改良UPPP联合等离子射频舌根打孔消融术治疗重度OSAHS的疗效和安全性分析

目的对比分析应用改良悬雍垂腭咽成形术(H-UPPP)联合或不联合等离子射频舌根打孔消融术(coblation-channelling of tongue, CCT)在治疗重度阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome, OSAHS)中的疗效和安全性。方法 60例伴有舌根肥大的多平面阻塞、重度OSAHS患者,根据患者意愿单纯采取H-UPPP或H-UPPP+CTT术各30例,全部患者均术前、术后半年、术后1年和术后2年行喉镜检查、ESS评分、VAS评分和PSG监测。结果两组患者术后半年、术后1年PSG监测、ESS评分和整体评价VAS评分无统计学差异(P0.05),术后2年两组PSG监测和总有效率差异具有统计意义,一组优于二组(P0.05)。无严重并发症发生。结论 H-UPPP联合CCT治疗合并舌根肥大的重度OSAHS患者是安全的,远期疗效更明显。     

鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响

目的探讨鼻腔扩容术对伴有鼻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主客观症状的影响,为鼻腔扩容术对鼻塞伴OSAHS的患者治疗提供有效的临床依据。方法选择69例伴有鼻塞的OSAHS患者,针对病变的鼻中隔、下鼻甲、中鼻甲、钩突、筛泡等不同部位的病变进行个体化的处理。根据呼吸暂停低通气指数(AHI)及最低动脉血氧饱和度(LSaO2)分为三组:轻度、中度与重度组。通过比较患者手术前后多导睡眠检测(PSG)结果及鼻塞视觉模拟评分量表(VAS)、Epworth嗜睡量表(ESS)、患者鼾声问卷(SS)评分,分析鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响。结果术后6个月随访显示,其中轻度OSAHS患者的AHI、LSaO2及平均动脉氧饱和度(MSaO2)有所升高(P<0.05),VAS、ESS及SS评分都有所降低(P<0.05)。中度OSAHS患者的PSG相关检测指标均无明显变化(P>0.05),VAS、ESS及SS评分有所降低(P均<0.05)。重度患者除VAS及ESS评分有所降低(P<0.05),PSG相关客观指标及SS评分均无明显变化(P>O.05)。结论鼻腔扩容手术可以改善鼻塞为主的OSAHS患者的鼻塞、睡眠打鼾及白天嗜睡等主观症状,对轻度OSAHS患者的疗效优于中重度OSAHS。对鼻塞伴OSAHS患者的治疗有重要的临床意义。     

改良Epworfh嗜睡量表的可行性分析

目的研究Epworth嗜睡量表(Epworth sleepiness score,ESS)评分及改良ESS评分对于重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者评估的意义及区别,探讨改良ESS评分的可行性。方法对232例初诊OSAHS患者同时进行多道睡眠图(polysomnography,PSG)监测、ESS评分及改良ESS评分,将其分值分别与PSG监测各项参数之间进行统计学分析。结果ESS评分和改良ESS评分均可以初步反映患者的嗜睡和缺氧程度。改良ESS评分的有效性更好,使用后正常组的嗜睡评分分值下降,重度OSAHS组与正常组的评分差距进一步加大,可以更好的对重度OSAHS患者进行初筛。结论改良ESS评分充分考虑了国人的生活习惯,可部分反映患者病情严重程度,可作为重度OSAHS患者病情筛查的临床线索之一。     

悬雍垂腭咽成形联合下鼻甲低温等离子射频消融术治疗重度OSAS的疗效分析

目的 探讨悬雍垂腭咽成形术(UPPP)联合下鼻甲低温等离子射频消融术治疗重度阻塞性睡眠呼吸暂停低通气综合征(OSAS)的疗效及联合手术治疗的临床依据.方法 对经临床检查和整夜睡眠监测确诊为重度OSAS的患者,而且,这些患者临床及影像学等辅助检查考虑阻塞部位以腭咽平面狭窄和单纯下鼻甲肥大为主的OSAS患者100例,随机分为两组,实验组进行UPPP联合下鼻甲消融术,对照组为单纯UPPP手术组,术后半年随访并复查PSG、ESS等进行主客观疗效评价并进行统计学分析.结果 所有患者术中、术后未出现严重并发症,术后6个月复查,实验组治愈率为6.0％(3/50)、显效率44.0％(22/50)、有效率为28.0％ (14/50)、总有效率为78.0％;对照组治愈率为6.0％ (3/50)、显效率为36.0％ (18/50)、有效率为14.0％ (7/50)、总有效率为56.0％.实验组与对照组相比,总有效率差异有统计学意义(P＜0.05);呼吸暂停低通气指数、最低血氧饱和度、ESS评分指标差异有统计学意义(P＜0.05).结论 UPPP联合下鼻甲低温等离子射频消融术治疗重度OSAS伴有慢性肥大性鼻炎患者疗效满意,可减轻患者分期手术的痛苦,手术创伤小,时间短,术后无严重并发症.     

改良悬雍垂腭咽成形术治疗轻中度阻塞性睡眠呼吸暂停低通气综合征

目的探讨改良悬雍垂腭咽成形(Hanuvulopalatopharyngoplasty,H-UPPP)治疗轻中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法 H-UPPP治疗57例经多道睡眠图(PSG)监测确诊为轻中度OSAHS患者,术前和术后6个月采用Epworth嗜睡量表(Epworth sleepiness score,ESS)评估其嗜睡程度,术后6个月复查PSG。结果患者术后6个月,ESS评分从术前7.9±2.1下降至4.3±2.5(P<0.01),AHI由术前(19.4±5.3)次/h下降至(9.4±6.3)次/h(P<0.01),最低动脉血氧饱和度由术前(77.3±5.6)%上升至(92.1±8.3)%。总有效率为84.2%(48/57)。结论手术适应证的选择是提高H-UPPP疗效的关键因素,H-UPPP治疗轻中度OSAHS有良好的近期效果。     

鼻腔扩容术对口咽平面以上阻塞性睡眠呼吸暂停低通气综合征的疗效分析

目的探讨鼻腔扩容术对阻塞平面位于口咽部以上的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法收集经多导睡眠监测(PSG)确诊为OSAHS的患者40例,阻塞平面均在口咽部以上。采用鼻腔扩容术,针对鼻中隔、下鼻甲、中鼻甲、钩突、鼻窦及腺样体等不同部位的病变分别进行处理。通过对比患者手术前后PSG检查结果以及症状视觉模拟量表(VAS)和Epworth嗜睡量表(ESS)评分,评估鼻腔扩容术对OSAHS的疗效。全部40例患者有37例(92.5%)完成了手术及术后随访。结果 37例患者中,临床症状改善总有效率为81.1%,其中治愈8.1%、显效37.8%、有效35.1%。术后6个月PSG检查结果AHI和LSaO_2,以及VAS和ESS评分与术前相比较,均有显著改变,差异有统计学意义(P0.05)。结论鼻腔扩容手术对阻塞平面位于口咽部以上的OSAHS患者有明显疗效,术后主观症状和客观评价指标均有显著性改变。     

改良悬雍垂腭咽成形术和鼻部手术治疗重度阻塞性睡眠呼吸暂停低通气综合征

目的对合并鼻部和口咽部阻塞的重度阻塞性睡眠呼吸暂停低通气综合征（ob-structive sleep apnea hypopnea syndrome,OSAHS）患者进行鼻部手术和改良悬雍垂腭咽成形术（uvulo-palatopharyngoplasty,H-UPPP）,探讨二者手术及不同顺序对疗效的影响。方法 OSAHS诊断和评估手术疗效采用多道睡眠呼吸监测（polysomnography,PSG）、嗜睡量表（Epworth sleep score,ESS）评分、体重指数（kg/m2,body mass index,BMI）和主观症状。患者按照单、双日的半随机方法分为A、B两组,A组61例先行鼻部手术,B组57例先行H-UPPP。A组术后3～5个月复查评估,B组术后6～8个月复查评估。A、B两组中无效者分别再行H-UPPP或鼻部手术。两组患者均在第二次手术后随访1年以上。结果 A组单纯鼻部手术后有效率为0,均再行H-UPPP,1年后复查评估有效率78.7%（48/61）。B组单纯H-UPPP有效率47.4%（27/57）,1年后随访复发4例;其余30例再行鼻部手术,1年后复查评估有效率70%（21/30）。A组总有效率78.7%（48/61）,B组总有效率77.2%（44/57）,两组总有效率无统计学意义（χ2=0.697,P〉0.05）。A、B两组联合手术者与单纯行鼻部手术或H-UPPP术的有效率有统计学意义（χ2=81.89,P〈0.05;χ2=4.070,P〈0.05）。A、B两组联合手术者有效率差异无统计学意义（χ2=1.208,P〉0.05）。A组单纯鼻部手术有效率与B组单纯H-UPPP有效率有统计学意义（χ2=37.468,P〈0.05）。结论治疗合并鼻部和口咽部阻塞的重度OSAHS患者,原则上可先行H-UPPP;无效或效果差者再行鼻部相关手术,从本组病例观察H-UPPP联合鼻部相关手术可提高有效率。     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

鼻腔扩容术对OSAHS患者的疗效分析

目的观察鼻腔扩容术治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床疗效。方法50例住院治疗的OSAHS患者,术前行多导睡眠呼吸监测（PSG）、纤维鼻咽镜检查及上气道三维CT重建,根据AHI分为轻度组和中重度组。鼻内镜下行鼻腔扩容术,术后6个月复查PSG及ESS评分。比较手术前后两组患者PSG相关参数及患者对手术疗效的主观评价,分析睡眠结构变化。结果轻度组患者手术前后ESS评分及鼾声指数比较,差异有统计学意义（P＜0.05）,AHI较术前明显改善（P＜0.05）,但LsaO2术后改善不明显（P＞0.05）;中重度组术后AHI及LsaO2改善不明显（P＞0.05）。轻度组患者术后睡眠结构得到有效改善,但中重度组只有部分改善。结论鼻腔扩容术可以有效改善轻度OSAHS患者PSG相关参数及睡眠结构,而中重度患者只能部分改善睡眠结构,却不能改善AHI及LsaO2水平。     

外科手术治疗对阻塞性睡眠呼吸暂停低通气综合征患者生活质量的影响

目的研究中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者经过外科手术治疗后,患者生活质量的变化。方法选择外科手术治疗中重度OSAHS患者40例,采用Calgary生活质量指数（Calgary sleep apnea quality of life index,SAQLI）在术前和术后6个月进行问卷调查,同时术前、术后6个月填写Epworth嗜睡量表（Epworth sleepiness score,ESS）,并且复查多道睡眠图（PSG）监测。结果术后6个月复查PSG与治疗前相比,呼吸暂停指数和夜间最低动脉血氧饱和度明显改善（P〈0.05）;SAQLI总分从术前3.91±0.5提高到术后4.99±1.1,具有显著性的统计学意义,其中以日常活动、症状方面更明显,社会活动及情感改善不明显,嗜睡症状明显好转。结论对OSAHS患者合理治疗,可有效提高生活质量;将ESS和SAQLI联合使用筛选高危患者是一个经济、简便和有效的方法。     

以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习

目的 探讨1例临床少见的以耳部症状首发、合并鼻咽部占位的肉芽肿性多血管炎(GPA)的临床特征、实验室检查、病理表现及诊疗过程。方法 回顾性分析患者的病例资料,总结病例特点并回顾国内外GPA相关文献。结果 患者以中耳炎、迷路炎症状为首发表现,合并鼻咽部占位,病程中逐渐出现面瘫,三叉神经刺激症状加重。多次留取耳及鼻咽部活检示急慢性炎症细胞浸润。升级抗生素,同时为避免中耳炎侵犯岩骨及颅内行乳突开放术。中耳局部炎症改善后其耳痛、面瘫等仍不缓解,但激素治疗有效,遂进一步完善自免病相关检查并再次行鼻咽部活检,最终确诊为GPA,予激素及免疫抑制剂治疗得以控制症状。术后3个月暂无显著肺部及肾脏受累表现。结论 临床上发现不典型的中耳炎或常规治疗反复不愈,且逐渐进展出现内耳、颅神经侵犯表现如眩晕发作、面神经麻痹等,同时激素治疗有效,且合并鼻咽部占位、鼻窦炎影像学表现,或累及其他器官如肺、肾脏时,均应考虑到GPA的可能。当反复留取病理活检未能取得特异性确诊依据时,动态监测抗中性粒细胞胞浆抗体、红细胞沉降率、尿潜血、胸部CT、血肌酐等也具有重要的提示意义。     

Polymyositis with dysphagia treated with endoscopic balloon dilatation

Polymyositis is characterized by non-specific inflammatory disease associated with an autoimmune disorder involving muscles of the limbs and neck. We report a case of an 80-year-old man who was referred to our clinic with a chief complaint of dysphagia and muscle weakness in all four limbs. The patient was diagnosed with polymyositis based on pathological findings, muscle weakness, electromyogram findings, and an elevated creatine phosphokinase level. The patient was also positive for HLA-DR3. Intravenous predonine administration was initiated, but dysphagia was not improved. We considered a cricopharyngeal myotomy, but this could not be performed because of heart failure. Endoscopic balloon dilation was performed and dysphagia improved on the same day. Therefore, we suggest that this method is a safe and effective approach for polymyositis with dysphagia.     

Cytokines in children with otitis media with effusion

We assayed 38 middle ear effusions from 23 children aged 4–13 years (mean 7) undergoing tympanostomy tube placements. All fluid was assayed for tumor necrosis factor (TNF) α, interleukin (IL) 1β, IL-8, and IL-10. Cytokine concentrations were measured by means of an enzyme-linked immunosorbent assay. Detectable levels of IL-1β, IL-8, and IL-10 were found in all of the effusions. TNF-α was detected in 18 of the middle ear effusions (47.4%). The mean concentration of TNF-α, IL-1β, IL-8, and IL-10 was, respectively, 0.423 ± 1.39, 30.58 ± 68.7, 7001.9 ± 6743, and 56 ± 58.7 pg/ml. There was a strong, statistically significant correlation between the concentrations of TNF-α and IL-1β (r = 0.87, P = 0.001) and between IL-1β and IL-8 (r = 0.53, P = 0.001). There was no correlation between the concentrations of IL-10 and other cytokines examined or between tympanic membrane pathology and the concentrations of TNF-α, IL-1β, IL-8, or IL-10. The presence of IL-10 in middle ear effusions may be one of the causes of a lack of clinical features of acute inflammation and may lead to a chronic inflammatory state. Received: 25 August 1999 / Accepted: 5 January 2000     

Decreased miRNA-320e correlates with allergy in children with otitis media with effusion

ObjectiveOtitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups.Materials and methodsThis study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973).ResultsMiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant.ConclusionsMiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.     

Experience with vertical partial laryngectomy with special reference to laryngeal reconstruction with cervical fascia

In this paper we report our experience of vertical partial laryngectomy using the superficial cervical fascia; we describe the technique and present the functional and oncological results of this method of treatment. A total of 42 patients with squamous cell carcinoma of the true vocal folds, in stage T(1) (n = 28) or T(2) (n = 14), were treated in our department using vertical partial laryngectomy during the decade 1987-1997. Nine patients had post-operative radiotherapy. The shortest follow-up time was three years. There were six recurrences in all, four in the larynx and two in the neck. All four of the laryngeal recurrences were treated with total laryngectomy and are doing well. Both the patients with neck metastases, who were treated with neck dissection, died. Permanent tracheotomy was necessary in one patient. There were no problems with aspiration. The recurrence rate was 14 per cent, the three-year survival index was 95.2 per cent and the three-year larynx preservation index was 90 per cent. According to our experience, vertical partial laryngectomy, using the method we describe, has a good functional and oncological result for stage T(1) and T(2) tumours.     

Vestibular rehabilitation with biofeedback in patients with central imbalance

Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now.ObjectiveThe aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort.Materials and MethodsThis is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP) and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all.Results75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients.ConclusionThe patients were able to use the electrotactile stimulus to improve their balance control.