低温等离子射频消融治疗常年性变应性鼻炎合并支气管哮喘的疗效及安全性评价

目的 探讨低温等离子射频消融治疗常年性变应性鼻炎合并支气管哮喘的疗效及安全性。方法 选择80例常年性变应性鼻炎合并支气管哮喘患者的临床资料,其中,观察组40例采用低温等离子射频消融术进行治疗,对照组40例采用微波治疗,比较两组的临床效果。结果 观察组支气管哮喘总有效率为90%,其常年性变应性鼻炎总有效率为95%,均明显高于对照组(P<0.05)。观察组鼻结膜炎生存质量问卷(RQLQ)评分、视觉模拟量(VAS)评分以及成人哮喘生存质量问卷(AQLQ)评分均较对照组明显改善(P<0.05)。结论 低温等离子射频消融术治疗常年性变应性鼻炎合并支气管哮喘疗效显著,改善了患者生活质量,值得临床应用。     

低温等离子射频消融对UPPP失败的补救性治疗

UPPP是治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要手术方法,其有效率长期徘徊在50%～60%左右[1],近年来认为多咽平面狭窄是影响其疗效的主要原因[2].笔者自2003年以来应用低温等离子射频消融技术对56例行UPPP治疗失败的OSAHS患者做补救性治疗,取得满意疗效,现报告如下.     

低温等离子射频消融治疗早期声门型喉癌的临床疗效分析

目的：探讨低温等离子射频消融在早期声门型喉癌临床应用中的疗效。方法经确诊的无淋巴结转移的早期声门型喉部鳞状细胞癌患者13例,均在全麻下行经支撑喉镜鼻内镜下低温等离子射频消融切除术。术后随访6个月至2年。结果所有患者均未行气管切开,术后无出血、感染、呼吸困难等并发症。13例患者肿瘤均切除彻底,其中1例出现前联合粘连,所有患者随访至今未出现复发。结论低温等离子射频消融治疗早期声门型喉癌疗效肯定,值得临床推广。     

低温等离子射频消融术治疗慢性肥厚性鼻炎疗效观察

目的探讨低温等离子射频消融术治疗慢性肥厚性鼻炎所致鼻塞的疗效。方法对50例慢性肥厚性鼻炎患者行鼻内镜下低温等离子射频消融术治疗双侧下鼻甲肥厚,所有患者应用视觉模拟评分表(visual analogue scale,VAS)评价术前及术后6个月鼻塞的主观感觉,同时在鼻内镜下对双侧下鼻甲与鼻中隔的最小距离进行评分,所有患者随访6个月以上。结果术前患者鼻塞视觉模拟评分表评分为8.96±0.49,术后6个月为2.64±0.80,两者比较差异具有统计学意义(P<0.01)。鼻内镜下检查双侧下鼻甲与鼻中隔的最小距离并进行评分,从术前2.64±0.60减少到术后1.18±0.44,与术前比较差异具有统计学意义(P<0.01)。结论低温等离子射频消融术是治疗慢性肥厚性鼻炎的有效方法,值得临床推广应用。     

等离子低温射频消融治疗鼻塞疗效评价

目的:评价等离子低温射频治疗下鼻甲肥厚的主观远期疗效。方法: 采用前瞻性非随机研究,均为门诊患者。美国Arthrocare等离子低温射频手术系统行下鼻甲消融,VAS评分法评价治疗前后鼻塞程度,t检验分析治疗前,治疗后2个月,治疗后1年疗效差异。结果:治疗前后 VAS统计学差异显著,1年后满意率100％,1次治疗满意率95%,除一例感染外,无其他并发症。结论:等离子低温射频是目前下鼻甲肥大消融治疗的微创、安全、有效的方法。图1表1参2     

等离子低温射频治疗慢性肥厚性鼻炎疗效观察

目的观察等离子低温射频治疗慢性肥厚性鼻炎的临床疗效.方法采用美国的ENTec-CoblatorTM等离子手术治疗仪对152例下鼻甲肥大致鼻塞患者双下鼻甲消融术.结果术后随访1年,治愈123例(80.9%),好转25例(16.5%),无效4例(2.6%),总有效率97.4%.结论等离子低温射频消融术是目前治疗慢性肥厚性鼻炎微创、安全、有效的方法,值得临床推广应用.     

低温等离子消融治疗慢性肥厚性鼻炎疗效观察

慢性肥厚性鼻炎是耳鼻咽喉科常见病，主要以单侧或双侧持续性鼻塞为临床特点。传统治疗方法是鼻甲部分切除。近几年随着激光、微波治疗的广泛应用，使得慢性肥厚性鼻炎的治疗取得了一定疗效，但术后鼻腔黏膜反应重，从而影响疗效和手术开展。我科2008年9月～2009年3月采用低温等离子消融系统治疗慢性肥厚性鼻炎82例，经临床观察，疗效显著，患者满意，现报道如下。     

鼻内镜下低温等离子手术治疗慢性鼻塞125例疗效观察

目的：探讨鼻内镜下低温等离子治疗慢性鼻塞前后鼻气道阻力（NAR）的变化。方法：对125例慢性鼻塞患者于低温等离子手术系统行下鼻甲减容手术,利用前鼻测压法对患者手术前后的NAR进行分析。结果：手术后NAR明显下降,手术前后NAR差异有统计学意义（P〈0．01）。结论：鼻内镜下低温等离子手术具有疗效确切、微创、术中痛苦小、术后恢复快等优点,值得临床推广。     

鼻内镜下等离子射频消融治疗变应性鼻炎疗效分析

目的探讨鼻内镜下等离子射频消融治疗变应性鼻炎的疗效。方法回顾2004年3月～2006年10月我科收治的160例变应性鼻炎患者在鼻内镜下行等离子射频消融治疗，根据1997年海口会议疗效评定标准判断其疗效。结果术后随访12个月，显效97例（60．6％），有效45例（28．1％），无效18例（11．3％）。总有效率88．7％。结论鼻内镜下等离子射频消融应用于治疗变应性鼻炎，治疗效果好，反应轻，方法简便，可获得满意疗效，值得临床推广。     

射频消融治疗下鼻甲肥厚所致鼻塞的疗效

目的 :探讨射频消融治疗下鼻甲肥厚所致鼻塞的效果。方法 :对 18例下鼻甲肥大致鼻塞患者采用射频消融术缩小双侧下鼻甲 ,术前及术后 3个月应用视觉模拟评分表 (VAS)来评价鼻塞的主观感觉。结果 :患者术前鼻塞VAS评分左侧为 (6 7.7± 9.4 ) % ,右侧为 (70 .5± 10 .5 ) % ;术后 3个月左侧为 (4 5 .0± 9.0 ) % ,右侧为(5 3.3± 11.6 ) % ,左右侧分别与术前比较 ,差异均有极显著性意义 (均P <0 .0 1)。随访 3个月 ,检查双侧下鼻甲与鼻中隔的最小距离从术前小于 0 .2cm增加到术后大于 0 .3cm。结论 :射频消融术是安全、有效、微创地治疗下鼻甲肥大所致鼻塞的较好治疗方法     

射频消融治疗下鼻甲肥厚

目的观察射频消融治疗下鼻甲肥厚的疗效。方法对50例下鼻甲肥厚患者采用射频消融下鼻甲,观察治疗效果。结果根据鼻塞视觉模拟评分(visualanalogscale,cmVAS)判断疗效,术前平均7.77±0.96,术后6个月平均3.95±0.80,t值13.47,P值<0.01,术前术后结果有显著性差异。结论射频消融是一种有效的治疗下鼻甲肥厚的方法,并增强了同期矫正鼻、口咽双平面阻塞的OSAHS手术的安全性。     

Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment

OBJECTIVE: To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. STUDY DESIGN: Prospective, nonrandomized study and outpatient treatment. METHODS: Twenty patients (age range, 23-77 y; median age, 52 y) enrolled in the study. There was one dropout. All the patients had nasal blockage despite medical treatment. Bipolar radiofrequency thermal ablation was delivered to inferior turbinates at 100 kHz with a voltage root mean square value of 168 to 182. The preoperative and postoperative nasal functions were investigated by immediate and long-term visual analogue scale (VAS) scores of symptom parameters, olfactory thresholds, saccharine transit time, rhinomanometry, and acoustic rhinometry. The follow-up was conducted at 1 week and 3, 6, and 12 months. RESULTS: The VAS scores of subjective complaints (nasal discharge, itching, sneezing, crusting) decreased, and the VAS scores of evaluation of the effectiveness (frequency of nasal obstruction, degree of nasal obstruction, and patient satisfaction) increased statistically significantly in the 12-month follow-up without relapses. There were no adverse effects on nasal epithelial clearance time and olfactory functions. In rhinomanometry the changes in total nasal resistance and response to the vasoconstrictor agent were not statistically significant. In acoustic rhinometry the change in the sum of both nasal cavity volumes from nostril to 5 cm was statistically significant 6 and 12 months after the treatments. The difference between the preoperative and postoperative vasoconstrictive effect was not statistically significant. CONCLUSION: The bipolar radiofrequency thermal ablation of inferior turbinates is a promising alternative, which should be considered when planning inferior turbinate interventions.     

低温等离子射频消融下鼻甲对鼻黏膜功能的影响

目的观察低温等离子射频治疗慢性肥厚性鼻炎对鼻黏膜传输功能的影响。方法应用糖精试验法测定60例(A组)慢性肥厚性鼻炎患者低温等离子射频术前及术后3、6个月的鼻腔黏膜纤毛输送率(MTR),并与45例微波治疗的慢性肥厚性鼻炎患者(B组)进行比较。结果A组术前鼻黏膜纤毛MTR为(7.64±1.56)mm/min;B组为(7.46±1.65)mm/min,其差异无统计学意义(P>0.05);A组术后3、6个月鼻黏膜纤毛MTR为(6.89±2.01)mm/min、(7.14±1.76)mm/min,分别与术前比较差异无统计学意义(均P>0.05);B组术后3、6个月鼻黏膜纤毛MTR为(3.16±1.32)mm/min、(3.12±1.29)mm/min,分别与术前比较差异有统计学意义(均P<0.01);两组术后3个月鼻黏膜纤毛MTR比较差异有统计学意义(P<0.01);两组术后6个月鼻黏膜纤毛MTR比较差异有统计学意义(P<0.01)。结论低温等离子射频治疗慢性肥厚性鼻炎对鼻黏膜纤毛无明显影响,没有破坏鼻黏膜纤毛的正常生理功能。     

三线减张鼻中隔矫正联合射频消融治疗持续性变应性鼻炎

目的　探讨三线减张鼻中隔矫正联合低温等离子射频消融治疗伴有鼻中隔偏曲的中-重度持续性变应性鼻炎（persistent allergic rhinit is,PAR）的疗效。方法 分别采用三线减张鼻中隔矫正术（对照组32例）和三线减张鼻中隔矫正联合低温等离子射频消融（观察组36例）治疗伴有鼻中隔偏曲的PAR,术后随访1年,根据症状和体征记分评定其疗效：≥66%为显效,65%～26%为有效,≤25%为无效。结果　对照组总有效率59.4%,观察组总有效率91.7%。观察组总有效率显著高于对照组（P＜0.05）。结论  对伴有鼻中隔偏曲的PAR,三线减张鼻中隔矫正联合低温等离子射频消融治疗PAR的疗效明显优于单纯三线减张鼻中隔矫正术。     

射频消融术治疗变应性鼻炎短期疗效的Meta分析

目的评价射频消融治疗变应性鼻炎的疗效。方法检索并选取国内外公开发表的有关射频消融治疗变应性鼻炎的随机、对照试验研究,纳入试验的质量用Jadad计分表评价,对纳入试验的疗效作Meta分析。结果共纳入6篇病例对照研究,累计样本量为696例,其中治疗组461例,对照组235例。Meta分析结果显示,射频消融治疗组在显效率方面优于对照组［RR=2.95,95%CI（1.94,4.48）,P=0.07］;在总有效率方面也优于对照组［RR=1.33,95%CI（1.20,1.46）,P=0.69］。结论射频消融治疗变应性鼻炎有较好疗效,但需设计更严谨的多中心、大样本的随机、对照试验来进一步证实。     

低温等离子射频治疗青少年腺样体肥大36例

目的 探讨腺样体肥大的微创治疗方法。方法采用低温等离子(radiofrequency ablation,RFA)治疗青少年腺样体肥大36例,局麻,间接喉镜下操作:对照组30例采用全麻下传统的腺样体刮除法。结果 两组有效率100％。但在住院/门诊比、麻醉、疼痛、术中出血、术后恢复日等方面有显著差异(P<0.05)。结论RFA可在局麻下进行,不需住院,操作简便、出血极少,微创、痛苦小、安全,疗效与传统的腺样体刮除法相当。     

Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode

OBJECTIVE: The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode. METHODS: A prospective, nonrandomized study of 11 patients (mean age, 47+/-12 y) with chronic nasal obstruction was conducted. Using patient-based visual analogue scales (VAS), symptom parameters were assessed. These included degree of nasal obstruction, frequency of nasal obstruction, and pain. Physician assessment of nasal obstruction was also collected by the principal investigator. Follow-up was conducted at 24 hours, 1 week, 4 weeks, 8 weeks, and 1 year. ANOVA was carried out to determine statistically significant differences in the data. Data were fit to a regression model, and confidence intervals were determined from a 95% confidence level. RESULTS: In patient-assessed degree of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.001, P<.0001, and P<.0008, respectively). There was no difference between 8 weeks and 1 year (P<.15). The data appeared to follow an exponential decay to a constant value. The pretreatment baseline average degree of obstruction was 7.5+/-0.5 on a scale of 0 to 10. The degree of obstruction after 8 weeks was 2.7+/-0.6. The time constant for this change was 21 days to reach 90% of the final value. At 1 year, degree of obstruction was 3.3+/-0.7. For frequency of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.0001, P<.0001, and P<.0001, respectively). There was no difference between 8 weeks and 1 year (P<.15). The pretreatment baseline average frequency of obstruction was 7.8+/-0.5. The remaining frequency of obstruction after 8 weeks was 2.9+/-0.6. The time constant was 18 days. At 1 year, frequency of obstruction was 3.3+/-0.6. Physician assessment of nasal obstruction revealed statistical significance among baseline and 4 weeks, and baseline and 8 weeks (P<.0055 and P<.0056, respectively). There was no difference between 4 weeks and 8 weeks (P<.24). The average initial obstruction was 83%+/-4%. The remaining obstruction after 8 weeks was 58% +/-5%. The time constant was 14 days. Mild pain was reported by 55% of patients during the procedure; the remaining 45% reported no pain. Only one patient required pain medication consisting of acetaminophen after the procedure. There were no significant complications. CONCLUSIONS: Degree and frequency of nasal obstruction, as reported by patients, decreased following RF tissue ablation of the inferior turbinates. This improvement in symptoms was still evident after 1 year (P<.001). Physician assessment of obstruction also correlated with patient reports for the initial 8-week study period. The procedure was safe and well tolerated. Thermocouples within the active electrode provided additional feedback to the operating surgeon allowing the use of relatively lower tissue temperatures, power, and energy as compared with traditional techniques. These results support the need for continued research to evaluate this modality as a treatment for chronic nasal obstruction.     

射频消融术治疗慢性肥厚性鼻炎

目的：探讨射频消融治疗慢性肥厚性鼻炎所致鼻塞的效果及对鼻黏膜功能的影响。方法：采用射频消融术治疗慢性肥厚性鼻炎60例的双侧下鼻甲,术前及术后3个月应用视觉模拟评分表（visual analogue scale, VAS）评价鼻塞的主观感觉;应用糖精试验法测定术前及术后3个月的鼻腔黏膜纤毛输送率（mucociliary transport rate, MTR）。结果：术前鼻塞VAS评分左侧为（68.7±9.6）%,右侧为（72.5±10.2）%;术后3个月左侧为（35.0±9.0）%,右侧为（40.3±10.6）%,与术前相比,差异均有统计学意义（P＜0.01）。随访3个月,双侧下鼻甲与鼻中隔的最小距离从术前小于0.2?cm增加到术后大于0.3?cm。术前鼻黏膜纤毛MTR为（7.64±1.56）mm/min,术后3个月鼻黏膜纤毛MTR为（6.89±2.01）mm/min,与术前比较差异无统计学意义（P＞0.05）。结论：射频消融术是治疗慢性肥厚性鼻炎所致鼻塞的较好方法,对鼻黏膜纤毛无明显影响,未破坏鼻黏膜纤毛的正常生理功能     

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy

Objective

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy.

Methods

Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides.

Results

The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45 ± 1.48 to 3.54 ± 1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55 ± 1.62 cm³ vs. 5.10 ± 1.47 cm³, (P < 0.01); left: 6.72 ± 1.53 cm³ vs. 5.00 ± 1.37 cm³, (P < 0.01)] respectively.

Conclusion

Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction.