耳内镜下软骨膜-软骨岛在鼓膜修补术中应用的效果分析

目的　探讨耳内镜下软骨膜-软骨岛在鼓膜修补术中应用的疗效。方法　回顾性分析2017年1月～2018年7月86例行鼓膜修补术的慢性中耳炎静止期患者,按随机数字表法随机分为观察组和对照组。观察组43例,使用软骨膜-软骨岛移植物行鼓膜修补术;对照组43例,使用全厚软骨-软骨膜移植物行鼓膜修补术。对比两组术前穿孔部位、穿孔大小、手术后鼓膜愈合率、术后6个月平均气导听阈及气骨导差。结果　对照组鼓膜愈合35例（81.4%）,再穿孔8例（18.6%）;观察组鼓膜愈合41例（95.3%）,再穿孔2例（4.7%）,两组鼓膜愈合率比较,差异有统计学意义（χ2=5.237,P＜0.05）。术后6个月纯音听阈检查,对照组平均气导听阈（33.54±4.81）dB HL,骨气导差（14.05±5.72）dB HL;观察组平均气导听阈（28.84±2.53）dB HL,骨气导差（9.40±2.77）dB HL,两组听力均较术前提高,两组间比较平均气导听阈和气骨导差的差异均有统计学意义（t =5.347、4.516,P 均＜0.05）。结论　耳内镜下软骨膜-软骨岛行鼓膜修补术鼓膜愈合率高,术后听力改善更显著,是一种有效的鼓膜修补方法。     

外耳道皮下组织压片行鼓膜穿孔修补术

目的探讨应用外耳道上壁中、外段皮下组织压片修补鼓膜穿孔的临床疗效。方法对65例（69耳）由中耳炎或外伤引起的鼓膜穿孔直径大于3 mm伴外耳道狭窄、弯曲患者,用此法行耳内切口、扩大外耳道,用外耳道上壁中、外段皮下组织压片行鼓膜修补术。结果67耳鼓膜穿孔修补术后愈合,穿孔愈合率97.1%。修补鼓膜愈合时间平均15.2 d。术后外耳道宽畅。随访0.5-3.5年,无鼓膜再穿孔。术后纯音测听（取0.5,1,2,4 kHz）气导听力提高10-30 dB（平均18.6 dB）者66耳,气骨导差距在10-20 dB,较术前平均缩小16.8 dB,听力改善率95.7%。另3耳听力无改善。结论用耳道上壁中、外段皮下结缔组织压片修补鼓膜穿孔是一种取材简便、术野显露好、愈合时间短、穿孔愈合率高的新术式,更适合鼓膜穿孔大、外耳道狭窄和弯曲者。     

软骨软骨膜在鼓膜修补中的应用

目的探讨鼓膜大穿孔采用软骨-软骨膜修补的方法及临床疗效。方法36例（40耳）鼓膜大穿孔（软骨-软骨膜组）采用软骨-软骨膜行鼓膜修补术并与同期46例（46耳）颞肌筋膜鼓膜修补术（颞肌筋膜组）进行比较。软骨-软骨膜组采用耳后切口,切取耳廓软骨-软骨膜,然后将软骨切成2～3条,将其相互部分重叠修复穿孔,修补鼓膜,同期行听骨链重建。结果随访1年,软骨-软骨膜组鼓膜穿孔愈合率为95.0%（38/40）;筋膜组鼓膜穿孔愈合率为89.1%（41/46）,两组相比无统计学意义（χ2=0.288,P=0.592）。颞肌筋膜组17耳鼓膜有钙化斑中,5耳穿孔未愈,占29.4%（5/17）;软骨-软骨膜组20耳鼓膜有钙化斑,其中1耳穿孔未愈,占5.0%（1/20）。两组鼓膜有钙化斑的病例鼓膜穿孔愈合率相比有统计学意义（χ2=4.031,P=0.045）。术后1年复查软骨-软骨膜组纯音听力平均气导听阈为36.9dB,平均骨气导差为17.8dB;筋膜组纯音听力平均气导听阈为35.5dB,平均骨气导差为15.9dB。两组比较无统计学意义（t=2.103,P=0.85）。结论软骨-软骨膜修补鼓膜穿孔是一种可靠的方法,其在修补鼓膜大穿孔和鼓膜伴有钙化斑的患者中有一定的优势。     

