类风湿性关节炎并喉梗阻气管切开术后长期带管一例

1病例报告患者,女,56岁,因声嘶3月加重10天、呼吸困难1天于2004年12月18日上午以“急性喉炎”入院。患者有“类风湿性关节炎”病史15年,曾经在省级医院住院治疗3个月,效果欠佳,现间断服药治疗。入院检查:患者急性病容,脸色红润,双唇无紫绀,咽部粘膜急性充血,会厌粘膜轻度充血。间接喉镜检查欠满意。颈部轻度压痛,未触及包块。呼吸较急促,Ⅱ°呼吸困难,吸气时胸骨上窝、锁骨上窝、肋间隙明显凹陷,喉部及肺部听诊可闻及喉鸣音,未闻及罗音。心率106次/分,律齐,未闻及病理性杂音。四肢远端关节宽大、畸形。入院后立即予地塞米松15mg、抗生素静脉…     

气管切开对喉癌并发喉梗阻患者远期临床疗效的影响

目的　分析气管切开是否影响喉癌并发喉梗阻患者总生存率（overall survival,OS）和无病生存率（disease free survival,DFS）,并探索潜在的原因。方法　本研究纳入2005年1月~2010年12月共695例T3～T4级喉癌患者,喉梗阻需先行气管切开再予喉癌根治性治疗。回顾性分析临床和随访数据,倾向性评分匹配（propensity score matching,PSM）去除混杂偏移因素,按照1∶1选择气管切开组（简称气切组）患者和对照组。Logistic模型分析与喉梗阻气管切开相关的变量,Cox模型分析影响喉癌OS和DFS的变量。结果　本组男性674例（97.0%）,女性21例（3.0%）,平均年龄60.9岁。142例（20.4%）患者因喉梗阻行气管切开,T3级气管切开比例为12.9%,低于T4级的45.1%。PSM校正数据后,气切组5年、10年的OS分别为47.5%和36.4%,5年、10年的DFS分别为43.4%和34.4%。对照组5年、10年的OS分别为59.7%和45.8%,5年、10年的DFS分别为52.4%和42.6%。气切组OS和DFS较对照组降低。气切组肿瘤直径和肿瘤面积大于对照组（直径：3.6 cm vs 2.8 cm;面积：10.4 cm2 vs 6.9 cm2）。较晚T分级、较大肿瘤直径和肿瘤面积三个变量和喉梗阻存在相关性,是需要气管切开的危险因素。单因素分析发现喉梗阻行气管切开是影响OS的因素,但多因素分析无统计学意义,此外局部区域复发、T分级、肿瘤直径、肿瘤面积四个变量均是影响喉癌患者OS和DFS的独立危险因素。结论　因喉梗阻行气管切开的喉癌患者生存率下降,较晚的T分级与较大的实体肿瘤均和喉梗阻相关,是影响生存率的危险因素,而气管切开仅作为解除喉梗阻的治疗方案,不是危险因素。     

支撑喉镜与鼻内镜结合治疗先天性喉蹼一例

患者,女,12岁,因声嘶伴呼吸困难10余年就诊。患者自幼声音嘶哑,活动及哭闹时有呼吸困难,并伴反复咳嗽咳痰,在当地医院曾反复抗炎对症治疗后未见好转。来我院后行纤维喉镜检查见双侧声带前1/2处有灰白色蹼膜联接覆盖,声门下见粘液性分泌物。以“先天性喉蹼”收住院(图1)。入院后     

喉软骨瘤术后复发一例报告

患者,男,56岁。5年前于外院行喉环状软骨瘤手术,术后一直声音嘶哑,无呼吸困难。4个月前开始劳累后气短,2天前呼吸困难加重,来诊时近Ⅲ°吸气性呼吸困难,于急诊室行紧急气管切开后收入院。纤维喉镜检查:左杓会厌襞向内移位,左声带固定,右声带及右杓会厌襞运动尚可,声门裂几近闭塞。CT检查:环状软骨弓后右侧部见软组织肿物,周边钙化,喉腔闭塞,杓状软骨结构紊乱。入院诊断:喉狭窄、喉软骨瘤复发。经气管切开处插管全麻,颈前正中切口,见皮下广泛瘢痕粘连,层次不清。正中裂开甲状软骨板,见环状软骨板偏右侧结节状膨胀性生长肿瘤样物,质较硬,2.0c…     

