经口鼻内镜下腺样体刮除术129例临床分析

腺样体亦称咽扁桃体,位于鼻咽顶后壁中线处,为咽淋巴环内环的组成部分。腺样体肥大多见于儿童,且常合并有慢性扁桃体炎,与分泌性中耳炎密切相关,一经确诊,应尽早施行腺样体切除术。2009年3月-2012年11月我科开展了经口鼻内镜下腺样体刮除术129例,取得了满意效果,现报道如下。     

间接喉镜下吸割器行腺样体切除术

随着鼻内镜的普及,内镜下腺样体切除术越来越普遍.但在手术过程中我们也遇到一些实际问题.2005年2月-2007年2月,我科在全身麻醉下行间接喉镜明视下腺样体切除术40例,取得较好疗效.     

腺样体刮除术后大出血1例

病人,女,7岁,因睡眠打鼾、张口呼吸3年,外院诊断为慢性扁桃体炎、扁桃体肥大、腺样体肥大.术前查凝血全套正常,血常规:血红蛋白112 g/L,白细胞8.4×l 09/L ,中性粒细胞55%、淋巴细胞45%,血小板335×109/L.肝、肾功能及心电图均在正常范围 内.于2001年8月1日上午9时在全麻下行双侧扁桃体切除及腺样体刮除术,术中出血约100 ml,1l时手术结束,送回病房.下午2时发现左侧鼻腔有鲜血流出,且呕吐鲜红色血液20 0 ml,于下午4时再次进入手术室进行压迫止血,术中出血约200 ml,输入红血球1.5 U ,血浆200 ml,行鼻咽填塞无法止血.     

腺样体刮除术后继发性大出血1例

患者,男,5岁,因睡眠打鼾,伴张口呼吸、憋气2年入院,诊断为扁桃体肥大、腺样体肥大.术前检查凝血正常,血常规检查:血红蛋白124g/L,中性粒细胞0.39,淋巴细胞0.48,血小板180×109/L,肝、肾功能及心电图均在正常范围.2005年2月2日在全麻插管下行双侧扁桃体切除及腺样体刮除术,1.5h手术顺利结束.术后患者常规应用抗生素预防感染,术后3d,患儿家长诉睡眠无打鼾,无其他不适,痊愈出院.2005年2月9日患者因感冒、发热哭闹、剧烈咳嗽,口吐鲜血3次,出血量约600ml,入院后检查示患儿呈贫血貌,精神差,双侧扁桃体窝光滑,无出血,鼻咽部有鲜血流下,先试用含肾上腺素的盐水棉球压迫鼻咽部10min,鼻咽部仍有活动性出血,故在鼻腔及鼻咽部丁卡因表面麻醉下,用两头带长线的纱球填塞鼻咽部(当时患儿出血量较多,精神极差,已无力抵抗),长线一头由前鼻孔引出,固定在面部,并收入院观察.住院后48h后取出纱球,未再出血,观察1周,痊愈出院.     

间接鼻咽镜直视下腺样体切除术

传统的腺样体切除术尽管能使大多数患者症状得到缓解,但因是在非直视下盲目操作,加之刮匙的局限性,术后残留率较高,导致术后短期内一部分患者症状复发或术后症状不能完全缓解,这一点已经得到共识。随着鼻内镜技术的广泛应用,传统的腺样体刮除术已渐被弃用,但鼻内镜直视下的腺样体切除术受条件局限。我科2005年6月～2007年3月在间接鼻咽镜直视下行腺样体切除术48例,亦取得了非常好的治疗效果,报道如下。     

鼻内镜下经口径路儿童腺样体刮除术

我科自2005年1月~2005年12月采用插管全身麻醉鼻内镜下经口径路行儿童腺样体刮除术50例,疗效满意,报告如下。1资料与方法1.1一般资料本组50例患者,男28例,女22例;年龄3.5~11.5岁;病程0.5~5年。其中以张口呼吸、睡眠打鼾及抽吸性鼻涕就诊者35例,鼻塞及流脓涕者10例,耳闷、听力下     