耳后进路-夹层法鼓膜成形术（附285例疗效分析）

目的分析慢性化脓性中耳炎及外伤性鼓膜穿孔患者行耳后进路-夹层法鼓膜成形术后的疗效。方法回顾性分析285例（308耳）行耳后进路-夹层法鼓膜成形术患者的临床资料。结果术后随访281耳（91．23％）鼓膜愈合，287耳（93．18％）术后气骨导差值在15dBHL以内；213耳术后气骨导差缩小≥15dBHL（包括15dB）听力提高69．16％，21耳术前、术后气骨导差值未改善（仍在15-30dBHL之间），占6．82％。无耳鸣、面瘫等严重并发症出现。结论慢性化脓性中耳炎和外伤性鼓膜穿孔患者行耳后进路-夹层法鼓膜成形术后鼓膜愈合率高，多数患者听力改善。     

软骨-软骨膜与颞肌筋膜修补鼓膜大穿孔的临床疗效分析

目的探讨软骨-软骨膜与颞肌筋膜修补鼓膜大穿孔的临床疗效。方法采用自体耳屏软骨-软骨膜作为移植材料修补鼓膜紧张部大穿孔46例（A组）,采用颞肌筋膜修补鼓膜紧张部大穿孔42例（B组）,对两组疗效进行分析对比。结果两组患者术后随访1年,软骨-软骨膜组鼓膜穿孔愈合率为97．83％（45／46）;颞肌筋膜组鼓膜穿孔愈合率为80．95％（34／42）,两组比较差异具有统计学意义（X2=5．095,P=0．024）;软骨-软骨膜组纯音听力平均气导听阈为27．86dB,平均骨气导差为16．83dB;颞肌筋膜组纯音听力平均气导听阈为27．70dB,平均骨气导差为16．15dB,两组比较差异无统计学意义（X2=0．876,P=0．381）。结论采用耳屏软骨-软骨膜作修补材料,具有取材方便、便于植入、抗感染性强等特点,对修补鼓膜大穿孔者术后效果好,复发率低,值得临床推广。     

鼓室成形术后主观听力改善与纯音测听结果关系的研究

目的 探讨慢性化脓性中耳炎鼓室成形术后主观听力改善与纯音测听结果的关系.方法 随访2000～2006年行鼓室成形术后1、3和5年的患者288例,复查纯音测听结果,并记录患者日常生活中听力改善情况.结果 鼓室成形术后,83.3%的患者(240/288)气骨导差在20 dBHL以内,85.8%患者(247/288)术后主观听力有明显改善.术后气导听阈下降小于或等于10 dBHL无实质性变化的患者中54.2%有主观听力改善;术后气导听阈下降30 dBHL时,100%的患者主观听力改善.结论 鼓室成形术前术后的气骨导差值、气导听阈值的变化,结合患者听力改变的主观感觉,可作为判断慢性化脓性中耳炎患者鼓室成形术后听力情况的评估手段.     

鼓膜修补术联合咽鼓管球囊扩张治疗鼓膜穿孔的疗效观察

目的探讨鼓膜修补联合咽鼓管球囊扩张治疗鼓膜穿孔的临床疗效。方法收集咽鼓管功能障碍的鼓膜穿孔患者22例(22耳),均在全麻下行鼓膜修补和咽鼓管球囊扩张术。结果术后随访6个月,一例因中耳腔感染中断随诊。其余21例患者鼓膜穿孔均愈合,鼓室图均显示为A型,21例患者术前平均气导听阈为(52.4±17.7)d BHL,平均气骨导差(27.4±11.2)d BHL。术后6个月平均气导听阈(30.9±10.5)d BHL,平均气骨导差为(16.3±12.0)d BHL。差异有统计学意义(P0.05)。结论咽鼓管球囊扩张可改善咽鼓管功能,鼓膜修补联合咽鼓管球囊扩张可用来治疗咽鼓管功能障碍的鼓膜穿孔。     

Over-under法与内置法Ⅰb型鼓室成形术疗效比较

目的 比较Over-under法和内置法Ⅰb型鼓室成形术治疗慢性化脓性中耳炎的疗效.方法 回顾性分析2012年3月至2014年3月间行Ⅰb型鼓室成形术的28例(28耳)单侧慢性化脓性中耳炎患者的临床资料,其中以Over-under法修补鼓膜且鼓室内放置明胶海绵15例(耳)(Over-under法组),以内置法修补鼓膜且鼓室内不放置明胶海绵13例(耳)(内置法组).术后1月复查耳内镜及纯音听阈,比较两组患者手术前后各频率及语频气导平均听阈的变化及鼓膜愈合情况.结果 两组患者术后移植鼓膜均愈合,鼓膜修补成功率均为100%;术后各频率气导听力均有不同程度的提高,Over-under法组手术前后0.25、0.5、1、2、4及8 kHz平均气导听阈差分别为14.33± 3.48、12.33±2.48、9.00±2.19、8.67±3.33、5.33±2.46、-1.00±3.56 dB;内置法组分别为21.92±3.78、19.23±3.09、12.69±2.24、7.69±1.34、6.92±2.97、7.69±3.70 dB,两组术后听阈均较术前降低;手术前后语频气导平均听阈差值Over-under法为10.00±1.91 dB,内置法组为13.21±1.78 dB,两组间听力改善程度比较差异无统计学意义(P>0.05).结论 针对可行Ⅰb型鼓室成形术的慢性化脓性中耳炎患者,无论选择Over-under法还是内置法,鼓膜修补成功率相似,术后听力改善程度无明显差异.     

