鼻内镜手术388例疗效分析

目的：探讨鼻内镜手术(ESS)治疗鼻窦炎的疗效。方法：对1999年1月—2002年5月间实施鼻内镜手术并完成术后随访的388例慢性鼻窦炎、鼻息肉患者进行了疗效分析。结果：388例中总的治愈好转率为86．86％，其中Ⅰ型1、2、3期分别为100％、100％、94．59％，Ⅱ型1、2、3期分别为100％、93．02％、76．47％，Ⅲ型为64．29％。结论：在手术成功的基础上加强术后随访和综合治疗是提高治愈好转率的关键。     

长期鼻饲的老年患者经导丝更换胃管的研究与探讨

后囊破裂、玻璃体脱出是白内障手术中最常见的并发症，其发生率国外报道为1％～5％，国内报道为5．4％，其对手术的现场操作及术后的视功能重建影响极大。因此，保持完整的后囊膜在一定程度上视为手术成功的重要指标。我科2003年1月-2006年10月，对进行白内障超声乳化吸出术发生后囊破裂、玻璃体脱出的56例患者，成功实施了一期后房型人工晶体悬吊术，追踪观察最长3．5年，最佳矫正视力1．2，疗效满意，现报道如下。     

子宫颈癌术后放疗90例远期疗效分析

目的分析子宫颈癌术后放疗及各项因素与远期疗效的关系，并与单纯放疗（外照射＋后装腔内治疗），单纯手术的疗效作对比分析。方法1993～1998年对90例宫颈进行了术后放疗＋后装腔内治疗，其中Ⅰ期17例，Ⅱ期72例。鳞癌84例．腺癌6例均为浸润肌层。盆腔有淋巴结转移23例。放疗采用6Mev电子直线加速全盆腔外照射，肿瘤量44～58Gy，加后装腔内放疗，肿瘤量25～30Gy，80例占88．3％。结果生存5年以上者74例，5年生存率为82．5％。年龄．期别，肿瘤大小，舾理类型，手术方式与远期疗效无明显相关。有无淋巴结转移5年生存率分别为63．3％和88．9％（P〈0．01），放疗刑量为44～58Gy。加后装腔内治疗组的5年生存率明显高于该刑量组．未加后装腔内治疗组，分别为91．6％和57．1％（P〈0．05）。结论本组术后外照射加后装腔内治疗与文献中单纯放疗、单纯手术的远期疗效进行比较显示：Ⅰ期、Ⅱa期病例无差异，Ⅱb期单纯放疗加后装腔内治疗为好，术中或术后发现病期较晚者补破疗或后装腔内治疗是必要的。     

1100例鼻内窥镜手术进行回顾性分析

目的：探讨鼻内镜手术治疗慢性鼻窦炎和鼻息肉疗效的影响因素及远期疗效。方法：对1998年～2004年间实施鼻内镜手术并完成术后随访半年以上的1100例病人进行分析。其中Ⅰ型320例。Ⅱ型610例，Ⅲ型170例。术后随访6月～18月，平均12月。结果：Ⅰ型治愈率为94．1％，Ⅱ型治愈率85．2％，Ⅲ型治愈率为65．4％。三型之间治愈率有统计学意义（P〈0．05）。结论：鼻内镜鼻窦手术治疗鼻窦炎、鼻息肉具有良好的疗效，术中采用合适浓度的肾上腺素液能达到很好的止血效果，术中对鼻甲的正确处理，术后定期随访能提高治愈率。术者良好的鼻窦解剖知识以及熟练的手术操作、正确的手术方法、麻醉选择以及杜绝术中盲目操作，是提高术后疗效、降低并发症的主要措施。     

高位食管癌的外科治疗体会

目的 探讨外科手术治疗高位食管癌的疗效。方法 回顾性分析1978年7月至2004年6月采用不同术式治疗高位食管癌320例患者的临床资料，其中，胸上段食管癌308例，颈部食管癌12例。结果 手术切除率为92．81％，吻合口瘘发生率5．05％，喉返神经损伤率4．71％，术后1、3、5和10年生存率分别为78．08％、41．88％、35．22％和27．27％。结论 对于高位食管癌，只要选择合适的手术方式，做好围手术期处理，手术治疗能够取得较好的疗效。     

