鼻内镜手术切除与传统手术治疗鼻腔鼻窦恶性肿瘤的疗效比较

目的比较鼻内镜手术切除与传统手术治疗鼻腔鼻窦恶性肿瘤的疗效。方法 2010年9月至2012年9月收治的56例患者应用传统手术治疗(对照组),2012年10月至2014年10月收治的56例患者应用鼻内镜手术切术治疗(观察组)。观察并记录两组患者的手术时间、术中出血、疼痛评分、术后并发症发生情况(颅内血肿、鼻腔粘连、视神经损伤、脑脊液漏)以及复发情况,比较手术前后患者的焦虑情绪情况。结果与对照组比较,观察组各型患者的手术时间、术中出血量、视觉模拟评分法(VAS)评分、并发症发生率、复发率、汉密尔顿焦虑量表(HAMA)评分总分及各因子分均明显降低。两组患者全部完成随访,与对照组比较,观察组患者生活质量各项指标均明显升高(P<0.01)。结论鼻内镜手术切除治疗鼻腔鼻窦恶性肿瘤可降低手术时间以及术中出血量,缓解患者的疼痛,并减少并发症以及术后复发率,改善患者的焦虑情绪,提高生活质量。     

鼻内镜手术切除治疗鼻腔鼻窦恶性肿瘤的临床疗效

目的评价鼻内镜手术切除治疗鼻腔鼻窦恶性肿瘤的临床疗效。方法将本院收入的56例鼻腔鼻窦恶性肿瘤患者分为2组,实验组行鼻内镜手术,对照组行传统鼻切开手术。比较2组手术时间,术中出血量,术后疼痛视觉模拟评分,术后并发症以及复发率的情况。结果实验组患者手术时间相比对照组短,疼痛情况也较对照组轻,并发症发生较少且复发率较低。结论鼻内镜手术切除鼻腔鼻窦恶性肿瘤的方法具有手术时间短,术后并发症少,术后复发率低的特点,值得推广应用。     

鼻内镜手术对晚期鼻窦恶性肿瘤患者术后恢复和术后并发症及情绪的影响

目的探讨鼻内镜手术对晚期鼻窦恶性肿瘤患者术后恢复、术后并发症及情绪的影响。方法纳入2012年1月至2013年12月间收治的98例晚期鼻窦恶性肿瘤患者,根据随机数字表法分为观察组和对照组,每组49例,观察组患者接受鼻内镜手术,对照组患者接受传统开放手术,观察和比较两组手术时间、住院时间、术后并发症及复发率、焦虑(SAS)及抑郁(SDS)评分。结果与对照组比较,观察组患者的手术时间、住院时间均明显缩短(P<0.05),术后并发症的发生率及复发率均显著降低(P<0.05),SAS、SDS评分均明显降低(P<0.05)。结论鼻内镜手术治疗晚期鼻窦恶性肿瘤具有损伤小、并发症少、恢复快等特点,能够保留鼻腔解剖结构和功能,稳定患者情绪,值得推广。     

鼻内镜手术联合低温等离子射频消融术治疗鼻腔鼻窦内翻性乳头状瘤的临床疗效及生活质量评价

目的：分析鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma, SNIP)经鼻内镜手术联合低温等离子射频消融术治疗的临床疗效及术后生活质量。方法：本研究设计为单中心回顾性研究,连续纳入2016年1月至2018年6月在我院接受单纯鼻内镜手术治疗的32例SNIP患者作为对照组,纳入2018年7月至2020年12月接受鼻内镜手术联合低温等离子射频消融术治疗的41例SNIP患者作为观察组,比较两组患者的手术相关指标(手术时间、术中出血量、住院时间、术后并发症等)、临床疗效,并随访其术后复发情况,采用鼻腔鼻窦结局测试22条量表(Sino-Nasal Outcome Test-22, SNOT-22)、疼痛视觉模拟评分量表(Visual Analogue Scale, VAS)对患者手术前后的生活质量进行评价。结果：观察组与对照组相比,术中出血量、住院时间均低于对照组,差异均有统计学意义(均P <0.05)。观察组的总有效率高于对照组(97.6%vs 84.4%),差异有统计学意义(χ²=4.142, P=0.042)。观察组T3期患者术后...     

3D-Slicer虚拟现实技术在鼻内窥镜下鼻腔鼻窦恶性肿瘤切除术中的应用效果

目的 探讨3D-Slicer虚拟现实技术在鼻内窥镜下鼻腔鼻窦恶性肿瘤切除术中的应用效果.方法 根据术中是否应用3D-Slicer虚拟现实技术将80例鼻腔鼻窦恶性肿瘤患者分为观察组和对照组,每组40例,对照组患者仅给予鼻内窥镜下肿瘤切除术,观察组患者在鼻内窥镜下肿瘤切除术中联合应用3D-Slicer虚拟现实技术.比较两组患者的围手术期指标、炎性因子[γ干扰素(IFN-γ)、白细胞介素-4(IL-4)]水平、生活质量[鼻腔鼻窦结局测试22条量表(SNOT-22)]和并发症发生情况.结果 观察组Ⅰ、Ⅱ型患者的手术时间、住院时间均明显短于对照组(P﹤0.01),术中出血量均明显少于对照组(P﹤0.01),肿瘤全切率为90.00％,高于对照组的72.50％(P﹤0.05).术后1周,两组患者IFN-γ水平均高于本组术前(P﹤0.05),IL-4水平均低于本组术前(P﹤0.05),且观察组患者IFN-γ水平高于对照组,IL-4水平低于对照组(P﹤0.05).术后1个月,两组患者SNOT-22量表各维度评分均低于本组术前(P﹤0.05),且观察组患者SNOT-22量表各维度评分均低于对照组(P﹤0.05).观察组并发症总发生率为12.50％,低于对照组患者的32.50％(P﹤0.05).结论 鼻内窥镜下鼻腔鼻窦恶性肿瘤切除术前使用3D-Slicer虚拟现实技术能有效改善围手术期指标,提高肿瘤全切率,降低术后并发症发生率,提高生活质量.     

鼻内镜联合低温等离子刀手术治疗鼻内翻性乳头状瘤的疗效观察

目的:探讨经鼻内镜下鼻腔鼻窦乳头状瘤切除的手术方式和经验,观察治疗效果。方法:对本院2010年2月至2015年2月收治的鼻腔鼻窦乳头状瘤48例患者的临床资料进行回顾性分析,患者均在鼻内镜下行低温等离子刀切除治疗或联合柯－陆式上颌窦入路或联合泪前隐窝入路切除肿瘤,其中鼻腔肿瘤29例,鼻窦肿瘤19例,对其临床疗效行追踪随访24~36个月,对手术方法和技巧进行总结分析。结果:本组48例患者均手术成功切除病变组织,4例患者在随访期间复发,复发率为8.33％,与国内报道鼻内镜鼻内翻乳头状瘤22%术后复发率相比较,复发率明显较低(P<0.05)。本组3例复发病例通过术后鼻内镜复查时发现,给予局部切除,经低温等离子刀局部电凝后治愈,1例经二次手术彻底清除病灶后治愈。无１例术中或术后严重并发症发生,达到了良好的临床疗效。结论:鼻内镜联合低温等离子刀切除鼻腔鼻窦乳头状瘤可取得较好的临床疗效,根据病变范围及分期选择合适的手术方式及术中准确判断切除瘤体的根蒂部对保证手术的成功具有重要意义,术后鼻内镜密切随访,联合低温等离子刀处理,对达到治愈的目的及降低二次手术概率具有重要的意义。     

跨学科管理对甲状腺癌手术患者负性情绪、术后恢复的影响

目的 研究跨学科管理模式对甲状腺癌手术患者负性情绪及术后恢复的影响.方法 选取外科行甲状腺癌手术切除的患者62例,按干预方法不同分为对照组与观察组,每组31例.对照组行常规管理方法,观察组行常规管理+跨学科管理.比较两组干预前后的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分及生活质量核心量表(QLQ-C30)评分,比较两组患者干预后的视觉模拟评分法(VAS)评分并记录两组患者术后下床活动时间、住院时间及并发症发生情况.结果 干预后,观察组患者的SAS评分、SDS评分、VAS评分均低于对照组,观察组患者的术后下床活动时间及住院时间均短于对照组,观察组患者的并发症总发生率(3.23％)低于对照组(19.35％),观察组患者QLQ-C30评分中躯体功能、情绪功能、角色功能、社会功能、认知功能及总健康状况评分均高于对照组,差异均有统计学意义(P﹤0.05).结论 跨学科管理能有效缓解甲状腺癌手术患者负性情绪,促进术后恢复,降低并发症发生率,提高患者生活质量.     

不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤的疗效观察

目的探讨不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤(NIP)的临床疗效。方法选取2009年2月至2016年8月间第三军医大学第二附属医院收治的126例NIP患者。根据手术方式不同分为切开组(鼻侧切开术,20例)、内镜组(鼻内镜下手术,58例)和联合组(鼻内镜下手术+柯路氏进路,48例)三组。比较三组患者的术后复发率、术中出血量及术后并发症发生率。结果切开组患者中,6例患者发生并发症,包括视力衰退1例,脑脊液鼻漏2例,伤口麻木2例,眼睛流泪1例;内镜组患者中,4例患者发生并发症,包括脑脊液鼻漏1例,伤口麻木2例,眼睛流泪1例;联合组患者中,6例患者发生并发症,包括视力衰退1例,脑脊液鼻漏2例,伤口麻木1例,眼睛流泪2例。三组患者术后并发症发生率比较,差异有统计学意义(P<0.05)。切开组患者术后并发症发生率高于内镜组患者,差异有统计学意义(P<0.05)。三组患者术中出血量比较,差异有统计学意义(P<0.01),其中切开组患者术中出血量明显高于内镜组患者与联合组患者,差异均有统计学意义(均P<0.01)。三组患者术后肿瘤复发率比较,差异有统计学意义(P=0.01)。切开组术后复发率为40.0%(8/20),高于内镜组的12.1%(7/58)和联合组的14.6%(7/48),差异均有统计学意义(均P<0.05)。结论鼻内镜下手术与鼻内镜下手术+柯路式进路治疗NIP患者的临床疗效明显优于鼻侧切开术,术后肿瘤复发率、术中出血量及术后并发症发生率均较低,值得推广。     

术前心理状态对全麻效果的影响

目的 研究术前心理状态对妇科肿瘤切除术患者全麻镇静时间、苏醒时间和术后疼痛的影响.方法 选择年龄在39～66岁,行择期妇科肿瘤切除术的患者105例,按照Zuang焦虑自评量表(SAS)对患者进行焦虑状态自评的分数,将105例患者分为对照组(A组)和焦虑组(B组)两组.观察上述两组全麻镇静时间、苏醒时间和术后视觉模拟(VAS)评分情况.结果 焦虑组全麻镇静时间、苏醒时间均明显长于对照组(P＜0.01),焦虑组的术后VAS评分也明显大于正常组(P＜0.01).结论 术前患者的焦虑心理状态对全麻效果有一定的影响,麻醉医师应重视术前访视患者.     

鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤,4例经鼻腔和鼻外切口双径路手术治疗,其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻,经治疗后好转;1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤,术后出现患侧内眦外移;4例良性骨源性病变患者行鼻内镜下病变部分切除术,其余病例均彻底切除肿瘤而无明显并发症,随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势,在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。     

Comparing the Efficacy of Alkaline Nasal Douches Versus Decongestant Nasal Drops in Postoperative Care After Septal Surgery: A Randomised Single Blinded Clinical Pilot Study

To compare the efficacy of alkaline nasal douches and decongestant nasal drops following nasal septal surgery. This was a prospective, randomised, single-blind pilot study. Twenty patients were included in each arm of the study undergoing elective nasal septal surgery. The primary outcome measure was nasal congestion. Secondary outcome measures were anosmia, facial pain, nasal discharge, and sneezing/itching. This study does not show any statistically significant difference between the two treatment groups. Symptoms of nasal congestion (P = 0.3), facial pain (P = 0.932), nasal discharge (P = 0.98), sneezing (P = 0.59) and anosmia (P = 0.208) were analysed before conclusion. Three patients in saline group and one patient in the nasal drops group had poor compliance to follow the advice, scoring 2 on a VAS score but the treatment was tolerated well in majority of the patients. No statistical significant differences were noted on analysing the post operative complications in either group. In this study, both nasal douches and decongestant nasal drop were well tolerated. Both treatments provided good postoperative relief from nasal congestion, nasal discharge, sneezing, facial pain and anosmia as days progressed. The post operative examination of the nose among these patients revealed no significant complications in either of the study arm.     

Nasal teeth: A case report

The ectopic eruption of the teeth into the nasal cavity is a rare phenomenon. We report a case of nasal tooth in the left nasal cavity in a 64-year-male. We describe the clinical and radiological findings of the case and discuss their etiology, diagnosis, complications and treatment.     

鼻腔和鼻窦内翻性乳头状瘤74例分析

１９８０～１９９１年收治鼻腔、鼻窦内翻性乳头状瘤（下称ＩＰ）７４例，全部为单侧发病，平均年龄４５．９岁。采用鼻内或鼻内＋Ｃａｌｄｗｅｌｌ－Ｌｕｃ手术或鼻侧切开术＋液氮冷冻治疗，总复发率３５．２％，其中恶变率为２１．６％（１６／７４），作者认为本病术前应作详细的影像学检查，尔后选择治疗。如病变局限，应在鼻内窥镜下作鼻内保守性手术，病变广泛或复发的病历应作鼻侧切开，内侧上颌骨摘除，术中采用液氮冷冻治疗，术后密切随访。     

鼻腔淋巴瘤病理分析

目的：探讨鼻腔淋巴瘤的病理特点及诊断要点。方法：对17例鼻腔淋巴瘤的临床病理资料及病理切片进行回顾性分析。结果：男14例，女3例，中位年龄52岁。组织学类型包括NK／T细胞淋巴瘤7例(41％)，外周T细胞淋巴瘤(非特殊型)8例(47％)，弥漫性大B细胞淋巴瘤2例(12％)。5例肿瘤旁鳞状上皮组织呈假上皮瘤样增生。结论：鼻腔淋巴瘤绝大部分为T细胞及NK／T细胞淋巴瘤，在病理诊断中应注意与小细胞癌等疾病鉴别。     

Giant Pleomorphic Adenoma of the Nasal Septum

Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. In rare cases, however, pleomorphic adenoma presents in various unusual sites such as the nasal cavity, paranasal sinuses, hypopharynx, pharynx, larynx, trachea and lacrimal glands. We present a rare case of 80-year-old woman with pleomorphic adenoma of the nasal cavity.     

A Comparative Study of Septoplasty With or Without Nasal Packing

This study was conducted to compare the outcome of septoplasty with or without Nasal packing. The study subjects were randomly allocated into two groups. There was significant reduction in frequency of post operative pain, headache, discomfort and duration of hospital stay in patients who have undergone septoplasty without nasal packing. However there was no difference in post operative bleeding and septal perforation between two groups. Therefore after Septoplasty without nasal packing is preferred alternative to with nasal packing.     

Cavernous Sinus Thrombosis of Nasal Origin in Children

Cavernous sinus thrombosis is a rare presentation. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. Nasal infections can give rise to serious intracranial complications. Presented here is a case series of cavernous sinus thrombosis of nasal septic origin. The purpose of this article is to report our experience in pediatric patients with this illness to ascertain a clinical course and outcomes for further clinical application. Eight (08) cases of nasalseptic origin of cavernous sinus thrombosis ata tertiary care teaching hospital in the north India region of India were included in the study. Cases presented with various symptoms like headache, proptosis, ophthalmoplegia and fever. The patients were investigated by doing High Resolution Computed Tomography of nose & PNS and brain with intravenous contrast. The cases were treated with intravenous broad spectrum antibiotics. Eight patients less than 16 years of age (mean age of 11.2 years)diagnosed with cavernous sinus thrombophlebitis due to nasal septic focus over the period of 05 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children. A conservative management strategy with antibiotics gave a good prognosis in these cases. There were no deaths. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.     

Impact of Septal Correction on the Blood Pressure of Hypertensive Patients with Deviated Nasal Septum

This study aims to evaluate the effect of septal correction on the blood pressure (BP) of patients with symptomatic nasal septal deviation and to assess whether a positive association exists between deviated nasal septum and hypertension. A prospective observational clinical study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. Hundred adults, aged 18–40 years, with symptomatic nasal septal deviation, newly detected untreated hypertension (mean BP ≥140/90 mmHg), undergoing submucosal resection of the septum and submucosal diathermy of hypertrophied inferior turbinate (when present), were included. Postoperative follow up for ENT examination and BP measurement was done at 1, 6 and 12 months. Seventy five males and 25 females met the inclusion criteria. 48 % were aged 31–35 years (mean = 31.83 ± 5.19 years). 71 % had anterior septal deviation, 13 % posterior deviation and 16 % a combination of both. Preoperatively, mean systolic blood pressure was 141.82 ± 1.70 mmHg and mean diastolic blood pressure was 91.04 ± 1.21 mmHg, which postoperatively decreased by 10–12 mmHg and 4–5 mmHg respectively. 79 % showed a significant (P < 0.001) decrease in BP postoperatively. 13 % showed no change in BP, of which 53.8 % had posterior deviation, demonstrating a significant association (P < 0.001) between type of deviation and response to surgery. In 8 %, a rise in BP over the follow up period was seen; of these, 62.5 % were aged 36–40 years, indicating a significant association (P < 0.001) between age and BP. Surgical correction of septal deviation is thus effective in controlling the BP of patients with anterior deviation, aged <35 years.     

The Role of Sensation in Subjective and Objective Evaluation of Nasal Patency

To assess if sensation of nasal mucosa affect the subjective sensation of nasal patency. This is a case control study with 50 patients, using 2% lignocaine as the active drug and normal saline as the placebo (2 groups of 25 patients each). Each subject had 2 ml of solution sprayed into the test nose. These subjects had no prior nasal symptoms, allergy or surgery. They were evaluated subjectively using Likert scale and objectively by acoustic rhinometry before and after lignocaine or normal saline. The patients in both normal saline and lignocaine groups demonstrated no significant change based upon Likert scale. The study also demonstrated the mean cross sectional area 1 (CSA1), mean cross sectional area 2 (CSA2), with mean Volume 1 and mean Volume 2, these results did not vary significantly in both groups with Acoustic Rhinometry. The analysis thus shows that the use of topical anesthetic spray on nasal mucosa produces no objective effect on nasal resistance or subjective sensation of altered nasal patency. Thus the study concludes that, tactile sensation of nasal mucosa does not play a role in the sensation of nasal obstruction.     

鼻和鼻型NK/T细胞淋巴瘤的治疗进展

鼻和鼻型NK／T细胞淋巴瘤是一种起源于NK细胞的少见的非霍奇金淋巴瘤，其临床病理表现独特，肿瘤浸润以血管为中心。伴有血管破坏和灶性坏死。其几乎可以侵及所有结外器官，侵袭性高，极易产生耐药性而疗效差。预后差，生存时间短，目前尚无最佳的治疗模式。本文对近年来采用的放疗，传统化疗，大剂量化疗结合干细胞移植和基于左旋门冬酰胺酶的联合化疗等治疗模式进行综合论述，比较各疗法的优缺点并介绍了最新发展趋势。