内镜下对传统腺样体刮除术的临床评估

目的在内镜直视下研究传统腺样体刮除术病变残留比率和残留的部位。方法对107例腺样体增生肥大患儿, 其中腺样体Ⅱ度肥大64例,Ⅲ度肥大43例,先行传统腺样体刮除术,然后在内镜直视下观察是否有病变残留以及病变残留的大小和部位,对有病变残留的患儿在内镜直视下应用切割吸引器切除腺样体残留组织。结果行传统腺样体刮除术的所有患儿均有不同程度的病变残留,显著残留率（病变残留最大径超过1cm）53.1%(57/107),其中腺样体Ⅱ度肥大显著残留率25.0%（16/64）,Ⅲ度肥大95.3%（41/43）,残留位于腺样体上极35例(61.4%)、腺样体靠近圆枕处28例(49.1%)、腺样体下级16例(28.1%)。结论传统腺样体刮除术极易遗留病变组织,部位包括腺样体上极、腺样体靠近圆枕处、腺样体下级。     

腺样体刮除术与Crisel，s综合征（附2例报告）

报告２例小儿腺样体刮除术后Ｃｒｉｓｅｌ‘ｓ综合征的临床资料，并结合本资料对腺样体利除术至Ｃｒｉｓｅｌ’ｓ综合征的病因、临床特点及处理原则进行讨论。     

间接喉镜明视下经鼻腔行腺样体切除术

目的 评估间接喉镜明视下经鼻底进入鼻息肉钳行腺样体切除术的疗效.方法 对80例腺样体肥大患者采用间接喉镜明视下经鼻底进入直头鼻息肉钳切除腺样体,采用双极或单极电凝经鼻或口行鼻咽部创面止血.结果 术中术野清楚,术后无出血,腺样体切除彻底,无周围正常组织损伤,无任何并发症出现.结论 间接喉镜下经鼻腔行腺样体切除术所需设备简单,易于操作,腺样体切除彻底,安全,无并发症.     

儿童局麻鼻内镜下腺样体刮除手术效果

目的 探讨局麻鼻内镜下腺样体刮除术的可行性和安全性.方法 486例患儿在局麻鼻内镜下行腺样体刮除术.采用1％的卡因鼻腔、鼻咽、口咽表面麻醉,鼻腔内填塞的卡因肾上腺素棉片表面麻醉.鼻内窥镜经鼻腔进入,腺样体刮匙经口腔进入,监视器直视下刮匙到达腺样体上部,自上向下后一次刮除.观察有否残留、出血、周边损伤,术毕.结果 ①手术...     

增殖体切除术对儿童慢性鼻窦炎疗效的影响

目的：探讨增殖切除术对儿童慢性鼻窦炎疗效的影响。方法：对儿童慢性鼻窦炎伴增殖体肥大33例行增殖体切除术,辅以药物治疗,观察疗效。结果：随访6～12个月,慢性鼻窦炎治愈24例,好转6例,无效3例,有效率91%。结论：增殖体肥大与慢性鼻窦炎有一定相关性。对伴有中重度增殖体肥大的慢性鼻窦炎患儿行增殖体切除术效果较好。     

电子喉镜在食管检查中的初步应用

目的 探讨电子喉镜在食管检查中的应用价值.方法 2009年6月至2011年6月在鼻腔表面麻醉下对50例患者应用电子喉镜进行食管检查,其中男32例,女18例;年龄16～88岁,平均53.8岁;慢性咽炎16例,单侧声带麻痹9例,吞咽不利6例,喉癌5例,下咽癌4例,慢性咳嗽和可疑食管异物各3例,颈部转移癌2例,喉接触性肉芽肿和颈部淋巴结肿大各1例.结果 经表面麻醉后,所有患者均能耐受并顺利完成检查,4例患者通过食管入口时出现轻微的恶心反应.食管镜检38例未见异常,发现食管霉菌病和食管炎各3例,食管异物和食管下端食物残留各2例,食管癌和食管划伤各1例,阳性发现率24％ (12/50).结论 电子喉镜可以兼顾经鼻电子食管镜或胃镜的一些功能,对食管病变的初筛诊断有一定意义.     

鼻内镜下经口鼻联合径路行腺样体切除术152例疗效分析

腺样体又称咽扁桃体、增殖体,位于鼻咽顶壁和后壁交界处,两侧咽隐窝之间.腺样体出生后即存在,6～7岁时最为显著,10岁后逐渐萎缩[1].腺样体因反复炎症刺激而发生病理性增生肥大,并引起相应的症状者称为腺样体肥大,本病常见于儿童,但部分成人亦可发生,常合并慢性扁桃体炎.肥大的腺样体不同程度地阻塞后鼻孔和压迫咽鼓管,以及分泌物对咽、喉和下呼吸道的刺激,可引起耳鼻咽喉和下呼吸道多种症状.     

