌前病变(声带白斑18例,声带角化症15例)随机分为中西医结合组(声带白斑10例,声带角化症7例)和西医对照组(声带白斑8例,声带角化症8例).对照组治疗方法为喉显微手术及术后使用抗生素;中西医结合治疗组为手术治疗加术后口服自拟中药汤剂. 结果中西医结合治疗组病变复发率为0%(0/17),单纯西医治疗对照组病变复发率为25.0%(4/16),差异有显著性意义(P＜0.05);治疗组喉显微术后声带黏膜及发音功能恢复正常时间平均为15.87±4.93天,对照组为26.56±13.08天,差异有显著性意义(P＜0.01). 结论中西医结合治疗喉癌前病变不仅创伤较小,且术后声带结构及功能恢复较快、原病变不易复发.     

激光治疗阻塞性睡眠呼吸暂停低通气综合征疗效评价

目的：探讨Nd：YAG激光治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法：对89例OSAHS患者行激光悬雍垂腭咽成形术(LAUP)．手术切除部分软腭及悬雍垂，在悬雍垂两侧向上楔形打开软腭。结果：术后6个月复查有76例行多导睡眠监测，治愈8例，显效36例，有效25例，无效7例，总有效率90．8％。结论：Nd：YAG激光具有止血凝固作用且穿透力强，手术视野清晰，并发症少，可缩短手术时间。LAUP治疗OSAHS效果良好。     

Effectiveness of Nd: YAG laser therapy on Japanese cedar pollinosis

Many have reported on the effectiveness of laser surgery therapy for perennial allergic rhinitis. However, the suppressive effects of laser irradiation on allergic rhinitis and its symptoms have not been reported in patients with pollinosis. This is because therapeutic effects on pollinosis are difficult to evaluate. The amount of pollen in the air varies during the year, and from year to year. Also, allergic symptoms develop due to exposure to the amount of pollen which is markedly influenced by the weather. In this study, the severity of allergic symptoms in the pollen season was compared between patients treated with early medication, non-treated patients and patients treated with preseasonal contact Nd: YAG laser surgery. Results suggests that laser surgery was effective in reducing the severity of symptoms in patients with cedar pollinosis. Symptoms were milder in the laser group than in the medication group and non-treated group for 3-4 weeks after the start of seasonal pollinosis, although no differences were noted in the early weeks. This may be explained by the fact that laser irradiation reduces the lamina propria of the nasal mucosa, the site of allergic reactions. This also suggests that allergic pollen can't penetrate the mucosal surface which shows squamous epithelization after laser irradiation.     

Biostimulative effects of Nd:YAG Q-switch dye on normal human fibroblast cultures: study of a new chemosensitizing agent for the Nd:YAG laser

Kodak Q-switch II is a new chemical with an absorption maxima at 1,051 nm, designed to be used as an Nd:YAG dye laser. The potential for this dye as a new chemosensitizing agent in the treatment of connective tissue diseases and wound healing with low energy Nd:YAG laser was examined. Two normal fibroblast cell lines were tested for sensitivity to various levels of this dye in vitro. These cells were exposed to Q-switch II dye at concentrations of 0.01, 0.1, 1, 10, 50, and 100 micrograms/ml for 1 and 24 hours. Cell viability was assessed by the trypan blue exclusion test. Cell duplication and DNA synthesis were measured by the incorporation of [3H]-thymidine at 6 and 24 hours postexposure to Q-switch II dye. At concentrations up to 10 micrograms/ml, both cell lines tested showed no changes in cell viability. However, at concentrations equal or higher than 50 micrograms/ml, more than 40% of the fibroblasts incorporated trypan blue after 24 hours of exposure to this dye, indicating significant cell destruction. The results indicate that Q-switch II dye is nontoxic to normal human fibroblast cultures and showed significant biostimulative effects on cell duplication at concentrations equal to or lower than 10 micrograms/ml. Further studies will be required to determine the usefulness of Q-switch II dye as a new photochemosensitizing agent for potential biostimulation of wound healing and/or treatment of connective tissue diseases with the Nd:YAG laser (near infrared, 1,060 nm) at "nonthermal" levels of energies.     

Bipolar radiofrequency treatment for snoring with mild to moderate sleep apnea: a comparative study between the radiofrequency assisted uvulopalatoplasty technique and the channeling technique

We compared radiofrequency techniques used in the treatment of snoring and obstructive sleep apnea [radiofrequency assisted uvulopalatoplasty (RAUP) and channeling] as regard the efficacy and morbidity. A pilot, prospective randomized single blinded study was conducted on 40 patients in the ENT Department, Kasr Al-Aini Hospital, Cairo University during the period from April to December 2003. Patients were randomized into two groups each consisting of 20 patients. The first group was treated by submucosal channeling of the palate, while the second group was treated by radiofrequency assisted uvulopalatoplasty (RAUP). Patients were followed for 4 months, filling a questionnaire in a standard visual analogue score pattern. Assessment was done prior to the surgery and was repeated 3, 10 days and 3 weeks postoperatively. Visual analogue scores were done for the following parameters: pain, speech deficits, dysphagia, and snoring (by the bed partner). Polysomnography was done pre to intervention and was repeated 4 months postoperatively. This work confirms the favorable effects of radiofrequency in the treatment of patients with snoring and mild to moderate obstructive sleep apnea (OSA) particularly on snoring, confirming the results of the previous studies and highlighting the more rapid relief of snoring and apnea in RAUP group compared to channeling group but with more postoperative pain and morbidity.     

金嗓利咽丸缓解鼾症射频消融术后反应的疗效观察

目的观察金嗓利咽丸对单纯性鼾症和阻塞性睡眠呼吸暂停低通气综合征患者射频消融术后反应的缓解效果.方法将60例患者分为治疗组和对照组,两组按入院顺序间隔选入,组间成员年龄、性别百分比和病情轻重无明显差异.治疗组自手术当日给予金嗓利咽丸6g,每天3次,连续7～10天.观察术后疼痛程度、创面愈合时间、术后口干和异物感的时间.结果术后6～10天,两组间疼痛程度出现差异,治疗组创面愈合较快;两组间口干和异物感在术后14天出现差异.结论金嗓利咽丸能缓解射频消融术后反应.