支撑喉镜下喉显微手术麻醉方法比较

目的比较全凭静脉麻醉和静吸复合麻醉在支撑喉镜手术的应用效果。方法选择ASAⅠ-Ⅱ级,拟行支撑喉镜手术的患者37例,随机分成全凭静脉全麻组和静吸复合全麻组。两组诱导方法相同,分别采用异丙酚和异氟醚、笑气吸入维持麻醉,两组均采用氯化琥珀胆碱静脉滴注维持肌松。手术过程中监测收缩压、舒张压、心率、心电图和脉搏血氧饱和度。结果全凭静脉麻醉组血压,心率波动明显,术中呛咳发生率高(P<0.05)。静吸复合麻醉组清醒时间短。结论静脉诱导,吸入维持的复合全麻是支撑喉镜手术较理想的麻醉方法。     

支撑喉镜下喉显微手术1290例临床分析

目的探讨支撑喉镜下喉显微手术临床上的可行性与疗效.方法经喉插管全身静脉复合麻醉支撑喉镜下应用喉显微手术切除病变,治疗各种喉疾病1290例.结果支撑喉镜下喉显微手术可将病变经喉内完整切除,术后经0.5～3年随访,1290例中,发声恢复正常996例,明显改善257例,复发需再次手术36例、黏连1例.结论支撑喉镜下喉显微手术精度高,患者创伤小,是治疗喉部病变特别是声带小结及声带息肉较好的方法,但需掌握适应证和预防并发症.     

支撑喉镜下喉显微手术500例报告

1986年2月至1994年9月,我科在全麻支撑喉镜下施行喉显微手术500例,取得满意效果。报告如下。     

支撑喉镜喉显微外科手术的麻醉(附84例报告)

目的探讨支撑喉镜喉显微外科手术与麻醉的关系.方法回顾分析84例于全麻支撑喉镜下显微外科手术的麻醉情况.结果84例均完整切除喉部病灶.环甲膜穿刺组2例穿刺针滑脱,气管插管组和塑料喷射管组未发生并发症.结论塑料喷射管经鼻置入声门下喷射通气优于环甲膜穿刺和气管插管麻醉,安全、方便、操作简单、并发症少.     

鼻窦内镜在喉显微手术中的应用

目的 探讨显微镜下喉显微手术暴露不佳时,鼻窦内镜辅助手术的可行性,比较鼻窦内镜及显微镜在喉显微手术中的优缺点。方法 2004年1月至2009年12月应用鼻内镜辅助完成喉显微手术28例。结果 28例均一次手术成功,临床治愈,无明显并发症。除2例喉乳头状瘤外,其余均未见复发。结论 鼻内镜在喉显微手术中具有较显微镜视野更清晰、操作简便、精确度高、创伤性小、术后并发症少等优点。     

支撑喉镜下喉显微手术舌神经损伤分析

随着支撑喉镜下喉显微手术的开展,其处理不当引起的一些手术并发症也日益受到重视,其中舌神经损伤逐步被人们所关注。本文回顾分析我们2003年11月至2010年3月336例支撑喉镜下喉显微手术患者,报道如下。     

喉显微手术的麻醉方法选择

咪唑安定和异丙酚是两种比较理想的复合应用的静脉麻醉药物,临床应用均起到镇静、遗忘和意识消失的作用。但对喉显微手术是否适用,尚鲜见有关文献报道。本文对此进行了临床观察,旨在探讨喉显微手术的麻醉选择。1　资料与方法1.1　临床资料选40例,按美国麻醉协会分级标准(ASA)～级的声带息肉患者,性别不限,年龄29～65岁,平均(43.7±9.6)岁;体重49～75kg,平均(64.3±6.1)kg。1.2　麻醉方法随机均分两组,每组20例。术前30min均给阿托品0.5mg肌注。麻醉诱导:I组静脉注射异丙酚2mg/kg;组静脉注射咪唑安定0.1mg/kg,加异丙酚2mg/kg。注药后,两组…     

表面麻醉支撑喉镜喉显微手术治疗声带良性病变

目的:探讨喉显微手术治疗声带良性病变的效果及麻醉选择。方法:手术在1%丁卡因表面麻醉支撑喉镜下进行,采用普通手术显微镜连接300mm焦距镜头观察病变。结果:872例中声带息肉353例,声带小结438例,声带囊肿81例,851例完成手术,697例1次治愈,总有效率为96.9%。结论:青、壮年患者,无明显心血管疾病,可选择表面麻醉手术,表面麻醉并发症少,恢复快,支撑喉镜下显微手术清除病变彻底。     