Development of laser ruler in rigid laryngoscope

Objectives

The objective of this study was to develop a new device that provides a simple, noninvasive method of measuring accurate lesion size while using an endoscope.

Methods

We developed a rigid laryngoscope with a built-in laser-ruler using a one-light emitting diode and an acrylic plate. The invention incorporates a built-in laser diode that projects an auto-parallel beam into the optical path of the rigid laryngoscope to form two spots in the field of view.

Results

While the interspot distance remains consistent despite changes in focal plane, magnification, or viewing angle of the laryngoscope, projection to an uneven surface introduces certain variations in the shape, and size of the spots, and the distance between the two spots.

Conclusion

The device enables a laryngologist to easily measure the distance between landmarks, as well as the change in real size, and the progressive change of vocal fold lesions in an outpatient setting.     

内镜引导下经鼻入路腺样体切除78例临床分析

目的 探讨内镜引导下、经鼻入路联合电动切割综合动力系统进行腺样体切除的技术要点和疗效分析。方法 确诊为腺样体肥大儿童78例, 2~13岁,主诉睡眠打鼾、憋气、张口呼吸71例,鼻塞、流涕5例,长期耳闷、听力下降2例,于全麻下行内镜引导下经鼻入路腺样体切除术。结果 手术时间平均28min,术中出血平均10mL,无原发性和继发性出血、咽鼓管损伤等手术并发症。 术后平均随访1 年, 患者症状明显好转,无鼻腔粘连、腺样体肿大等发生。结论 内镜引导下经鼻入路联合电动切割综合动力系统腺样体切除术具有术野清晰, 切除准确, 止血彻底, 效果良好的特点。     

经间接喉镜和直接喉镜杓状软骨拨动术的比较研究

目的 :探讨在局麻下经间接喉镜和直接喉镜杓状软骨拨动术对气管插管致环杓关节脱位的疗效。方法 :将 2 3例气管插管致环杓关节脱位患者随机安排在局麻下经间接喉镜或直接喉镜行杓状软骨拨动术 ,并对两组进行比较。结果 :每组患者的治疗起始时间与发音功能康复时间呈正相关 ;两组患者的治疗起始时间和发音功能康复时间的比较差异无显著性意义 (P >0 .0 5 ) ,复位次数差异有显著性意义 (P <0 .0 5 ) ,术后咽喉疼痛反应持续时间的差异无显著性意义 (P >0 .0 5 )。结论 :喉损伤的治疗起始时间对患者完全恢复发音功能有重要影响。两种方式对环杓关节脱位均有良好疗效。直接喉镜杓状软骨拨动术对喉损伤病程偏长的患者较为适合     

Adenoidectomy With Laser or Incisional Myringotomy for Otitis Media With Effusion

Objective To compare the effectiveness of CO₂ laser myringotomy to incisional myringotomy at the time of adenoidectomy for refractory otitis media with effusion (OME). Study Design Controlled retrospective consecutive case series. Methods All children undergoing myringotomy and adenoidectomy for OME in the spring of 1999 had 1.7‐mm‐diameter perforations created in their tympanic membranes using a CO₂ laser and conventional microslad. Their ears were evaluated at first postoperative visit (mean, 16.65 days after surgery) by a validated otoscopist to determine the presence or absence of perforations and middle ear effusions. These patients were compared with historical controls comprising all children undergoing incisional myringotomy and adenoidectomy in 1998. A χ² analysis was performed to compare the results of these two myringotomy techniques. Results Twenty‐three children (39 ears) underwent laser myringotomy and adenoidectomy in 1999, compared with 26 children (48 ears) who underwent incisional myringotomy and adenoidectomy in 1998. In the laser myringotomy group, 8 of the 39 ears had a persistent opening at first follow‐up; 4 of the 39 ears showed evidence of effusion. In the incisional myringotomy group, all 48 ears had healed; 7 of these ears showed evidence of effusion. Conclusion Myringotomies created using the CO₂ laser are more likely to be patent at first postoperative visit than those made with incisional technique (P < .01). However, this prolonged middle ear ventilation does not significantly decrease the prevalence of effusion (P > .1).     

Adenoidectomy for otitis media with effusion in 2-3-year-old children

Objective

To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME.

Methods

Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months.

Results

Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p = 0.87; M&T vs. A-M, p = 0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups.

Conclusions

Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.