射频消融术治疗舌部静脉畸形

目的 探讨射频消融术治疗舌部静脉畸形的效果.方法 回顾性分析2013年7月至2014年7月收治的30例舌部静脉畸形的病例资料,从单侧病变到弥漫性广泛病变,其中23例接受了射频消融术,选取直径为0.5 mm的工作尖端的射频消融电极针,功率调至25 W,将工作尖端刺入距病变最底部即最深处约1 mm处,通电行消融工作15 ～30 s,其后依次退出电极针1 mm,直至距病变表面1 mm处,分别行多点消融.结果 15例单侧病变一期手术彻底消融;8例双侧均受累及病例,一期行一侧病变射频消融术,术后3～6个月再行二期射频消融手术,其中5例彻底消融.23例术后随访3个月至1年半,手术消融20例,无复发,且舌两侧对称,无明显瘢痕,外观满意.另外3例仍有部分残余.结论 射频消融术弥补了传统手术的不足,治疗舌静脉畸形基本达到治愈,无明显并发症,且外观良好.     

鼻内镜下用等离子射频消融治疗儿童腺样体肥大的疗效观察

目的:探讨电视监视鼻内镜下低温等离子射频消融术治疗儿童腺样体肥大的临床疗效.方法:对90例腺样体肥大患儿采用0°鼻内镜及等离子射频消融治疗系统进行治疗,观察其疗效及并发症.结果:90例术后1～3个月复查临床症状均消失,2例合并鼻窦炎保守治疗2个月后痊愈,随访1年均无复发及并发症.结论:该手术方法视野清晰,操作方便,术中损伤小,无并发症,具有很好的临床应用价值.     

不同鼻内窥镜手术治疗腺样体肥大效果研究

目的比较鼻内窥镜下等离子低温射频消融术与动力系统腺样体切除术治疗腺样体肥大的效果和安全性。方法随机将58例腺样体肥大患者分为2组,各29例。均在鼻内窥镜下施术。对照组使用动力系统腺样体切除术,观察组使用等离子低温射频消融术。比较2组治疗效果。结果 2组治疗总有效率及手术时间差异无统计学意义(P0.05)。观察组术中出血量少于对照组,差异有统计学意义(P0.05)。结论鼻内窥镜下等离子低温射频消融术与动力系统腺样体切除术治疗腺样体肥大,均可获得较好的治疗效果。但等离子低温射频消融术可减少术中出血量。     

甲状腺舌管囊肿及瘘管患儿围手术期护理

小儿甲状腺舌管囊肿及瘘管是胚胎期甲状腺舌管闭合不全而形成的先天性发育异常 ,表现颈部正中部位发生囊肿或瘘管 [1]。我院 1 997～ 1 999年对31例甲状腺舌管囊肿及瘘管患儿进行手术治疗 ,予以精心护理 ,疗效满意。1　临床资料31例中 ,男 1 6例、女 1 5例 ,1～ 3岁 1 5例 ,～7岁 1 3例 ,～ 1 4岁 3例。本组病例均在基础加颈浅丛神经阻滞麻醉下施行瘘管切除术 ,术毕放置橡皮引流条 1根。术后 2 9例一次手术成功 ;2例复发(舌骨中段未切除及瘘管切除不全所致 ) ,再次行舌瘘管切除术 ,术后均顺利康复 ,1年内随访无复发。2　护理2 .1　术前护理2…     

射频消融在腹腔镜脾部分切除术中的应用

目的探讨射频消融在腹腔镜脾部分切除术中应用的可行性。方法回顾性分析我院2013年1月至2016年1月12例外伤性脾破裂患者行射频消融辅助腹腔镜脾部分切除术的临床资料,分析手术时间、术中出血量及术后并发症等。结果 12例患者均成功行射频消融辅助腹腔镜脾部分切除术,保脾率100%,无中转开腹病例。手术时间(89±18)min,术中出血量(93±25)mL,术后引流时间(3±1)d,引流量(50±28)mL,住院时间(6.8±1.2)d,仅2例出现术后并发症。结论射频消融辅助腹腔镜脾部分切除术安全有效,具有可行性。     

低温射频消融治疗儿童阻塞性睡眠呼吸暂停低通气综合征

目的 探讨低温射频消融双侧扁桃体对儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）的治疗作用. 方法 2003年1月～2006年1月,30例经多导睡眠监测（polysomnography,PSG）证实的儿童OSAHS,年龄3～10岁,平均5.8岁,均行双侧扁桃体低温等离子刀消融术,对21例合并腺样体肥大者同时行腺样体刮除术,其中3例合并分泌性中耳炎行鼓膜穿刺抽液. 结果 术后6个月睡眠打鼾、张口呼吸症状消失,双侧扁桃体Ⅰ～Ⅱ度,咽腔无狭窄,听力恢复正常.20例术后1年PSG示治愈10例,显效8例,有效2例. 结论 低温射频等离子扁桃体消融术治疗儿童OSAHS是有效而且安全的.     

