鼻内窥镜在经口腺样体刮除术中的应用

目的探讨将鼻内窥镜技术用于经口腺样体刮除术的可行性和优缺点.方法在鼻内窥镜及电视监视下行经口腺样体刮除术40例,治疗由腺样体肥大引起的睡眠呼吸障碍、咽鼓管功能障碍和鼻阻塞并随访.结果术后腺样体切除干净,无残体存留,鼻咽部及鼻后孔结构显示良好,无出血、咽鼓管损伤等并发症发生,随访1～36个月,患者睡眠打鼾、呼吸暂停、鼻阻塞及听力障碍等症状均消失或明显缓解.结论 本法使传统腺样体刮除术能在直视下进行,增加了手术的安全性和准确性,病变去除更加彻底,既提高了手术疗效,又减少了并发症的发生.     

鼻内镜下三种方法切除儿童腺样体

目的总结鼻内镜下三种不同的手术方法治疗儿童腺样体肥大的经验,探索最佳的治疗方案。方法选择2009年6月～2011年10月全麻下经鼻内镜腺样体切除患儿1148例,应用90°成人鼻内镜经口腔径路低温等离子切除腺样体368例,90°成人鼻内镜经口腔径路Medtronic动力系统切吸术切除腺样体肥大677例,0°小儿鼻内镜下经鼻腔径路Medtronic动力系统切除腺样体103例。结果9 0°成人鼻内镜下口腔径路低温等离子切除腺样体的3 6 8例患儿术后无明显疼痛和出血,基本不影响进食;90°成人鼻内镜经口腔径路Medtronic动力系统切吸术切除腺样体的677例患儿中有较明显的疼痛,术后出血7例,占1.03%;0°小儿鼻内镜经鼻腔Medtronic动力系统切除腺样体手术时间长,操作困难,术后需要鼻腔填塞。结论 90°成人鼻内镜经口腔径路Medtronic动力系统切吸术和等离子消融术治疗腺样体肥大是很好的微创手术方法,但笔者更倾向于应用等离子消融术。     

Transoral "adenoidectomy" excision of juvenile nasopharyngeal angiofibromas

OBJECTIVES: We describe a minimally invasive technique for excision of selected juvenile nasopharyngeal angiofibromas (JNAs) using indirect visualization of the nasopharynx. METHODS: An observational case series with follow-up of 9 months to 3 years was performed. The subjects included 4 teenage boys with early-stage nasopharyngeal angiofibromas. The intervention included computed tomography, magnetic resonance imaging, angiography and embolization, tumor excision, pathologic examination, and follow-up. The outcome measures included blood loss, perioperative morbidity, and surgical cure. RESULTS: Four teenage boys underwent excision of early stage JNAs--3 with preoperative embolization. The JNAs were excised under indirect mirror guidance with an adenoid curette and the nasopharynx packed. Residual tumor was removed endoscopically. The operative time was less than 1 hour in each case, and blood loss was less than 100 mL. All 4 boys are free of disease. CONCLUSIONS: With the advent of refined imaging techniques and relatively safe preoperative embolization, minimally invasive approaches to JNA excision have been advocated. Endoscopic transnasal piecemeal excision is feasible but time-consuming. Transoral avulsion of the tumor mass by adenoidectomy techniques combined with endoscopic removal of tumor remnants from the pterygopalatine fossa allows complete, controlled surgical excision with minimal blood loss.     

Endoscopic surgery of nasopharyngeal angiofibroma

Juvinile nasopharyngeal angiofibromas are highly vascular benign tumors but with an agressive behaviour with invasion of skull base and vital structures. Our study includes 11 male patients that underwent surgery for angiofibromas between 1992-2002 with an endoscopic surgical approach and embolization before surgery. The average age was 14.7 years old. Using Fisch staging, 8 patients were stage II. All cases achieved symptomatic remission, with no complications but the recurrence was 36.3%. The endoscopic excision is a safe and effective minimally invasive surgical treatment in patients in stage I and II. It should be considered as a first-choice option for these cases.     

经鼻内镜手术治疗鼻咽血管纤维瘤7例

目的：探讨鼻内镜下切除鼻咽血管纤维瘤的临床效果。方法：对7例鼻咽血管纤维瘤患者采用鼻窦切割吸引器逐渐吸切去除血管瘤组织，并将根部的骨膜给予去除。结果：7例患者手术均一次性成功，未见肿瘤组织残留。术后随诊3～18个月未见肿瘤复发，未出现严重并发症。结论：鼻内镜下用鼻切割吸引器切除鼻咽血管纤维瘤是治疗鼻咽血管纤维瘤较好的术式，值得推广应用。     

An alternative to a postnasal pack for the arrest of perioperative hemorrhage following curettage adenoidectomy

Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.     

鼻内镜直视下反向切割器经口腺样体切除术的临床应用

目的探讨40.反向鼻窦切割刀头在鼻内镜下切除腺样体术的应用价值.方法全麻下对2002年4～12月收治住院的27例腺样体肥大或慢性腺样体炎患者进行鼻内镜直视下反向切割器经口腺样体切除术,分析手术难易程度、手术效果以及随访结果.结果全部手术过程顺利,腺样体切除迅速,出血量少,无副损伤,其它耳鼻合并症也能同时解决,术后恢复良好.结论鼻内镜直视下反向切割器经口腺样体切除术是一项安全有效、简单易行的手术方法,值得推广甚至是常规手术.     

经鼻内镜下改良鼻咽血管纤维瘤切除术

如何减少经鼻内镜下鼻咽纤维血管瘤切除术的出血量，缩短手术时间，对该手术的推广非常重要，我们引对此点进行了改进。     

Endoscopic treatment of juvenile nasopharyngeal angiofibroma.

Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.     

Gold laser versus curettage adenoidectomy: incidence of complications and otorrhea after concurrent pressure-equalization tube placement

OBJECTIVES: To measure the incidence of postoperative complications and otorrhea in patients undergoing Gold laser or curettage adenoidectomy with pressure-equalization (PE) tube placement. STUDY DESIGN: A prospective study of 100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting. METHODS: Pediatric patients with chronic otitis media with effusion and adenoid hypertrophy after failure of medical management were included in the study. Adenoid size and middle ear status were recorded at surgery. The total adenoidectomy procedure time was recorded. All patients were evaluated at 1 week, 1 month, and 4 months postoperatively. The incidence of nasal complications and otorrhea was recorded. RESULTS: There was no statistical difference in age, race, sex, adenoid size, or middle ear status between groups. The laser group had a shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024). There was no difference in nasal complications between groups. CONCLUSIONS: The Gold laser adenoidectomy technique can be safely performed with PE tube placement and may offer advantages over the traditional curettage adenoidectomy technique.