鼻咽癌根治性放疗后残留和复发颈淋巴结的手术治疗远期疗效研究

目的：探讨鼻咽癌根治性放疗后残留和复发的颈部淋巴结手术治疗的疗效及影响因素。方法：1994－1997年住院的68例鼻咽癌根治性放射治疗后有颈部淋巴结残留和复发的患者进行手术治疗，随访进行远期疗效预后分析，并以坟要影响因素进行了初步分析。结果：根治性放疗后颈淋结残留和复发的鼻咽癌患者行手术后的三年、五年局部颈部淋巴结转移复发的控制率（95％CI）分别为30．2－50．2％和20．2－30．4％，淋巴结复发控制的中位时间27月。鼻咽癌根治性放疗后行颈部淋巴结手术治疗术后三年、五年生存率（95％CI）分别为43．1－52．1％和18．1－30％，中位生存时间为32月。颈部淋巴结大小，活动度及手术方式与患者的预后有关（P＜0．05），而性别、年龄及颈部残留与复发与患者生存率无明显差异（P＞0．05）。结论：对根治性放疗术后颈淋结残留和复发的鼻咽癌患者行手术治疗能有效的提高患者的生存率。     

高原地区鼻内窥镜鼻窦手术298例疗效观察

目的 探讨高原地区鼻内窥镜鼻窦手术的疗效和影响手术疗效的相关因素。方法 对2003年4月至2005年6月随访的298例鼻内窥镜鼻窦手术进行临床分析。298例中Ⅰ型104例（34．9％），Ⅰ／型163例（54．7％），Ⅲ型31例（10．4％），同期行鼻中隔矫正术94例，中鼻甲修整病例174例。结果Ⅰ型治愈率为93．3％，Ⅱ型治愈率为84％，Ⅲ 治愈率为51．8％。三型之间治愈率差异有显著性（P〈0．05），手术并发症的发生率为6．3％。结论 鼻内窥镜手术是治疗慢性鼻窦炎和鼻息肉的有效方法，高原地区手术疗效与过去文献资料比较Ⅰ Ⅱ型无明显差异，但Ⅲ型有显著差异。     

分期手术治疗食管贲门癌术后胸内吻合口瘘15例体会

我院从1985年2月至1996年12月．对606例食管、贲门癌患进行了手术治疗．发生吻合口瘘17例．发生率28％，对其中15例进行了分期手术治疗．治愈13例．死亡2例．治愈享80％．疗效满意。     

儿童阻塞性睡眠呼吸暂停低通气综合征112例的手术疗效分析

目的：探讨儿童阻塞性睡眠呼吸暂停综合征（OSAHS）手术成功和失败的原因，以提高手术预评估水平，提高手术疗效。方法：将我院2003—07／2008—03手术治疗的112例临床资料完整的OSAHS患儿进行了疗效分析。结果：治愈102例（91．1％）包括单侧扁桃体切除后对侧扁桃体代偿增生肥大者2例，再次行对侧扁桃体切除后治愈；显效9例（80％），包括肥胖4例，鼻阻塞4例；好转1例（o．9％），为肥胖伴下颌骨后缩者。结论：儿童OSAHS大多手术疗效较好，少数肥胖、鼻阻塞及下颌后缩疗效欠佳。     

鼻内窥镜手术治疗儿童慢性鼻窦炎

目的 分析鼻内窥镜手术治疗儿童慢性鼻窦炎的适应证、注意事项和疗效。方法 回顾性分析了该科1998年1月～2001年7月在鼻内窥镜下手术治疗的54例儿童鼻窦炎和鼻息内的临床资料。结果 随访1～4年，按照海口会议鼻内窥镜手术疗效评定标准，54例中治愈22例(40．7％)，好转26例(48．1％)，无效6例(11．1％)，总有效率为88．9％。术中术后无1例出现严重并发症。术后并发症主要是术腔粘连。结论 经鼻内窥镜手术是治疗儿童慢性鼻窦炎较为理想的手术方式，但应严格掌握手术适应证，术中同期处理相关病变；术后需加强随访治疗。     

Hyperthyroidism in the Land of Graves: Results of Treatment by Surgery, Radio-iodine and Carbimazole in 837 Cases

A review of the outcome of treatment by subtotal thyroidectomy,radio-iodine and carbimazole of 837 patients with hyperthyroidismseen consecutively over the period 1954–78 inclusive ispresented. The age and sex distribution, the male to femaleratio, the ABO blood group distribution and the prevalence ofpernicious anaemia and diabetes mellitus in these patients wasalso analysed. Life-table data showed that the five-year andten-year cumulative relapse rates following a two-year courseof carbimazole (n = 162) were 56 per cent and 62 per cent; followingsurgery (n = 266), 6 per cent and 10 per cent and followingradio-iodine (n = 43), 3 per cent and 14 per cent. Five-yearand ten-year cumulative hypothyroid rates after surgery were10 per cent and 18 per cent, and after radio-iodine 10 per centand 30 per cent. Hypothyroidism did not occur after carbimazoletherapy. Of 31 patients who took carbimazole for less than twoyears (mean 11 months, range 6–19 months), 91 per centhad relapsed at five years. Of 79 patients treated for longerthan two years (mean 3.8 years, range 2–14 years), relapserates at five and eight years were 49 per cent and 62 per cent.Nine patients (3.4 per cent) suffered permanent vocal cord paralysisand five (1.9 per cent) had permanent hypocalcaemia. The male/female ratio was 9.9 to 1, with a peak female prevalencebetween 25 and 30 years and a peak male prevalence between 40and 45 years. The ABO blood group distribution among patients did not differsignificantly from the distniution in the general population(x² = 13.4, p = 0.2). Forty-seven patients (5.6 per cent) had diabetes mellitus andthyrotoxicosis whilst two patients (0.23 per cent) had diabetes,thyrotoxicosis and pernicious anaemia.     

Long-term results following 131I treatment for Graves' disease in Hong Kong Chinese--discriminant factors predicting hypothyroidism

The clinical outcome of 1028 Hong Kong Chinese patients with Graves' disease treated with radioiodine therapy and followed for a mean of 9.85 +/- 4.84 years (range 2-20) was analysed. Retreatment was required by 413 patients (40.2 per cent), with 134 patients (13.0 per cent) requiring more than two 131I doses. One hundred and eighty-nine patients received carbimazole after 131I until euthyroidism was achieved. The cumulative incidence of hypothyroidism at one, five, 10 and 15 years was 9.6 per cent, 31.4 per cent, 53.8 per cent and 65.8 per cent, respectively. The average incidence of hypothyroidism after the first two years was 3.3 per cent per annum. Stepwise logistic regression analysis of pretreatment variables suggested that a combination of adjunctive carbimazole therapy, absence of ophthalmopathy and longer effective half-lives of 131I were of value in predicting which patients were less likely to develop permanent hypothyroidism. However, the probability of accurately predicting permanent hypothyroidism based on the present model was only 60 per cent. We believe that no single pretreatment variable, or combination of variables, predicts long-term hypothyroidism with sufficient confidence to justify the use of a 'formula' approach for prescribing 131I therapy for Graves' disease.     

Gastric ulcer and cancer.

The incidence of gastric carcinoma was studied in a series of 210 patients presenting with apparently benign gastric ulcer. In eight cases (3.9 per cent), carcinoma was diagnosed within 18 months and was almost certainly present from the outset; in 2.4 per cent the diagnosis was delayed for over three months, and the five-year death-rate due to gastric carcinoma was 3.2 per cent. In a mean follow-up period of 5.7 years after the first diagnosis of an ulcer (8.2 years after first symptoms), three fresh cases of gastric carcinoma were found, and in two of these the cancer was at a different site from the ulcer. The five-year incidence of fresh gastric carcinoma was 0.6 per cent. Unsuspected superficial spreading carcinoma was detected by histology in 5.4 per cent of gastrectomy specimens. The significance of these findings is discussed in relation to the management of gastric ulcer and the early diagnosis of cancer.     

OCCURRENCE OF POLIOMYELITIS VIRUS IN AUTOPSIES,PATIENTS, AND CONTACTS

1. Poliomyelitis virus has been recovered in monkeys from 50 per cent of spinal cords, 10 per cent of olfactory bulbs, 50 per cent of tonsil-adenoid tissue, and from 26 per cent of the colon contents of autopsies; from the stools of 20 per cent of patients, and of 5 per cent of the contacts examined in this series. 2. Other materials as indicated in Table I were tested without success. 3. In autopsies with positive cords, tonsil-adenoid tissues, or colon contents were positive in 73 per cent. 4. 22 per cent of stools from patients with paralysis yielded virus and 19 per cent of the stools from patients without paralysis yielded virus. 5. 20 per cent of the stools from males and 22 per cent of the stools from females yielded virus. 6. 40 per cent of 35 stools from patients under 16 years yielded virus while 8 per cent of 38 stools from patients above the age of 15 yielded virus. 7. 71 per cent of the cords of 35 autopsies under 16 years yielded virus while 31 per cent 16 years and over yielded virus. 8. Repeat stools from 5 positive cases, 1 month after the first positive stool, were negative. The stool of one contact was positive the 2nd month after first recovery but was negative the 3rd month.     

Gastric Ulcer and Cancer

The incidence of gastric carcinoma was studied in a series of210 patients presenting with apparently benign gastric ulcer.In eight cases (3.9 per cent), carcinoma was diagnosed within18 months and was almost certainly present from the outset;in 2.4 per cent the diagnosis was delayed for over three months,and the five-year death-rate due to gastric carcinoma was 3.2per cent. In a mean follow-up period of 5.7 years after first diagnosisof an ulcer (8.2 years after first symptoms), three fresh casesof gastric carcinoma were found, and in two of these the cancerwas at a different site from the ulcer. The five-year incidenceof fresh gastric carcinoma was 0.6 per cent. Unsuspected superficial spreading carcinoma was detected byhistology in 5.4 per cent of gastrectomy specimens. The significance of these findings is discussed in relationto the management of gastric ulcer and the early diagnosis ofcancer.     

A clinical study of type 2 neurofibromatosis.

The clinical features, age at onset of symptoms and survival of 150 patients with type 2 neurofibromatosis were studied. The mean age at onset was 21.57 years (n = 110) and no patients presented after 55 years of age. Patients presented with symptoms attributable to vestibular schwannomas (acoustic neuroma), cranial meningiomas and spinal tumours. In 100 patients studied personally by the authors 44 per cent presented with deafness and this was unilateral in the majority (35/44). Deafness was accompanied by tinnitus in a further 10 per cent and muscle weakness or wasting was the first symptom in 12 per cent. Less common presenting symptoms were seizures (8 per cent), vertigo (8 per cent) numbness and tingling (2 per cent) and blindness (1 per cent). Eleven patients were diagnosed asymptomatically through screening. Café au lait spots occurred in 43 per cent (n = 43) but only one case had six. Skin tumours were detected in 68 per cent (68/100) and 38 per cent (34/90) had an identifiable lens opacity or cataract. The mean age at death in 40 cases was 36.25 years and all but one death was a result of a complication of neurofibromatosis. There are marked inter-family differences in disease severity and tumour susceptibility.     

Clinical features and natural history of von Hippel-Lindau disease

The clinical features, age at onset and survival of 152 patients with von Hippel-Lindau disease were studied. Mean age at onset was 26.3 years and 97 per cent of patients had presented by aged 60 years. Retinal angioma was the first manifestation in 65 patients (43 per cent), followed by cerebellar haemangioblastoma (n = 60, 39 per cent) and renal cell carcinoma (n = 15, 10 per cent). Overall, 89 patients (59 per cent) developed a cerebellar haemangioblastoma, 89 (59 per cent) a retinal angioma, 43 (28 per cent) renal cell carcinoma, 20 (13 per cent) spinal haemangioblastoma and 11 (7 per cent) a phaeochromocytoma. Renal, pancreatic and epididymal cysts were frequent findings but their exact incidence was not accurately assessed. Mean age at diagnosis of renal cell carcinoma (44.0 +/- 10.9 years) was significantly older than that for cerebellar haemangioblastoma (29.0 +/- 10.0 years) and retinal angioma (25.4 +/- 12.7 years). The probability of a patient with von Hippel-Lindan disease developing a cerebellar haemangioblastoma, retinal angioma or renal cell carcinoma by age 60 years was 0.84, 0.7 and 0.69, respectively. A comprehensive screening protocol for affected patients and at-risk relatives is presented, based on detailed analysis of age at onset data for each of the major complications. Median actuarial survival was 49 years, with renal cell carcinoma the leading cause of death.     

Long-term Results Following 131I Treatment for Graves' Disease in Hong Kong Chinese--Discriminant Factors Predicting Hypothyroidism

The clinical outcome of 1028 Hong Kong Chinese patients withGraves' disease treated with radioiodine therapy and followedfor a mean of 9.85±4.84 years (range 2–20) wasanalysed. Retreatment was required by 413 patients (40.2 percent), with 134 patients (13.0 per cent) requiring more thantwo ¹³¹I doses. One hundred and eighty-nine patients receivedcarbimazole after ¹³¹I until euthyroidism was achieved. Thecumulative incidence of hypothyroidism at one, five, 10 and15 years was 9.6 per cent, 31.4 per cent, 53.8 per cent and65.8 per cent, respectively. The average incidence of hypothyroidismafter the first two years was 3.3 per cent per annum. Stepwiselogistic regression analysis of pretreatment variables suggestedthat a combination of adjunctive carbimazole therapy, absenceof ophthalmopathy and longer effective half-lives of ¹³¹I wereof value in predicting which patients were less likely to developpermanent hypothyroidism. However, the probability of accuratelypredicting permanent hypothyroidism based on the present modelwas only 60 per cent. We believe that no single pretreatmentvariable, or combination of variables, predicts long-term hypothyroidismwith sufficient confidence to justify the use of a ‘formula’approach for prescribing ¹³¹I therapy for Graves' disease.     

Long-term Survival After Resuscitation From Ventricular Fibrillation Occurring Before Hospital Admission

Factors related to long-term (post-discharge) outcome followingsuccessful resuscitation from pre-hospital ventricular fibrillationby a physician-manned mobile coronary care unit were studied.Between 1 January 1966 and 31 December 1987, 190 patients wereresuscitated from pre-hospital ventricular fibrillation (158male; mean age 56 years). The aetiology of ventricular fibrillationwas acute myocardial infarction in 131 patients (69 per cent),ischaemic heart disease without infarction in 48 (25 per cent)and other or unknown in 11 (6 per cent). Predicted actuarialsurvival rates at 1, 2, 5, 10 and 20 years were 76 per cent,66 per cent, 41 per cent, 27 per cent and 12 per cent respectively.Of 128 recorded deaths over 20 years, 85 per cent were cardiacand 48 per cent were defined as sudden death outside hospital.Factors significantly associated with increased long-term mortality(p<0.05), based on analysis of 10 year actuarial life tablesusing the Lee–Desu statistic were ventricular fibrillationdue to ischaemic heart disease without infarction rather thanacute myocardial infarction, a history of previous myocardialinfarction, a history of hypertension, digoxin and diuretictherapy before ventricular fibrillation and digoxin as dischargemedication, and failure to stop smoking after discharge fromhospital by patients who had been smoking prior to ventricularfibrillation. In addition, Cox's regression analysis showedthat patient age     

Long-term survival after resuscitation from ventricular fibrillation occurring before hospital admission.

Factors related to long-term (post-discharge) outcome following successful resuscitation from pre-hospital ventricular fibrillation by a physician-manned mobile coronary care unit were studied. Between 1 January 1966 and 31 December 1987, 190 patients were resuscitated from pre-hospital ventricular fibrillation (158 male; mean age 56 years). The aetiology of ventricular fibrillation was acute myocardial infarction in 131 patients (69 per cent), ischaemic heart disease without infarction in 48 (25 per cent) and other or unknown in 11 (6 per cent). Predicted actuarial survival rates at 1, 2, 5, 10 and 20 years were 76 per cent, 66 per cent, 41 per cent, 27 per cent and 12 per cent respectively. Of 128 recorded deaths over 20 years, 85 per cent were cardiac and 48 per cent were defined as sudden death outside hospital. Factors significantly associated with increased long-term mortality (p less than 0.05), based on analysis of 10 year actuarial life tables using the Lee-Desu statistic were ventricular fibrillation due to ischaemic heart disease without infarction rather than acute myocardial infarction, a history of previous myocardial infarction, a history of hypertension, digoxin and diuretic therapy before ventricular fibrillation and digoxin as discharge medication, and failure to stop smoking after discharge from hospital by patients who had been smoking prior to ventricular fibrillation. In addition, Cox's regression analysis showed that patient age greater than or equal to 60 years was significantly associated with increased long-term mortality. On multivariate analysis, factors independently associated with increased long-term mortality were ventricular fibrillation occurring before 1977, previous myocardial infarction or hypertension and digoxin as discharge medication.(ABSTRACT TRUNCATED AT 250 WORDS)