钛合金听骨Ⅰ期听骨链重建临床疗效分析

目的 探讨钛合金听骨赝复物在鼓室成形术中Ⅰ期听力重建的效果.方法 回顾性分析676例2008年6月至2011年1月行开放式鼓室成形伴Ⅰ期听骨链重建术的病例,从中筛选具有完整中长期随访资料者106例(107耳),根据应用钛合金为全部听骨赝复物( total ossicular replacement prosthesis,TORP)或部分听骨赝复物(partial ossicular replacement prosthesis,PORP)将其分为PORP组(86耳)和TORP组(21耳),随访6至30个月,分别比较两组手术前后0.5、1、2、4 kHz纯音气导平均听阈、平均气骨导差的变化及术后听力重建成功率的情况.结果 PORP组术前气导平均听阈为(49.0±12.6)dBHL,术后为(31.3 ±7.1)dBHL,听力平均提高了17.7 dBHL.TORP组术前气导平均听阈为(48.5 ±4.8)dBHL,术后为(29.4 ±4.7)dBHL,听力平均提高了19.1 dBHL.PORP组术前平均气骨导差为(27.0±7.1)dB,术后为(14.5 ±4.6)dB,气骨导差闭合12.5 dB.TORP组术前平均气骨导差为(29.1 ±7.2)dB,术后为(16.3 ±4.2)dB,术后气骨导差闭合12.9 dB.两组听力重建的成功率分别为83.7％和71.4％.两组在听力提高、气骨导差闭合、听力重建成功率等方面差异均无统计学意义(P值均＞0.05).总体听骨假体排出率为0.9％( 1/107).结论 应用钛合金听骨赝复物行鼓室成形术Ⅰ期听力重建,可有效提高听力,其排异率低.     

中耳炎鼓膜小穿孔耳内镜治疗的研究

目的　探讨鼓膜小穿孔的慢性化脓性中耳炎耳内镜下手术修补方式的选择。方法　回顾性分析2016年3月～2018年10月我科诊治的90例慢性化脓性中耳炎鼓膜小穿孔患者,根据修补方式（内置法或夹层法）和手术时鼓室黏膜情况（干耳或湿耳）,观察对比鼓膜愈合率及术后3个月听力改善情况。结果　90例患者干性穿孔53例,鼓膜穿孔边缘潮湿者（湿耳）37例;内植法64例,夹层法26例。术后鼓膜一期愈合87例,夹层法术后鼓膜愈合率高于内植法,但两者比较差异无统计学意义（P =0.554）。湿耳组中夹层法修复鼓膜成功率高于内植法,两者比较差异有统计学意义（Fisher确切概率法P =0.047）。术后3个月平均气导听阈较术前显著提高,差异有统计学意义 （t =5.055,P＜0.05）,气骨导差明显缩小与术前比较,差异有统计学意义（t =5.351,P＜0.05）。结论　耳内镜下内置法鼓膜成形术治疗中耳炎鼓膜小穿孔,有微创、便捷和疗效确切等优势。针对鼓膜穿孔边缘潮湿、耳漏反复发作及前上象限穿孔者,该术式需慎重考虑,应优先选择夹层法鼓膜成形术。     

CO2 laser in otolaryngology-head and neck surgery: a retrospective analysis of complications

A retrospective review was conducted of all patients undergoing CO2 laser surgery by members of the Department of Otolaryngology-Head and Neck Surgery at Northwestern University Medical School from January 1, 1980 through December 31, 1981; 204 cases were identified and all are included in this report. Early in our department's experience with laser surgery, an endotracheal tube fire occurred. This incident precipitated a departmental review of complications associated with the use of the CO2 laser and resulted in the formulation of a laser safety protocol. All patients in this group were treated under the directives of this protocol; the operative complication rate was low. This retrospective analysis of complications associated with the use of the CO2 laser under a strictly applied protocol demonstrates the relative safety associated with judicious use of this instrument.     

早期声带癌的CO2激光微创治疗

目的 探讨CO2激光治疗早期声带癌（T1、T2）的疗效。方法 回顾性分析经CO2激光治疗的26例早期声带癌（T1a期12例、T1b期2例和T2期12例）疗效和手术并发症。结果 术后随访5～15个月,所有患者无严重并发症,发音功能恢复良好,复发3例（复发率11.5%）,再次行CO2激光手术2例,行全喉切除术1例。结论 CO2激光手术具有手术创伤小、并发症少和发音功能保留满意等优点,是早期声带癌理想的治疗方法。     

早期声门型喉癌的CO_2激光手术治疗

目的：探讨CO2激光手术治疗声门型喉癌的临床治疗效果。方法：112例声门型喉癌患者均在全身麻醉下经口气管插管,用支撑喉镜充分暴露声门,完全看清肿瘤后,显微镜下用CO2激光沿肿瘤外缘切除声门肿瘤,安全边界为3~5mm。术后随诊12~62个月。结果：112例支撑喉镜下CO2激光手术后8例局部复发,局部复发率7.14%,T1a复发率0.89%、T1b复发率0.89%、T2复发率5.40%,组间差异有统计学意义（χ2=5.306,P〈0.01）。病变侵犯前连合复发率7.14%,病变未侵犯前连合复发率7.14%,2组差异无统计学意义（χ2=0.000,P〉0.01）。1例患者术后当天出现喉腔大出血,经再次手术,应用带吸引单极电凝止血成功。结论：激光手术治疗早期声门型喉癌疗效可靠,喉功能保全好,是早期喉癌较为理想的治疗方式。     

显微支撑喉镜下CO2激光手术或联合干扰素治疗复发性小儿喉乳头状瘤疗效对比

目的 探讨白细胞干扰素联合显微支撑喉镜下CO2激光手术治疗复发性小儿喉乳头状瘤的临床疗效。方法 回顾性分析61例复发性小儿喉乳头状瘤的临床治疗资料,运用解剖划分法,评估单纯显微支撑喉镜下CO2激光治疗(A组)、或联合干扰素共同治疗(B组)复发性小儿喉乳头状瘤这两种方案的临床效果。结果 两组乳头状瘤范围,① 术前均为1～8个解剖亚区,平均值A组为(3.45±1.86)个、B组为(3.53±1.67)个解剖亚区;② 术后A组1～4个、平均(2.09±0.87)个解剖亚区,B组1～3个、平均(1.47±0.63)个解剖亚区(P<0.05)。结论 单纯显微支撑喉镜下CO2激光手术与联合干扰素治疗复发性小儿喉乳头状瘤均能延缓肿瘤复发,联合治疗组较单纯手术组复发范围小。     

Treatment of port wine stains with the CO2 laser

Port wine stains represent a relatively common congenital vascular lesion, often appearing on the head and neck. Sixty-six consecutive treatments of port wine stains are evaluated in this study. This represents 38 patients, with many of these patients receiving multiple treatments to different areas of the lesion. All patients were treated with a CO2 surgical laser system. Of these patients, 62.9% showed good to excellent blanching, with the remainder showing fair or poor results. Hypertrophic scarring occurred in 7.4% of cases. The CO2 laser represents another tool with which these lesions can be treated. Further clinical experience is required with both the argon and the CO2 laser if the treatment of these disfiguring lesions is to be improved.     

Use of potassium titanyl phosphate (KTP) laser in management of subglottic hemangiomas

OBJECTIVE: to study the role of KTP laser in management of subglottic hemangioma. DESIGN: retrospective analysis of patients with subglottic hemangioma treated by the senior authors. Setting: tertiary care teaching hospital. PATIENTS: twelve patients with subglottic hemangiomas. INTERVENTION: patients were treated with KTP laser (eight cases), CO(2) laser (two cases) or observation (two cases). MAIN OUTCOME MEASURE: resolution of symptoms, decrease in size of subglottic hemangioma or tracheotomy decannulation. RESULTS: All patients treated with KTP laser or CO(2) laser had resolution of symptoms and five tracheotomy-dependent children were decannulated. CONCLUSION: subglottic hemangioma is a potentially life-threatening disease seen in young children. Most authors recommend use of either CO(2) or open surgical excision. There is very little data available on the use of KTP lasers in the management of subglottic hemangiomas. The KTP laser beam is preferentially absorbed by hemoglobin making this laser system more applicable to the treatment of vascular tumors such as the hemangioma. KTP laser is a good tool for management of subglottic hemangioma with a low incidence of complications.     

CO2激光喉显微手术治疗早期声门型喉癌疗效观察及相关因素分析

目的探讨CO2激光喉显微手术治疗早期声门型喉癌的疗效和安全性,对手术注意事项进行探讨。方法在显微支撑喉镜下,对27例早期声门型喉癌患者采用CO2激光手术治疗,其中Tis6例,T1a8例,T1b7例,T26例。累及前联合者3例,未累及前联合者24例。结果全部患者CO2激光手术均成功,术后无一例患者出现呼吸困难、出血等严重并发症。随访3年以上,存活率100％。2例患者复发,其中1例行CO2激光喉显微手术再切除,1例行喉垂直部分切除并术后放疗,随访2年均未再复发。结论CO2激光喉显微手术是治疗早期声门型喉癌的有效方法,通过选择合适的患者及注意术中操作,可减少甚至避免显微喉镜激光手术引起的声带粘连。     

Complications after CO(2) laser surgery of laryngeal cancer in the elderly

CONCLUSION: Cancer of the larynx in elderly patients should be treated with curative intention, if the extension of the primary tumour allows safe resection. Transoral CO(2) laser microsurgery is associated with a low rate of major complications and can be regarded as suitable even for elderly patients. Age itself should never be the sole factor in deciding which therapy should be undertaken. OBJECTIVES: In the industrialized nations the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. Nowadays laryngeal cancer is often treated by transoral CO(2) laser microsurgery. Because of a variety of comorbidities, the incidence of perioperative complications in the group of elderly patients is of increasing interest. To date, no references in the literature have discussed complications after transoral CO(2) laser microsurgery in this age group. Patients and methods. Twenty-four patients over the age of 75 suffering from squamous cell carcinoma of the larynx and treated by transoral CO(2) laser microsurgery since 1998 were analysed for intraoperative and postoperative complications. RESULTS: There was no evidence of surgery-related complications at all. Postoperatively, 6 of 24 patients complained about dysphagia. Due to intraoperative placement of nasogastric feeding tubes in these six cases further complications such as pneumonia resulting from aspiration could have been avoided.     

Tonsillectomy by CO@ laser microsurgery--an analysis of clinical and morphological data

BACKGROUND: Tonsillectomy by CO(2) laser microsurgery is an almost bloodless procedure that has developed to an alternative to traditional dissection tonsillectomy during recent years. It has been suggested that the laser technique more precise than the conventional one, however, attempts to investigate this morphologically have not yet been undertaken. In addition, there is a need for large clinical studies to compare the postoperative bleeding risk of both procedures. METHODS: The charts of 617 patients who underwent routine tonsillectomy between 1995 and 1998 at the ENT department of Darmstadt Hospital, were retrospectively investigated with regard to postoperative bleeding events. A total of 467 patients were treated by the conventional technique and 150 by CO(2) laser microsurgery (continuous mode, 5 W). Moreover, 2 mm serial sections of tonsils of 56 consecutive patients treated in 1999 (31 conventional and 25 laser tonsillectomies) were used to determine peritonsillar (Vp) and tonsillar tissue volumes (Vt). RESULTS: The postoperative bleeding risk following laser tonsillectomy differed slightly from that following the conventional technique (12.0% vs 14.6%; P=0.499; Fisher's exact test). However, the incidence of severe bleeding events requiring revision in general anesthesia was significantly reduced (0.7% vs 4.9%; P=0.015; Fisher's exact test). Tonsillar specimens that were removed by laser surgery contained significantly less peritonsillar tissue than those from conventional procedures (Vp/Vt 5.1%+/-0.6% vs 10.8%+/-1.1%; P below 0.001; Mann-Whitney U-test). CONCLUSION: CO(2) laser microsurgery improves the precision of tonsillectomy and provides a maximum protection for the peritonsillar tissue. The incidence of severe bleeding events is markedly reduced. Laser tonsillectomy is therefore recommended for patients with clotting disorders or those requiring a particularly exact preparation technique.     

CO2 laser cordectomy as a day-case procedure

OBJECTIVE: To evaluate the safety of CO2 laser cordectomy in the treatment of glottic carcinoma as a day-case procedure. STUDY DESIGN: This was a retrospective study of a cohort of 73 patients with glottic carcinoma treated by laser cordectomy as a day-case procedure using a CO2 laser, between January 2000 and June 2004. RESULTS: There were no major complications and no patients required reintubation. More than 90 per cent of the patients were discharged on the day of the procedure. There were seven unplanned admissions to hospital but none of these appeared to be the direct result of the surgery, and the patients were discharged the next day. All the patients stated they would have further surgery in this manner if required. CONCLUSION: Laser cordectomy for glottic carcinoma can be safely performed as an out-patient procedure if patients are carefully selected according to specific criteria.