美蓝在甲状舌管囊肿（瘘）切除术后中的应用附68例报告

目的：总结甲状舌管囊肿（瘘）切除术的的经验，减少手术复发率。方法：68例甲状舌管囊肿和瘘管中常规注入美蓝，显示囊肿（瘘管）的范围，方向及走行，分支，协助术中仔细分辨，解剖，彻底切除，结果：甲状舌管囊肿切除术58例，无复发，甲状舌管瘘切除术10例，复发1例，本组复发率1．5％。结论：甲状舌管囊肿（瘘管）中注入美蓝手术，可降低甲状舌管囊肿（瘘）切除术的术后复发率。     

鼻内镜下腺样体切除术20例疗效分析

目的:评价鼻内镜下腺样体切除术临床应用价值及疗效.方法:对确诊为腺样体肥大的20名患者实施鼻内镜腺样体切除术,评价术后及随访效果.结果:20例全部一次性切除,切除平均时间4.6分钟,术中出血少,术后无并发症及复发病例.结论:鼻内镜下腺样体切除术效果肯定,可为首先治疗方法.     

甲状腺舌管囊肿与瘘的诊断和治疗

目的 探讨甲状腺舌管囊肿与诊治问题。方法 回顾性分析我院手术治疗67例甲状腺舌管囊肿与瘘患者的临床资料。结果 本组术前诊断率为92．5％，行B超检查者诊断准确率为96．1％；全组均行手术治疗，其中作单纯切除14例，连部分舌骨膜切除12例，连舌骨中段切除（Sistrun′s手术）41例。54例获随访，其中随访舌管囊肿患者43例，复发4例，复发率9．3％；随访瘘管患者11例，复发2例，复发率18．2％。结论 高频超声检查对甲状腺舌管囊肿的诊断及鉴别诊断具一定特征性及临床价值。术后复发原因与手术方式以及术前感染是否控制有关，在囊肿未感染前正确施行Sistrunk′s手术可降低要后复发率。     

局麻鼻内镜下腺样体切除术临床分析

目的 探讨局麻下经鼻内镜治疗青少年及成人腺样体肥大的方法.方法 对126例青少年及成人腺样体肥大者进行局麻鼻内镜下治疗,89例以自动吸引切割器行腺样体切除术,37例以腺样体刮匙配合自动吸引切割器进行切除.伴有鼻腔鼻窦其他病变者先给予相应的治疗.结果 全面病例手术顺利,除3例分泌性中耳炎术后耳部症状改善不佳外,其余患者均...     

Total glossectomy: is it justified?

Background: The treatment of advanced malignancies of the tongue with total glossectomy is controversial. Methods: The present study retrospectively reviews 20 patients that had total glossectomy with or without laryngectomy performed at the Princess Alexandra Hospital (Woolloongabba, QLD, Australia) over the past 10 years. The clinicopathologic parameters, perioperative morbidity and mortality were assessed. Results: The 5 years disease free and disease specific survival rates were 34% and 38%, respectively. Ninety per cent of patients acquired independent oral feeding prior to discharge, while 57% of patients that had laryngeal preservation performed achieved satisfactory vocal rehabilitation. Conclusion: Total glossectomy is an oncologically sound surgical procedure that should only be performed in carefully selected patients with advanced malignancies affecting the tongue.     

High energy single session radiofrequency tongue treatment in obstructive sleep apnea surgery

OBJECTIVE: To evaluate the safety and outcomes of a high-energy single session treatment as an alternative to a cumulative energy multiple staged approach when using temperature-controlled radiofrequency tissue ablation (TCRFTA) for tongue base obstruction in sleep apnea surgery. STUDY DESIGN AND METHODS: Retrospective study of 176 consecutive Fujita II (tongue and palate level obstruction) patients undergoing single session palate, tonsil, and nasal surgery, and concurrent tongue base TCRFTA by the application of 10,500 J of energy. RESULTS: Median follow-up was 156.5 days. There were no serious complications. There were five (2.8%) superficial tongue ulcers, and three (1.7%) persistent taste disturbances after treatment; 174 patients were on sustainable oral intake and adequate oral pain control within 24 hours of surgery; 98 had comparable post operative sleep studies. Apnea-hypopnea indexes decreased from 35.3 +/- 23.9 to 22.6 +/- 21.5 (P < 0.0001). Epworth Sleepiness Scale scores improved from 11.2 +/- 4.9 to 5.9 +/- 4.6 (P < 0.000001). CONCLUSION: High energy single session tongue base TCRFTA is a safe procedure with low morbidity.     

The efficacy of tongue resection in treatment of symptomatic macroglossia in the child

Nine patients with symptomatic macroglossia, 3 with Beckwith-Wiedemann syndrome, 3 with Down's syndrome, and 3 with lymphatic malformation of the tongue, were evaluated for postoperative improvement following partial glossectomy. Symptoms evaluated were speech intelligibility, oral competence at rest, drooling, and normal deglutition. All patients with Down's syndrome and Beckwith-Wiedemann syndrome were improved postoperatively. All patients with Down's syndrome exhibited improved deglutition and reduced drooling. Only 1 patient (33%), however, achieved oral competence. Speech was improved postoperatively in 2 patients (67%) with Down's syndrome. Patients with lymphatic malformation of the tongue did not exhibit consistent long-term improvement postoperatively, suggesting that conservative management of macroglossia in this patient group may be indicated.     

Surgical radiofrequency ablation of both atria for atrial fibrillation: results of a multicenter trial

BACKGROUND: The Cox maze procedure has shown to be effective in treating atrial fibrillation. Radiofrequency ablation, with a similar objective, has been used as an adjunct to conventional cardiac surgery for the treatment of atrial fibrillation in more than 20 centers in Australia and New Zealand since March 2000. This is a report of those results. METHODS: One hundred thirty-two patients in 20 centers underwent radiofrequency ablation as an adjunct to conventional cardiac surgery, with a standardized lesion set created with a flexible, 7-electrode, temperature-controlled probe (Cobra; EPTechnologies, San Jose, Calif). All data were entered into a central registry, with regular follow-up prompted by the registry cocoordinator. Each radiofrequency scar was made with standard parameters requiring 2 minutes of tissue coagulation at 80 degrees C to 85 degrees C. Patients undergoing mitral procedures had radiofrequency ablation performed in the left atrium endocardially. Patients undergoing aortic valve replacement or coronary artery bypass surgery underwent epicardial radiofrequency ablation of the left atrium. Epicardial radiofrequency ablation lesions on the right atrium were common to both groups of patients. Preoperatively, 75% of the patients had chronic atrial fibrillation, 21% had paroxysmal atrial fibrillation, and 4% had flutter. Surgical procedures performed included mitral valve procedure in 60%, coronary artery bypass grafting in 14%, aortic valve replacement in 7%, and coronary artery bypass grafting plus aortic valve replacement in 4%. RESULTS: There were no major complications related to the use of radiofrequency ablation. There were no soft tissue or cardiac perforations. Ten patients were defibrillated into sinus rhythm within 3 months postoperatively. The freedom from atrial fibrillation was 84% at 3 months, 90% at 6 months, and 100% at 12 months. All patients at 12 and 18 months' follow-up were in sinus rhythm. There were no thromboembolic complications. CONCLUSIONS: Surgical radiofrequency ablation can be performed safely as an adjunct to conventional cardiac surgery. A standardized lesion set created by using similar temperature settings can be adopted in multiple centers and might be effective in treating atrial fibrillation. Data collection through a central registry has helped in monitoring the effectiveness of this new technique in a scattered population.     

Acute exacerbation of macroglossia leading to necrosis of the anterior third of the tongue.

Macroglossia is defined as an enlarged tongue that protrudes beyond the teeth or the alveolar ridge in the resting position. Macroglossia may be classified into generalised and localised based on the extent of tongue involvement. Each of these groups can be subdivided into congenital, inflammatory, traumatic, metabolic and neoplastic lesions [Myer III CM, Hotaling AJ, Reilly JS. The diagnosis and treatment of macroglossia in children. Ear Nose Throat J 1986;65:444-8]. The congenital causes are vascular anomalies such as haemangioma and lymphovenous malformations. We report the case of a large lymphovenous malformation of the tongue in a 17 month old child who developed an acute exacerbation of macroglossia following trauma. This eventually led to necrosis of the anterior third of his tongue requiring a partial glossectomy.     

Temperature-controlled radiofrequency energy delivery for gastroesophageal reflux disease: the Stretta procedure

BACKGROUND: The delivery of temperature-controlled radiofrequency (RF) energy has been utilized effectively for the treatment of benign prostatic hyperplasia, sleep-disordered breathing, joint laxity, tumors, and cardiac dysrhythmias. The mechanism of action of RF delivery, depending on the specific disease pathophysiology, is related to wound contraction/remodeling or nerve pathway ablation. More recently, temperature-controlled RF energy delivery has been applied for the treatment of gastroesophageal reflux disease (GERD). PURPOSE: To review the use of temperature-controlled RF energy in clinical applications, specifically the safety and efficacy data regarding endoluminal delivery of RF energy for the treatment of GERD (Stretta procedure). RESULTS: Endoluminal RF energy delivery to the gastroesophageal junction for the treatment of GERD is performed using conscious sedation on an outpatient basis. After treatment, medication use is significantly reduced or eliminated at 6 and 12 months, and there is a significant reduction in both the distal and proximal esophageal acid exposure on 24-hour ambulatory pH testing. All studies reviewed demonstrate improvement in GERD symptom scores, heartburn, satisfaction, and quality of life after treatment. There have been no cases of achalasia or stricture resulting from this procedure. Data support both an augmentation of the physical barrier function of the gastroesophageal junction and a reduction in triggering of transient LES relaxations as plausible mechanisms of action for this procedure. CONCLUSION: Endoluminal RF energy delivery has been shown in several studies to be safe and effective for the treatment of GERD and is a promising new technology for this chronic disorder.     

Is total glossectomy for advanced carcinoma of the tongue justified?

Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However, even though total glossectomy is a major surgical procedure that impacts on speech, deglutition and quality of life, it may offer patients the best chance of cure in many centres, especially in the developing world. METHODS: We did a retrospective chart review of all patients at Groote Schuur Hospital, Cape Town, who had undergone total glossectomy, with or without total laryngectomy, for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004. RESULTS: Eight patients had a total glossectomy performed during the study period. At 2, 3 and 5 years 63%, 38% and 25% of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding, and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88%) reported pain relief following surgical excision. Perineural invasion was present in 75%, and 38% had positive resection margins. Five patients had recurrence, 2 cervical, 1 local, and 2 local and cervical. CONCLUSION: Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option, particularly in the developing world setting. It has cure rates superior to primary radiotherapy, and provides motivated patients with excellent pain relief and a reasonable quality of life.     

Tongue reconstruction with the gracilis myocutaneous free flap

We describe our experience in tongue reconstruction using the transverse gracilis myocutaneous (TMG) free flap after major demolitive surgery for advanced cancer. This technique was used in 10 patients: seven underwent total glossectomy and three partial glossectomy. In eight patients we performed motor reinnervation attempting to maintain muscular trophism and gain long-term volumetric stability. The follow-up period ranged from 6 to 28 months. The overall flap survival was 100%. Nine out of 10 patients resumed oral intake. Our preliminary experience shows that this flap is a good reconstructive option for total glossectomy patients, whereas it is less suited for reconstruction of hemiglossectomy defects. Functional and objective evaluation of the tongue reconstructed with TMG free flap requires further and standardized evaluation.     

应用岛状烦肌粘膜瓣修复部分舌缺损

目的:探索一种用相同或相似组织修复舌缺损的方法,介绍岛状颊肌粘膜瓣修复部分舌缺损的经验。方法:应用以面动静脉为蒂的岛状颊肌粘膜瓣修复16例舌癌切除后的部分舌缺损。结果:16例患者术后岛状颊肌粘膜瓣全部完全成活,效果满意。无血肿、感染、腮腺导管损伤、面神经损伤和开口功能障碍等并发症,舌的形态、功能良好。1例半舌切除后的患者术后肌电图显示,颊肌粘膜瓣内的肌肉获得神经再支配且运动良好。结论:面动静脉岛状颊肌粘膜瓣组织学上类似于舌组织,血运丰富,转移灵活,可以获得神经再支配,有重建舌的运动功能的潜能,是修复舌缺损的一个良好选择。     

Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies

BACKGROUND: The purpose of this study was to describe the impact of partial lateral glossectomy on midsagittal tongue movement during speech. METHODS: Using B-mode ultrasound, the midsagittal tongue movement of 10 patients with lateral partial glossectomy during a standardized reading passage was analyzed before and after surgery. Six normal adults served as control speakers. The main outcome measure was the tongue velocity during speech. The technique of defect reconstruction (local vs flap) was included as a covariate in the analysis. RESULTS: Following the surgery, all patients significantly increased the velocity of the midsagittal tongue movements during the reading passage. CONCLUSION: The results demonstrated that the patients with partial glossectomy compensated for the lateral tongue resections by increasing the velocity of the residual tongue during speech. The study provides first insights into the biomechanical aspects of spontaneous articulatory compensation following lateral tongue resections.