喉全切除术在治疗中晚期喉癌中的应用

目的:探讨喉全切除术治疗中、晚期喉癌的疗效。方法:对573例喉癌患者行喉全切除术,声门上型370例,声门型90例,跨声门型75例,声门下型21例,放疗后复发17例。其中143例行单纯喉全切除术,430例同期行颈廓清术(单侧239例,双侧191例)。在喉全切除术中行气管外口造大孔术,共308例。结果:3、5及10年生存率分别为69.5%(398/573),61.1%(350/573),46.3%(149/322);220例死亡病例中,45.0%(99/220)死于局部复发;22.3%(49/220)死于颈部转移。术腔感染和咽瘘的发生率分别为12.2%,5.2%。16.6%气管外口造大孔术患者气管外口再度狭窄需行Ⅱ期气管外口扩大术或戴套管维持呼吸。13.6%的患者可以行喉部分切除术,由于不同的原因行喉全切除术。结论:喉全切除术作为治疗中、晚期喉癌的主要手段,其适应证随喉癌外科技术的发展而逐渐缩小。在采取积极的颈廓清术情况下,局部复发是主要的死亡原因。     

Perichondrial-cartilage island graft in one stage tympano-ossiculoplasty

A one stage reconstruction of the tympanic membrane and the ossicular chain using a composite graft of tragal perichondrium with cartilage is described (Type III tympanoplasty). The long-term results in 18 operated cases reveals closure of the air-bone gap to within 0 to 10 dB in 72% of the cases. The above procedure used autologous graft material, does not disturb the remaining middle ear structures, can be performed under local anesthesia, and in most cases is done on an outpatient basis.     

钛质人工听骨在一期鼓室成形术中的应用

目的研究钛质人工听骨植入在一期鼓室成形术中的疗效。方法对3 1例用钛质人工听骨行一期鼓室成形术的患者,随访3-6个月。通过计算术前术后纯音测听得出气骨导阈值的平均值,比较手术后气导的恢复情况和手术前后的气骨导差。结果 3 1例患者术后鼓膜愈合良好,未见人工听骨排异反应,及听骨脱出,有1例在术后2个月时发生感染。31耳术前气导听力30.00~88.75dB,平均为(59.27±15.67)dB,术后气导平均听力为(43.10±14.64)dB,与术前相比,差异有统计学意义(P<0.05)。术前骨导听力为10.00~43.75dB,平均为(23.06±9.18)dB,术后骨导平均听力为(22.82±7.49)dB,与术前相比,差异无统计学意义(P>0.05)。术前气骨导差(ABG)为11.25~62..5dB,平均为(36.21±11.88)dB,术后ABG平均为(19.40±12.92)dB,二者比较,差异有统计学意义(p<0.05)。术后ABG≤20dB且ABG较术前缩小15dB为听力提高有效,共有13耳,有效率为41.94%(13/31)。结论钛质人工听骨植入在一期鼓室成形术中可以取得满意的听力效果,术后并发症少,排除率低,在有听骨链破坏行Ⅰ期鼓室成形术中值得推广应用。     

全喉切除改良气管-咽吻合Ⅰ期发声重建术

目的：探讨全喉切除Ⅰ期发声重建术的改进术式。方法：采用低位气管切开，全喉切除，食管前壁黏膜重建声门，气管切口处造瘘．颈段气管上提并缩窄吻合于舌根的方法行全喉切除及Ⅰ期发声重建木35例。结果：33例(94．29％）术后获得了不同程度的发声功能．不能发声者仅2例(5．71％)。全部患者术后均可经口进食，未出现严重的影响生存质量的误咽。结论：与以往的发声重建术相比，本术式具有发声成功率高、发声质量良好、误咽率低等优点，且无须置人人工发声装置．值得推广。     

晚期喉咽癌和喉癌全喉切除术后咽皮肤瘘

目的:探讨晚期喉咽癌和喉癌患者施行全喉切除术后咽皮肤瘘的位置、易患因素、处置及其结果.方法:回顾性分析因喉咽癌或喉癌施行全喉切除术的198例患者的资料,分析多因素对咽皮肤瘘形成的影响.结果:发生咽皮肤瘘患者33例(16.7%),内瘘口位于黏膜吻合口上段23例(69.7%),下段7例(21.2%),中段3例(9.1%);喉咽癌与喉癌的咽皮肤瘘发生率分别为24.7%和11.6%,其差异具有统计学意义(P<0.05);术后持续发热>5 d与≤5 d者咽皮肤瘘的发生率差异具有统计学意义(P<0.01);28例通过保守治疗痊愈,5例手术修复.结论:全喉切除术后咽皮肤瘘内瘘口多发生于舌根处和气管造瘘后上方,肿瘤部位和术后发热是咽皮肤瘘形成的重要易患因素.     

Management of general anesthesia for mastoid-tympanoplasty: anesthesia and surgical considerations

Bleeding can be minimized during general endotracheal anesthesia for mastoid-tympanoplasty surgery by a satisfactory anesthesia, normal spontaneous ventilation without expiratory or inspiratory obstruction, proper positioning of the patient, and controlled hypotension at 95 systolic blood pressure with oxygen 6 liters/min. and halothane 1.5-2 percent. Trimethaphan 0.1 percent may be added. The degree of hypotension is controlled by the depth of anesthesia with halothane, positioning, and if it is required, titration with trimethaphan. Controlled mild hypotension with halothane facilitates mastoid-tympanoplasty surgery. It has been used in more than 300 patients, with ages ranging from six to 72 years. The results have been highly successful and satisfactory. There was no morbidity or mortality related either directly or indirectly to the use of this technique.     

钛人工听骨在Ⅰ期鼓室成形术中的临床疗效分析

目的观察钛人工听骨在慢性中耳炎患者进行Ⅰ期听力重建鼓室成形术中的应用情况,为钛人工听骨的临床使用提供参考。方法以2008年9月至2010年6月在南昌大学第一附属医院耳鼻咽喉-头颈外科住院手术的慢性中耳炎患者为研究对象,回顾性分析299例(耳)使用钛人工听骨进行I期听力重建鼓室成形术的疗效,对患者进行纯音听力检查,比较术前和术后气骨导差的变化。手术方法均为开放式鼓室成形术,视上鼓室外侧壁(桥)保留与否和植入人工听骨类型的不同,将术后听力结果随访完整的112例病例分为三组:组一:留桥鼓室成形术,植入PORP;组二:断桥鼓室成形术,植入PORP;组三:断桥鼓室成形术,植入TORP。结果 :术后随访3月至1年,术后气骨导差≤20dB者共43例,其中植入部分人工听骨(PORP)42例,植入全人工听骨(TORP)1例。组一与组二比较,术后气骨导差无统计学意义,但各组之间术前与术后气骨导差改善均有统计学意义,植入PORP组比植入TORP组术后气骨导差改善更明显,且有统计学意义。所有病例无胆脂瘤复发,3例人工听骨排出。结论手术方式与术后听力改善无关,植入的方式与术后听力改善有关。     

Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients.