小切口非超声乳化人工晶体植入术临床分析

目的比较小切口无缝线非超声乳化白内障人工晶体植入术与常规角膜缘大切口白内障人工晶状体植入术的手术效果.方法对比6mm巩膜隧道切口摘除白内障后房型人工晶体植入术与常规大切口手术.结果临床观察术后1周及1、3个月的疗效,实验组视力恢复优于后者(P＜0.05).结论小切口非超声乳化白内障人工晶体植入术,手术切口小,术后散光小,视力恢复快.在基层医院具有重要的临床推广价值.     

小切口及“T”形肌骨膜瓣在人工耳蜗植入手术中的应用

目的 探讨小切口及“T”形肌骨膜瓣在人工耳蜗植入术中的应用及效果。方法 回顾性分析56例(57耳)就治于大理白族自治州人民医院的重度、极重度感音神经性聋患者,采用耳后皮肤小切口并制作“T”形肌骨膜瓣完成人工耳蜗植入手术,术后记录切口长度、操作时间及术后愈合情况。结果 平均切口长度为(3.5±0.5)cm;平均操作时间为(95±10)min。术后1耳出现切口感染植入体排除,其余患者愈合良好,未出现皮瓣相关并发症。结论 小切口、“T”形肌骨膜瓣应用于电子耳蜗植入手术,不增加手术操作时间,且具有较好的手术视野及较低的皮瓣并发症。     

隧道自闭式小切口不缝线非超声乳化人工晶体植入术的临床观察

目的探讨隧道自闭式小切口不缝线非超声乳化人工晶体植入术的临床疗效.方法对30例老年性白内障34眼行巩膜隧道反眉形自闭式6mm小切口手术,并与传统的10～13mm大切口病例术后视力及角膜散光情况进行对比.结果小切口组34眼术后5d及2个月裸眼视力≥0.5者分别为75%与92%,大切口组12眼分别为55%与75%.差异有高度显著性(P＜0.01),角膜散光度小切口组术后5d及2个月为1.73±0.32D,与常规大切口组2.92±0.97D相比差异有高度显著性(P＜0.01),结论采用巩膜隧道自闭式小切口不缝线非超声乳化人工晶体植入术适应证广,不受核硬限制,易掌握,手术操作简便,费用低廉,不需昂贵医疗设备,对组织损伤轻,切口愈合好,视力恢复快,角膜散光小,且稳定,并发症少.     

直线式小t切口非超声乳化白内障摘除人工晶体植入术

目的评价直线式小切口非超声乳化白内障摘除人工晶体植入术的临床效果.方法采用国产显微镜及器械在角膜缘右上角象限为白内障患者270例、294眼做垂直斜型内大外小切口,信封式截囊,水离核,晶体圈匙娩出晶体核,囊袋内植入5.5mm宇宙型人工晶体.结果术后1周视力≥0.5216眼(72.4%),术后1月视力≥0.5252眼(85.9%).术后角膜散光度与同期常规超声乳化术组124例、136眼比较差异无显著性(P＞0.05).结论直线式小切口非超声乳化白内障摘除人工晶体植入术操作简单,设备价廉,手术效果与超声乳化相当,可在基层医院推广.     

小瞳孔下的白内障超声乳化摘除联合人工晶体植入术

目的 研究小瞳孔状态下白内障超声乳化的手术技巧和要点。方法 采用不切开瞳孔括约肌的瞳孔牵拉扩张法及拦截劈裂技术对46例（52只眼）小瞳孔的白内障行超声乳化。 结果 52只眼中47只术后瞳孔全部恢复原状,另有5只眼在分离切除机化膜粘连后再行牵拉扩张,术后基本恢复圆瞳孔,术后1个月裸眼视力≥0.5者38只眼（73%）。结论 采用非切开瞳孔牵拉扩张可使小瞳孔白内障术后恢复生理性圆瞳孔及术后较好的视力恢复。     

Results after supracricoid horizontal partial laryngectomy

Objectives

This study analyzed oncological and functional results of supracricoid horizontal partial laryngectomy.

Methods

A retrospective study was conducted involving 20 patients with squamous cell carcinoma (SCC) of the larynx who underwent SCPL between 1996 and 2005 in Faculty of Medical Sciences of Santa Casa Hospital of Sao Paulo, Brazil. There were 18 male and 2 female patients with ages ranging from 39 to 74 years (median = 58 years), of whom 19 were smokers and 14 alcoholics. The tumors were present in the glottis in 16 cases and supraglottis in 4; 5 were stage I or II and 15 were stage III or IV. We analyzed treatment given when rehabilitation was unsuccessful, oncological results of SCPL, including local and regional recurrences, time to recurrence and treatment given, distal metastases, global survival, survival free of disease, and appearance of second primary tumors. We also calculated the index of functional preservation of the larynx.

Results

Rehabilitation of swallowing capabilities and speech was achieved in 18 patients. Removal of the tracheostomy varied between 1 and 9 months. Rehabilitation was unsuccessful in two patients. Three patients required a total laryngectomy, two for unsuccessful rehabilitation and one for recurrence. The preservation of a functional larynx was 85%, with 10% of patients requiring a total laryngectomy after failed rehabilitation.

Conclusions

Supracricoid horizontal partial laryngectomy is an efficient surgical oncology technique that yields good functional results for the treatment of laryngeal cancer.     

The freiburg incision for cochlear implantation -- initial results

BACKGROUND: Cochlear implant surgery is a well standardized therapy for rehabilitation of congenital or acquired deafness at all ages. Mastoidectomy, posterior tympanotomy, cochleostomy and electrode insertion are performed consistently worldwide. Recently newly developed types of incision are taken into account. In our experience over more than 15 years the extended endaural incision has proven to be reliable with a low complication rate. OBJECTIVE: To evaluate a modified retroauricular incision for clinical use and complication rate in cochlear implant surgery with devices of different manufacturers. MATERIAL AND METHODS: We performed a prospective analysis of cochlear implant surgeries between 03/2003 and 03/2004. In all cases a modified retroauricular incision was used. Necessary adaptations of incision, depending on the device used, and postoperative complications were evaluated. RESULTS: In 76 ears a retroauricular incision was performed. Depending on the shape and size of receiver/stimulator an extension of the incision was necessary. The mean observation time was 6.3 months. Intra- or postoperative complications were not observed. In one case a skin dehiscence following trauma 28 days after surgery was reported without dehiscence of fascia or implant failure with uneventful healing after secondary suture. CONCLUSIONS: With regard to the results with the extended endaural incision the modified retroauricular incision allows a safe access for cochlear implant surgery. Observation of long term results and outcomes in revision surgery is mandatory.     

Effect of cochlear implantation on horizontal semicircular canal function

The objective of this study was to assess the influence of a cochlear implant (CI) on horizontal semicircular canal (hSCC) function, to test the correlation with symptomatic vertigo and to identify possible risk factors for a postoperative vestibular impairment. In a prospective observational study design, forty-seven adult patients who had undergone cochlear implantation at Cochlear Implant Center at a tertiary referral university hospital, Munich, between 2003 and 2007, were studied. Postoperative vertigo symptoms were assessed using a questionnaire followed by a structured interview. Patients were subjected to caloric and rotational chair vestibular function tests pre- and postoperatively. The CI operation was performed with a retroauricular transmastoidal approach by three different surgeons. Thirty-six implants were Cochlear Nucleus 24 devices and 11 implants were MedEl devices. Twenty-one (45%) patients reported vertigo symptoms after CI. Functional testing of the hSCC yielded valid results in 45 of the 47 patients. Thirty-two percent of patients had a substantially reduced hSCC function after CI. Responses of caloric irrigation showed a significant worsening postoperatively in the CI ears. No direct correlation between a decrease in caloric response and risk of postoperative vertigo symptoms could be established. For the criteria age, sex, implant type, surgeon, cause of deafness, petrous bone CT findings and preoperative vertigo, there were no significant differences between the patients with and the patients without postoperative vertigo. Besides morphological changes, a cochlear implantation also causes functional damage of vestibular parts of the labyrinth. Our study showed a significant worsening of the caloric response. However, this alteration did not lead to vertigo complaints in all patients. It is therefore presumed that additional damage to sensory or visual afferents and central vestibular compensatory mechanisms play a role.     

Results of pediatric bone-anchored hearing aid implantation

INTRODUCTION: The bone-anchored hearing aid (BAHA) system uses an osseointegrated titanium implant to propagate sound directly to the inner ear through the bones of the skull, bypassing the impedance of the skin and subcutaneous tissues. Children as young as 18 months have had hearing rehabilitated with this device. OBJECTIVES: The goals were to evaluate the efficacy of patient selection criteria, the safety and effectiveness of the implantation procedure, and the level of patient satisfaction after BAHA implantation in children. METHODS: The records of all pediatric patients implanted in Edmonton were retrospectively reviewed. Twenty patients, who received 25 implants, with postimplantation follow-up of 6 months or greater, were included. The average follow-up was 3 years, 7 months. RESULTS: Of 20 original implants, 3 were lost owing to trauma, whereas 2 failed to osseointegrate. All were successfully reimplanted. Complications related to the implants included three instances of skin necrosis around the abutment. All patients and caregivers reported greater than 95% improvement in patient-identified listening situations. Pure-tone averages improved from a mean of 49 dB for the better hearing ear preoperatively to 16 dB with the BAHA set at normal listening levels. CONCLUSIONS: The BAHA provides a safe and effective means of rehabilitation of conductive or mixed hearing loss in the pediatric population. Our patients report a high level of satisfaction and continued use of their devices.     

胸骨上小切口无注气内镜甲状腺手术的临床体会

目的 总结胸骨上小切口无注气内镜甲状腺手术在美容效果、手术适应证、安全性等方面的临床体会。方法 以Miccoli术式为基本框架,采用自行设计的悬吊拉钩及固定横杆建立手术空间,用高频超声刀作为切割和止血工具,对51例结节性甲状腺肿患者和1例甲状腺乳头状癌患者行全内镜下手术治疗。结果 全部手术顺利完成,无1例因术中或术后出血而改为开放式操作,除1例恶性病例出现暂时性喉返神经麻痹外,其余均无喉返神经损伤。结论 胸骨上小切口无注气内镜甲状腺手术切口小,创伤小,恢复快,具有良好的美容效果和安全性,并发症少,可操作性强,具有广泛的推广前景。     

高龄老年性白内障患者小切口手法碎核人工晶状体植入术

目的探讨高龄老年性白内障患者小切口手法碎核白内障摘除及人工晶状体植入术的效果.方法比较5.5mm反眉弓巩膜隧道切口手法碎核白内障摘除人工晶状体植入术与常规切口手术.结果经术后1周、1月及3月临床观察,小切口手法碎核组视力恢复优于常规切口手术(P＜0.05),散光绝对值差异有高度显著性(P＜0.01).结论小切口手法碎核白内障摘除术适于高龄老年性白内障.     

Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision

Objective: The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty.

Study design: Prospective clinical study.

Methods: Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success.

Results: Mean follow-up time was 14.76?±?4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4?kHz were 13.87?±?7.30?dB HL, 9.09?±?7.59?dB HL, 9.74?±?6.40?dB HL and 7.46?±?6.37?dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p?p?>?.05).

Conclusions: Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.