鼻内镜联合支撑喉镜在喉显微手术中的应用

2006年10月－2007年10月,我科应用鼻内镜联合支撑喉镜行喉显微手术42例,均取得满意效果,现报道如下。     

全麻下声带手术

1993至1999年我们在全麻显微支撑喉镜下为82例声带新生物行摘除术,疗效满意,报告如下. 1 资料与方法 1.1 临床资料声带新生物82例中男49例,女33例,23～61岁.声带息肉47例,声带小结23例,声带乳头状瘤5例,声带囊肿4例,声带血管瘤2例,声带结核1例. 1.2 麻醉与手术方法 1.2.1 麻醉方法术前1h肌注阿托品0.5ug,安定10mg,利用快速诱导气管内插管.诱导用药为依托米酯0.3mg/kg,氯化琥珀胆碱1.5～2.0mg/kg,诱导后经口插入带低压套囊气管插管,男性用内径6.5mm插管,女性用内径6.0mm插管,将气管导管套囊打气固定后,接麻醉机行常频控制呼吸,呼吸频率20/min.维持用药为持续静滴2%普鲁卡因,术毕即刻给新斯的明对抗肌松.     

15%硝酸银鼻腔局部应用治疗变态反应性鼻炎和血管舒缩性鼻炎

为研究15%硝酸银鼻腔局部应用治疗变态反应性鼻炎的效果和机理,将15%硝酸银涂敷于下鼻甲前端和相对应的鼻中隔粘膜.结果表明,打喷嚏、流水样涕、鼻塞、头痛,分别有76.4%、74.2%、68.9%、74.0%的患者得到控制和缓解,随访1～3年,26.9%的患者疗效较好,余者在初次治疗后6个月至3年内复发,经2～3次治疗临床症状缓解和得到控制.提示该法治疗变态反应性鼻炎和血管舒缩性鼻炎效果较好,且使用方便、安全,可反复使用,无副作用,患者易接受.     

颅底骨折合并脑脊液耳鼻漏(附26例报告并文献复习)

治疗颅底骨折合并脑脊液耳鼻漏26例,在临床诊断上CT具有特异性的定位诊断价值.治疗应以保守为主,多数患者可获满意疗效.手术对严重硬脑膜撕裂和迟发性脑脊液漏患者是可靠且有效的治疗方法之一.成功的关键是诊断定位准确,治疗及时,术式正确.     

内窥镜手术及局部应用氟康唑治疗霉菌性鼻窦炎

对10例慢性霉菌性鼻窦炎行内窥镜手术后局部应用抗霉菌药物氟康唑治疗,9例痊愈,1例加用口服抗霉菌药治愈.随访6个月至4年,仅1例因鼻咽癌放疗于1年后复发,经再次局部应用氟康唑治愈.手术治疗可去除窦腔内病变积存物并改善引流,局部应用氟康唑可抑制或杀灭霉菌,促进病情恢复并减少复发机会.氟康唑局部应用方法简便,毒副作用少,节省开支.     

彩色多普勒血流显像对中晚期青光眼患者的眼血流动力学研究

为探讨血管因素在中晚期青光眼患者视功能损害机制中的作用,选择中晚期青光眼患者27例、52眼,用彩色多普勒超声检查仪测定每眼的眼动脉、睫状后短动脉及视网膜中央动脉的血流速度,并选择年龄、性别与患者相匹配的正常人25例、50眼为对照组.结果显示,青光眼组的眼动脉、视网膜中央动脉及睫状后短动脉的血流速度明显降低,阻力指数明显增高,而慢性闭角型青光眼及开角型青光眼之间则无明显差异.证明中晚期青光眼视功能损害与视神经的血供不足密切相关.     

湿润烧伤膏联合YAG激光治疗鼻中隔粘膜出血

应用湿润烧伤膏(MBO)联合YAG激光治疗鼻中隔粘膜出血60例.通过临床观察,YAG激光凝固、炭化血管效果较好,MBO可促进创面粘膜上皮生长、止痛消炎,二者联合应用,增强了治疗效果,缩短了治疗时间,复发率低,患者痛苦小.     

