鼻内镜术并下鼻道上颌窦置管冲洗与单纯鼻内镜上颌窦口扩大术治疗上颌窦真菌病近期疗效观察

目的对66例上颌窦真菌病分别采用两种不同手术方式（鼻内镜上颌窦口扩大术和鼻内镜术并下鼻道上颌窦置管冲洗）的疗效观察。方法将66例非侵袭性上颌窦真菌病随机分为两组,每组33例患者均单侧发病,一组行单侧鼻内镜上颌窦口扩大术,一组行鼻内镜术并下鼻道上颌窦置管冲洗治疗术,随访1～5年。回顾性分析比较两种不同处理方式的疗效。结果行单侧鼻内镜上颌窦口扩大术一组治愈29例,复发3例,治愈率为87.9%,行鼻内镜术并下鼻道上颌窦置管冲洗一组治愈32例,复发1例,治愈率为97%。结论鼻内镜术并下鼻道上颌窦置管冲洗治疗术是治疗上颌窦真菌病的一种安全有效的手术方法。     

鼻内镜下真菌球型上颌窦病变的手术治疗

目的 探讨真菌球型上颌窦病变的发病原因、鼻内镜手术方法及临床疗效.方法 回顾性分析50例真菌球型上颌窦病变患者的临床资料.结果 全部患者经鼻内镜手术治疗均获临床治愈,无1例出现手术并发症.随访6个月～2年,复发2例.结论 鼻腔、鼻窦局部解剖异常是真菌球型上颌窦病变患者患病的主要原因.鼻内镜手术是治疗真菌球型上颌窦病变的有效手段.     

65例上颌窦真菌病临床分析

目的探讨手术治疗上颌窦真菌病的疗效。方法回顾性分析4年间65例上颌窦真菌病的手术治疗方法及效果,其中采用上颌窦根治术5例,单纯鼻内镜术38例,鼻内镜下中下鼻道双径路手术16例,鼻内镜下鼻内外双径路手术6例。结果65例中62例一次性治愈未再复发,3例再次手术后也达治愈标准。结论对上颌窦真菌病的手术治疗,鼻内镜下绝大多数可达根治,如妨碍术野可加用下鼻道或鼻外双径路方式,这样既可达到微创的要求,也可达到治愈的效果。     

鼻内镜手术治疗真菌性鼻窦炎效果观察

目的:评价鼻内镜手术对真菌性鼻窦炎的治疗效果.方法:对63例经组织病理学确诊为真菌性鼻窦炎患者行手术治疗.6例单纯筛窦病变采取鼻内镜Messerklinger术式;14例单纯蝶窦病变采取鼻内镜手术;单纯上颌窦病变中11例采取Caldwell-Luc手术,18例采取鼻内镜手术,13例采取两者联合手术.结果:本组随访0.5-4年.除11例上颌窦病变采取单纯Caldwell-Luc术式者3例术后复发,余采用鼻内镜进路或两者联合进路的病例术后未见复发,治愈60例,治愈率95.2%.结论:鼻内镜手术能较好处理筛窦、蝶窦真菌病,对上颌窦真菌病根据病变情况酌情采取鼻内镜或与Caldwell-Luc联合手术,治疗效果满意.     

鼻内镜下治疗上颌窦囊肿38例疗效分析

目的探讨鼻内窥镜下摘除上颌窦囊肿的方法。方法回顾性分析鼻内镜手术治疗38例（41侧）上颌窦囊肿的临床资料;其中经下鼻道开窗27例,经上颌窦自然口10例,中、下鼻道同时开窗4例。结果所有囊肿均在鼻内窥镜下摘除。平均随访12个月,无复发。结论鼻内镜手术是治疗上颌窦囊肿安全有效的方法。     

上颌窦囊肿40例手术治疗分析

目的探讨鼻内镜下手术摘除上颌窦囊肿不同径路的方法。方法回顾分析焦作市第二人民医院2005-04-2009-05收治的40例上颌窦囊肿患者的临床资料。结果 40例患者上颌窦囊肿均成功摘除,无严重并发症。随诊6个月~1 a,无复发。结论应用鼻内镜手术摘除上颌窦囊肿创伤小,操作简便,效果良好,是治疗上颌窦囊肿安全、有效方法。     

鼻内镜下手术治疗上颌窦囊肿的临床分析

目的探讨鼻内镜下手术治疗上颌窦囊肿的方法及效果。方法回顾性分析2006年10月至2009年10月鼻内镜下手术治疗上颌窦囊肿患者45例的临床资料。结果患者手术均获成功,鼻腔内并无出血、黏连、感染等症状。经术后l周的检查,发现开窗处也较为宽畅,无明显分泌物及结痂。所有患者均随访1年,无囊肿复发。结论鼻内镜下手术治疗上颌窦囊肿疗效明显,值得临床推广运用。     

非侵袭型鼻窦真菌病20例临床分析

目的:探讨非侵袭型鼻窦真菌病的临床特点.方法:对经手术及病理证实的20例患者的临床资料进行回顾性分析.结果:20例中位年龄48.5岁,男女比例1:3.主要症状为涕中带血、鼻塞,有干酪样物排出10例.鼻窦CT均显示有不均匀高密度钙化影似"金属异物影".经手术治疗均获痊愈,其中鼻内镜鼻窦手术17例,上颌窦根治术2例,上颌窦途径筛窦切除术1例.术中见窦腔有褐色、灰黑色干酪样或泥沙样团块.术后病理报告均见真菌菌丝或孢子.18例随访0.5～6.5年无复发,2例失访.结论:该病好发于中年女性,血涕、鼻腔干酪样、泥沙样易破碎团块分泌物及鼻窦特征性类似"金属异物影"的CT表现是术前重要诊断依据;最终诊断有赖于病理检查;鼻内镜鼻窦手术为其有效的治疗手段.     

鼻内镜下鼻腔外侧壁切开入路治疗上颌窦病变

目的:报告经鼻内镜鼻腔外侧壁切开入路治疗上颌窦疾病的手术方式,并探讨其适应证及手术方法.方法:回顾性分析9例经鼻内镜鼻腔外侧壁切开切除上颌寞病变的病例,其中男6例,女3例,年龄35～61岁,平均45岁,5例有2次以上手术史,手术均在全麻下进行,均行鼻内镜下鼻腔外侧壁切开切除上颌窦病变,术后复位下鼻甲黏膜瓣,并完成下鼻道开窗.结果:所有患者均一次性切除病变,随访1年以上无复发,无面部麻木、溢泪等并发症.结论:鼻内镜下外侧壁切开入路治疗上颌寞病变视野宽,病变切除彻底,保留鼻腔外侧壁结构,鼻腔功能恢复快,疗效满意.     

鼻内镜下上颌窦囊肿摘除术36例分析

目的:探讨鼻内镜下上颌窦囊肿摘除术的3种路径。方法:3种路径分别是:上颌窦自然口开窗路径;下鼻道开窗路径;中下鼻道联合进路路径,分别为5例、6例、25例。结果:所有囊肿均成功摘除。随访6个月以上无复发。结论:鼻内镜下上颌窦囊肿摘除与传统手术相比具有创伤小、操作简单,且效果良好,是治疗上颌窦囊肿的安全有效方法。     

Acute Ischemic Sinus Node Dysfunctions in Dogs

The effects of the occlusion of the two main atrial arteries irrigating the sinus node on sinus rhythm and postpacing sinus recovery were studied in 12 anesthetized dogs. Records of spontaneous rhythm and of postpacing sinus recovery were taken at control and hourly for 6 hours after the occlusion. The spontaneous cycle length (AA interval) was 335 +/- 11 ms at control and 416 +/- 17 ms (mean +/- SE) (p less than 0.005) one hour after the occlusion. It remained nearly unchanged during the following 5 hours of observation. The occlusion also shortened atrioventricular conduction time (AV interval) and reduced P-wave amplitude in ECG lead II in 9 of these dogs. While the control postpacing sinus recovery time was 397 +/- 13 ms, the 1-hour value was 715 +/- 165 ms. This prolongation persisted during the first four postocclusion hours but was less marked during the last two hours of observation. Moreover, the postpacing mode of return of the AA intervals to their prepacing value (sinus recovery pattern) became characteristically slow and progressive after occlusion, complete postpacing recovery often occurring only after 100 or more beats. Sequences of escape atrial and/or AV junctional rhythms were frequently seen during this recovery. Atrial extrasystoles and short sequences of atrial tachycardias were observed in most dogs after occlusion. Conversely, none of these changes occurred during a 6-hour experimental time in 5 control dogs in which the same protocol, occlusion excepted, was repeated. These observations show that the sinus node function in the dog is consistently affected by impairing its blood supply. Ischemic dysfunctions include sinus slowing, pacemaker shift, prolonged sinus recovery time, delayed postpacing recovery and supraventricular tachyarrhythmias.     

Electrophysiological Testing of Sinus Node Function: Diagnostic and Prognostic Application-Including Updated Information From Sinus Node Electrograms

Sinus node function, including automaticity, conduction, and refractoriness, can be studied in the human electrophysiology laboratory. This review details the current methods used for such studies and discusses their clinical value. Of special emphasis in this article is the role of sinus node electrography in the clinical laboratory. Included also is an update of the data relating the duration of sinus node depolarization as measure on sinus node electrograms to other parameters that assess sinus node function as well as data supporting the direct relationship between the duration of the sinus node depolarization and the severity of sinus node dysfunction.     

孤立性蝶窦病变的诊治体会

目的：提高对孤立性蝶窦病变的诊断率和治疗率。方法：回顾分析1995年～2002年3月17例孤立性蝶窦病变的临床表现。结果：蝶窦病变最主要的临床症状为头痛，约占76．5％；其次为眼部症状，再次为鼻部症状。结论：孤立性蝶舞病变并非罕见，但临床症状无特异性表现，医师对该病认识不足是导致误诊的主要原因。CT、MRI和鼻内窥镜检查提高了对喋窦病变的诊断水平，且经鼻窦内窥镜手术对其治愈有显著的优越性。     

Cough Syncope Caused by Sinus Arrest in a Patient with Sick Sinus Syndrome

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. This paper presents a case of 63-year-old man with recurrent dizziness and syncope. The 24-hour ambulatory electrocardiogram and intracardiac electrogram showed sinus node dysfunction with sinus arrest, both spontaneous and inducible by voluntary cough. Sinus arrest was sometimes associated with dizziness. A permanent VVI pacemaker was implanted and no further cough syncope has occurred. We suggest that sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome.     

Sinus Node Modification Using Radiofrequency Current in a Patient with Persistent Inappropriate Sinus Tachycardia

Radiofrequency catheter modification of the sinus node for persistent inappropriate sinus tachycardia has not been previously reported. This article describes a patient in whom radiofrequency current was used to ablate an incessant automatic tachycardia focus mapped to the region of the sinus node, where a discrete multicomponent electrogram demonstrating earliest atrial activation was recorded. A transient junctional rhythm developed immediately after ablation, with rapid subsequent emergence of a stable rhythm having normal sinus nodal characteristics.     

The Heart Rate Response to Carotid Artery Massage in a Sample of Healthy Elderly People

Carotid artery massage was carried out in a cross-section of 95 healthy elderly subjects (51 men and 44 woman, mean age of 74 years) to assess the heart rate response and associated symptoms. These subjects were drawn from a larger group of randomly selected healthy elderly people living in Southampton. They had no history of myocardial infarction or stroke and were not taking any drugs that might enhance the carotid sinus reflex. A continuous distribution of response to carotid artery massage was seen with a median percent change in RR interval of 11.6% (IQR 22.9%); 66% had a percent change in RR interval of < 20%, 90% had a change of < 50%, and 9.5% a change of > 100%. Carotid sinus hypersensitivity (sinus arrest > 3 s) was found in 4 previously asymptomatic subjects; a prevalence of 4.2% (95% CI 1.2%–10.4%), and this was associated with dizziness in 2 of these 4 subjects. Dizziness also occurred in one other subject who had a change in RR interval of 178%, The definition of an abnormal carotid sinus reflex is arbitrary given the continuous RR interval response to carotid artery massage. In diagnosing carotid sinus syndrome, the RR interval response to carotid artery massage alone is not sufficient, as this maneuver must also reproduce the patient's presenting symptoms.     

内胚窦瘤的超声诊断

内胚窦瘤又称卵黄囊瘤。本病高度恶性,发展快,转移早,预后差。但系统超声资料仍属空白。本文对经手术病理证实的28例内胚窦瘤进行了回顾性分析,较详细地总结了其声象学特征,提出了超声诊断的依据,结合临床及血清AFP水平明显升高,我们认为术前内胚窦瘤的超声诊断是完全可能的。本组回顾性诊断率为92.86％,较过去17.86％的诊断率明显提高。     

Natural History of Sinus Node Chronotropy in Paced Patients

The natural history of chronotropic incompetence is not clear. To assess this, we evaluated corrected sinus node recovery time (cSNRT) and sinus node chronotropy at rest and during exercise in two groups of syncopal patients with sinus node disease. Group A comprised patients with resting bradycardia but normal cSNRT and group B had resting bradycardia and prolonged cSNRT (> 1000 ms). An additional two groups (C and D) were studied. Group C comprised patients with complete AV (CAVB) and no evidence of sinus node disease and group D were asymptomatic controls of similar age. At diagnosis, patients with symptomatic bradycardia but normal cSNRT and no evidence of carotid sinus syndrome (group A) had resting bradycardia and impaired peak heart rate (PHR-I) on exercise compared to controls (P < 0.001 and P < 0.05, respectively), but no reduction in exercise duration. At follow-up group A patients demonstrated an increase in resting rate that was significantly slower than the controls (P < 0.01). Peak heart rate (PHR-II) also remained significantly slower (P < 0.05). There was no difference in exercise duration between groups A and D at follow-up. Group B was further subdivided according to follow-up findings of preservation of atrial activity in seven patients (group B-1) and junctional rhythm without any atrial activity in four patients (group B-2). Retrospective analysis showed no significant difference in resting heart rate at initial examination but group B-2 showed a significantly lower peak heart rate on exercise compared with B-1 (P < 0.01). Follow-up exercise tests revealed reduced exercise capacity in B-2 patients when compared with B-1 (P < 0.05) and both B-1 and B-2 had significantly reduced exercise capacity when compared with control groups C and D (P < 0.001). Group C patients had an initial sinus node chronotropic response to exercise, which was not different from control but significantly better (P < 0.01) than group B. At follow-up, the mean peak sinus rate of group C patients was unchanged, while there was an insignificant prolongation of cSNRT. Thus, patients with resting bradycardia, blunted peak heart rate response to exercise, and markedly prolonged CSNRT are those most likely to show chronotropic incompetence over the long-term and should be considered for rate responsive dual (or single) chamber pacing systems.     

Reappearance of Persistent Normal Sinus Rhythm in a Patient with the Sick Sinus Syndrome Following Cardiac Pacing for 10.5 Years

A patient with symptomatic sick sinus syndrome which manifested as a brady-tachy syndrome, was admitted to our institute in 1969. Following cardiac pacing for 10.5 years, the brady-tachy syndrome disappeared and normal sinus rhythm was restored. Her stable normal sinus rate has persisted up to the present, 2.5 years after termination of pacing.     

High Density Endocardial Mapping of Shifts in the Site of Earliest Depolarization During Sinus Rhythm and Sinus Tachycardia

BETTS, T.R., et al. : High Density Endocardial Mapping of Shifts in the Site of Earliest Depolarization During Sinus Rhythm and Sinus Tachycardia. Previous mapping studies of sinus rhythm suggest faster rates arise from more cranial sites within the lateral right atrium. In the intact, beating heart, mapping has been limited to epicardial plaques or single endocardial catheters. The present study was designed to examine shifts in the site of the earliest endocardial depolarization during sinus rhythm and sinus tachycardia using high density activation mapping. Noncontact mapping of the right atrium during sinus rhythm was performed on ten anesthetized swine. Recordings were made during sinus rhythm, phenylephrine infusion, and isoproterenol infusion. The hearts were then excised and the histological sinus node identified. The mean minimum and maximum cycle lengths recorded were   355 ± 43   and   717 ± 108 ms   . A median of three (range two to five) sites of earliest endocardial depolarization were documented in each animal. With increasing heart rate the site of earliest endocardial depolarization remained stationary until a sudden shift in a cranial or caudal direction, often to sites beyond the histological sinoatrial node. The endocardial shift was unpredictable with considerable variation between animals; however, faster rates arose from more cranial sites   (r = 0.46, P = 0.023)   . There was no difference in the mean cycle length of sinus rhythm originating from specific positions on the terminal crest   (r = 0.44, P = 0.17)   . Cranial sites displayed a more diffuse pattern of early depolarization than caudal sites. In the porcine heart the relationship between heart rate and site of earliest endocardial depolarization shows considerable variation between individual animals. These findings may have implications for clinical mapping and ablation procedures. (PACE 2003; 26[Pt. I]:874–882)