颈深部蜂窝组织炎并发喉梗阻昏迷抢救成功1例

患者 ,男 ,40岁。因“发热 1ｄ ,舌根微痛 6ｄ,伴进行性吞咽和呼吸困难 3ｄ”就诊。 7ｄ前 ,患者出现无诱因的低热 ,服用“阿司匹林”后次日退热 ;但出现舌根轻微痛 ,偏左侧 ,持续 6ｄ。今晨起感吞咽疼痛 ,渐重且渐有呼吸不畅 ,声嘶。 3ｈ后自己开车就诊。既往无药物及食物过敏现象。体检 :神志清楚 ,呼吸较急促 ,尚可平卧。左咽侧索及偏左舌根部轻度肿胀隆起 ,略发白 ;双扁桃体无异常 ;间接喉镜下见会厌根部肿胀 ,左披裂及梨状窝粘膜轻微肿胀 ,略发白。声门区不能窥视。左下颌角后下的颈部软组织逐渐隆起肿胀 ,张力大且有触痛 ,局部皮温高…     

神经性肌强直症并发喉阻塞临床分析（附1例报告）

目的 探讨神经性肌强直症并发急性喉阻塞的诊断及治疗，并结合文献对此病的病因、发病机制、临床表现及诊治进行复习。方法 回顾性分析我科2000年收治的l例神经性肌强直症并发喉阻塞患者的诊治情况。结果 应用苯妥英钠加气管切开可以防治本病。结论 喉阻塞常首诊于耳鼻咽喉一头颈外科，而以神经性肌强直症并发者易造成误诊或误治，因此，保持病人呼吸道通畅，急诊行气管切开是必要的。     

喉异物并声嘶误诊一例

患者男,59岁,因持续声嘶一月余伴呼吸困难一周于2005年11月入院。患者一月前不慎摔倒,头面部先着地,口唇及颏部撞击在水泥台阶上,口唇裂伤,上下门齿脱落,当即出现声音嘶哑,无明显呼吸困难,无呛咳。当地医院予以清创缝合及抗炎、雾化治疗,声嘶无缓解并逐渐出现咽喉部分泌物增多,     

Parathyroid adenoma causing spontaneous cervical hematoma: a case report

A case of parathyroid adenoma causing a spontaneous cervical hematoma is reported. A 55-year-old woman presented with painful swallowing, dysphagia, and dyspnea. Primary hyperparathyroidism and a parathyroid tumor on the left side of the neck had been found 2 years earlier. Fiberoptic laryngoscopy and computed tomography (CT) showed a narrowing of the airway as a result of a retropharyngeal hematoma, and tracheostomy was carried out. Parathyroidectomy was performed 5 months after the absorption of the hematoma, with no complications. A pathological diagnosis revealed a parathyroid adenoma with hemosiderin deposition and fibrosis. Serum calcium and intact parathormone levels normalized postoperatively. Although a spontaneous cervical hematoma resulting from parathyroid tumors rarely occurs, it may lead to an airway compromise. Physicians should be aware of this if such tumors are managed conservatively without surgery.     

妊娠期咽喉反流引起喉梗阻的诊治探讨(附1例报告)

目的 通过回顾性分析2019年11月收治的1例妊娠期咽喉反流引起喉梗阻患者的资料以探讨妊娠期咽喉反流引起喉梗阻的诊治。方法 患者女,29岁,孕28周。因“声嘶1个月、吞咽伴呼吸困难半个月”入院,患者入院时喉梗阻Ⅲ度,电子喉镜检查提示会厌无水肿,环后区黏膜水肿明显,声带黏膜充血、水肿,声门裂狭窄,紧急行气管切开,并行喉部活检术。患者填写入院时、治疗1个月后、产后1个月反流症状指数评分量表（RSI）,医师根据电子喉镜填写入院时、治疗1个月后、产后1个月反流体征评分量表（RFS）。结果 患者气管切开后呼吸困难缓解,喉部病理活检提示炎性细胞浸润,间质充血,未见癌细胞。患者入院时、治疗1个月后、产后1个月RSI评分分别为15、13、7分;入院时、治疗1个月后、产后1个月RFS评分分别为17、17、9分。产后1个月成功拔管。结论 反流是妊娠期常见反应,但妊娠期反流引起喉梗阻报道极少。抗酸药在妊娠期有一定的安全性,但疗效还有待进一步研究。反流症状严重出现喉梗阻Ⅲ、Ⅳ度时可考虑行气管切开,反流所致的症状和体征可在妊娠结束后逐渐消失。     

Parathyroid cervical hematoma: a case report

Haemorrhagic cysts of the parathyroid gland are rare. Our case report concerns a presentation with a constrictive cervical haematoma, confirmed by ultrasound-guided aspiration. The haematoma, rapidly recurred, indicating exploration of the neck and haemostasis. Histological examination of excised tissue showed the haemorrhagic nature of the cyst.     

Middle ear adenoma: a case report

Middle ear adenoma (MEA) is a rare neoplasm with benign clinical behavior. The immunohistochemical and ultrastructural studies revealed the mixed, bidirectional mucinous and neuroendocrine character. These tumors have been known by many different names, reflecting the controversies relating to their histogenesis and differentiation. The term middle ear adenoma was proposed by Hyams and Michaels in 1976 and since this time over 100 cases were described in the literature. The most often symptoms of the MEA are the unilateral hearing loss and the tinnitus. MEA should be treated by surgery and very attentive postoperative follow-up. The prognosis of these tumors are good. The histological structure of middle ear adenoma, as well as symptomatology, treatment and clinical behavior are discussed on the basis of the literature. A case of histologically confirmed middle ear adenoma in a 34 year old women is presented.     

喉部不典型类癌一例

喉部不典型类癌作为喉部神经内分泌癌其中1个亚型,在临床上较为罕见。本文报道了1例珠海市人民医院耳鼻咽喉科收治的69岁男性患者,主诉为咽部异物感2月余,加重伴咳嗽、咽痛2周,完善检查并行病理活检后诊断为喉不典型类癌,舌根部乳头状瘤。全麻下行舌根肿物切除术+全喉切除术+区域性双颈部淋巴清扫术+气管造瘘术,术后行放射治疗,随访1年,患者恢复良好无复发。本文总结其病例特点并通过文献复习,介绍神经内分泌癌的好发部位、临床特点、病理分型及治疗方法。     

Congenital laryngeal cyst: a case report

Congenital laryngeal cysts are a rare cause of stridor in the neonate. Nevertheless, delayed diagnosis and treatment can cause life-threatening airway obstruction. Even though the diagnosis is easily made by careful inspection, treatment results often in recurrence. These facts are illustrated by a case of a baby with a saccular cyst. Immediately after diagnosis and 5 days later the cyst was de-roofed using a CO2 laser via an endolaryngeal approach. Because of a second recurrence an excision of the cyst was performed via a lateral cervical approach.     

遗传性血管神经性喉水肿1例

目的 通过报道1例遗传性血管神经性喉水肿（HALE）患者的发病和诊治经过，以提高临床医师对HALE这一罕见病的认识。方法 患者，女，71岁，因"咽痛、呼吸困难伴颈部肿胀半天"、以"喉水肿"收住院。患者反复发作喉水肿、颜面水肿、四肢水肿50余年，外院一直不能明确诊断。结果 入院后积极给予对症应急处理，患者口唇颜面及颈部肿胀较前明显减轻，完善补体C4和补体C1酯酶抑制剂检查考虑为HALE，患者后赴北京查补体C1抑制物0.05 g/L，确诊为HALE，现采用达那唑治疗中，发作频率明显减少。结论 HALE是一种罕见且有致命威胁的疾病，有家族遗传倾向，易误诊，临床医生应提高认知度，避免严重并发症的发生。     

Adult laryngeal cavernous hemangioma: a case report

We describe a case of laryngeal venous malformation, discovered by dysphonia. This malformation has a different histology and evolution compared to infant laryngeal hemangioma. The histological exam shows large and multiple vessels lined by regular endothelium. There is no spontaneous regression; this malformation can be stable or increase and induce a laryngeal obstruction. Although inconstant, a bluish colour, seen at endoscopy, suggests the presence of venous malformation. The diagnostic is confirmed by MRI, which shows local extension. We propose regular clinical and radiological supervision for asymptomatic venous malformations. Treatment is recommended only for symptomatic patients usually by laryngeal microsurgery or cervicotomy. Per cutaneous sclerosis is an interesting alternative therapy alone or prior to surgery. Regular follow-up is essential in order to detect frequent recurrences.     

喉基底细胞腺瘤1例

1病例报告 患者,女,63岁。因间断性呼吸困难1年加重1个月并伴有咳嗽带血,于2012年7月31日入院。体检：双侧鼻腔通畅,无异常分泌物和出血,咽黏膜慢性充血,扁桃体无肿大,喉发声正常,无声嘶,颈部未触及肿块及肿大淋巴结。     

Parathyroid gland adenoma in primary hyperparathyroidism: report of two cases--chief and oxyphil cell adenoma.

Parathyroid adenomas are classified into two types: chief cell and oxyphil cell variants. In this report two types of parathyroid adenoma in association with hyperparathyroidism were examined. Both cases had suffered from renal calculi, and underwent operation. The laboratory tests showed high serum calcium and parathyroid hormone (PTH) levels. An exploratory surgery revealed a solitary tumor in each case. After extirpation of the parathyroid tumor these data returned to normal values. Electronmicroscopically, oxyphil cell adenoma in this report was characterized by numerous mitochondria and annulate lamellae in the cytoplasm. In some tumor cells secretory-like granules were observed.