声频共振耳聋治疗系统与右旋糖苷治疗突发性聋的比较

用声频共振耳聋治疗系统仪治疗突聋52例、52耳,并与右旋糖苷相对照,治愈率为34.92%,有效率为84.62%,对照组分别为14.71%和72.06%,差异有显著性(P＜0.05).声频共振治疗仪输出的声、频、热、电、磁叠加共振效应与药物相配合,能加速改善耳蜗及周围组织的血液循环,提高治疗突聋的效果.     

UTILITY OF VIBRANT SOUNDBRIDGE IN PATIENTS WITH CONGENITAL MIDDLE AND OUTER EAR DEFORMITIES

Objective To report use of the Vibrant Soundbridge (VSB) in patients with congenital deformation of the middle and outer ears and investigate its utility in this patient population.Method Four patients with congenital deformation of middle and outer ears underwent VSB implantation. All were male (aged 3-18 years,average 13.5 years) and operated on the left side.Malformation was bilateral in 3 patients and unilateral in 1 patient. Surgical techniques were modified to accommodate each patient’s unique conditions and needs.The implant site was approached via the facial recess in 3 patients and through a retro-facial nerve route in 1 patient. The VSB implant was connected to either the stapes (2 cases) or the round window (2 cases).Pure tone and speech audiometry results and daily communication capabilities before and after VSB activation were compared.Results The operations were successful in all patients, with no complications. The patient communication level improved significantly after VSB activation. Average air conduction pure tone threshold or conditioned reflex audiometry threshold improved by 35 dB in the 0.25-4 kHz range,from 69 dB HL before VSB activation to 34 dB HL after.The sentence recognition rate in quiet at 65 dB SPL went up to 86% from 0% without VSB for patients with bilateral deformation and remained at 100% for the patient with unilateral deformity. However, for the latter patient, the rate improved to 20% from 0% without VSB in noise (-8 dB SNR).Conclusion VSB is an excellent solution for improving hearing in patients with congenital deformation of middle and outer ears.Operation can be completed and good results can be achieved even in patients with unique conditions and needs.     

Extended hemilaryngectomy for T3 GLOTTIC CARCINOMA WITH PRESERVATION OF SPEECH AND SWALLOWING

Total laryngectomy is often applied in the treatment of invasive squamous cell carcinomas that fix one side of the larynx. The major drawback, of course, is loss of the voice. In many instances, however, preservation of the uninvolved portion of the larynx is compatible with adequate tumor margins, and the preserved laryngeal remnant, although it cannot be reconstituted to allow breathing, can readily be used for voice. The principle involved is the creation of a valved tracheopharyngeal shunt, which functions as a neoglottis during expiration but constricts to close during swallowing. To accomplish this the recurrent laryngeal nerve and the myomucosal segment of intrinsic glottic musculature to which it is attached is preserved on the uninvolved side. The myomucosal segment is formed into a mucosal lined tube by releasing the soft tissues from the cartilage. The diameter and flaccidity of the tube is augmented by incorporating a flap of hypopharyngeal mucosa. Safe performance of this operation depends on careful preoperative evaluation and laryngoscopic verification and a close-working relationship with an interested surgical pathologist. The first 7 consecutive cases in which this management program has been applied are presented in review. The patients, ranging in age from 58 to 69 years old, had T₃ grade 2 or 3 invasive squamous cell carcinoma. The average hospitalization was 13 days. The longest follow-up is 5 years. Clear surgical margins, local control of the disease, and satisfactory voice without significant aspiration have been achieved thus far in each case. The average subglottic pressures measured at the tracheotomy were 25 ± 6 cm. of water (threshold opening) and 43 ± 20 cm. of water (for phonation). Whether these encouraging initial results can be widely duplicated will probably depend on the care with which cases are selected. The dangers of applying this surgery to patients with extensive submucosal spread will be obvious to experienced laryngologists.     

垂体生长激素腺瘤患者血清GH水平与肿瘤侵袭性及复发的关系

目的：探讨垂体生长激素腺瘤患者血清生长激素（ＧＨ） 水平与肿瘤侵袭性及复发的关系。方法：采用放射免疫分析方法对３６ 例垂体生长激素腺瘤患者测定血清ＧＨ 水平进行回顾性研究。结果：所有垂体生长激素腺瘤患者血清ＧＨ 均＞ １０ｍｇ／Ｌ,侵袭型垂体生长激素腺瘤患者血清ＧＨ 水平术前（８６ ．３１ ±４３ ．８１ｍｇ／Ｌ） 和术后（４６ ．４１ ±１８ ．７２ｍｇ／Ｌ） 分别显著高于非侵袭型术前（５８ ．００ ±１２ ．６３ｍｇ／Ｌ） 和术后（１２ ．３６ ±３ ．９８ｍｇ／Ｌ）（ Ｐ＜ ０ ．０５ ;Ｐ＞ ０ ．０１） ;Ⅲ,Ⅳ级垂体生长激素腺瘤患者血清ＧＨ 水平术前（８４ ．８５ ±４６ ．３３ｍｇ／Ｌ） 和术后（４４ ．９４ ±１７ ．４７ｍｇ／Ｌ） 分别显著高于Ⅰ,Ⅱ级术前（５７ ．６４ ±１２ ．６７ｍｇ／Ｌ） 和术后（１４ ．６７ ±３．２０ｍｇ／Ｌ）（ Ｐ＜０ ．０５ ;Ｐ＜ ０ ．０１） ;血清ＧＨ 水平升高与患者性别、年龄无显著相关性（ Ｐ＞ ０ ．０５） ;术后侵袭型垂体生长激素腺瘤３ 年复发率４２ ．９ ％ （６／１４） 显著高于非侵袭型９ ．１ ％ （２／２２）（ Ｐ＜ ０ ．０５） 。结论：垂体生长激素腺瘤患者血清ＧＨ 水平与肿瘤的临床行为有关,可作为垂体     

THE LEVEL OF CERVICAL LYMPH NODE METASTASES: THEIR PROGNOSTIC RELEVANCE AND RELATIONSHIP WITH HEAD AND NECK SQUAMOUS CARCINOMA PRIMARY SITES

It would seem logical that patients with nodal metastases low in the neck would fare less well than patients with disease high in the neck. The penultimate UICC classification suggested that neck node level was important although there was no mention of this in the most recent classification. In addition, patients with carcinomas at the various sites would be expected to have different patterns of nodal involvement. Of 3419 patients with head and neck squamous carcinoma on the Liverpool University Head and Neck Unit database, 947 had neck node metastases. The neck node levels were coded as (I)sub-mandibular, (II) above the thyroid notch, (III) below the thyroid notch and (IV) supra-clavicular/posterior triangle nodes. Levels II and III contained the deep jugular chain. The relationship between node level and site and sub-site and survival were analysed with particular emphasis on multivariate methods. The 5-year survival for the whole group was 51% and survival fell with decreasing node level (I-IV) being 37% for sub-mandibular nodes, 32% for deep cervical nodes and 25% for lower deep cervical nodes. The 18-month survival for supra-clavicular and posterior triangle nodes was 21%. The difference in survival was significant (x²₃= 24.42, P < 0.001). Multivariate analysis confirmed that as the level of the nodes fell from the sub-mandibular refion to the supra-clavicular region the prognosis worsened (estimate = -0.3378, P = 0.0003). Level II (upper deep cervical) nodes were the most commonly involved with regards to all primary sites and formed 69% of all neck node metastases. Over three quarters of laryngeal oropharyngeal and hypopharyngeal metastases went ot this level whereas only 47% of oral cancers did. Most of the remainder of these latter lesions metastasized to level I (42%). These findings were confirmed by multiple logistic regression. When studying survival for lymph node level with regard to site all sites had a reducing prognosis with decrasing node level except for larynx. Multiple linear regression showed an association between decreasing node level and increasing N-stage (P = 0.001) with increasing T-stage (P = 0.0014) and as the site moved from the mouth to the larynx (P = 0.0047). The present data support the view that neck node level is important as regards prognosis for most sites in the head and neck. The data confirm the clinical view that deep cervical nodes are most frequently affected by head and neck cancer with level IV nodes being unusual and clinically tending to herald a non head and neck tumour and that level III nodes are relatively uncommon. This is surprising as one would expect at least a proportion of laryngeal carcinomas and quite a high proportion of lhypopharyngeal carcinomas to metastasize to this region.