对耳内镜手术的思考

本文回顾了耳内镜发展的历史与现状,详细描述耳内镜的技术难点,在结合耳科技术和设备要求的基础上,提出了耳内镜手术的分类:一是耳内镜设备作为应用工具的地位分类,二是耳内镜按手术部位和技术要求分类。最后提出耳内镜微创能力的两种评价指标。本文旨在通过阐述耳内镜手术的分类,以期对开展耳内镜技术的单位或者个人能有一定的帮助或者指导意义。     

头颈外科医师培训与教学思考

头颈外科是耳鼻咽喉头颈外科学科下设的一门三级学科，创建于于上世纪50年代的美国，经过几十年的发展，与耳科、咽喉科、鼻科一起构成了耳鼻咽喉头颈外科。头颈外科研究领域涵盖了从颅底、颔面到上纵隔这一范围的良、恶性病变的诊断和治疗，头颈外科的发展是学科发展的必然，但其基本要求是头颈外科医师能适应其发展，因此头颈外科医师培训已日渐重要。在20世纪50年代，我国建立肿瘤医院时设立了头颈外科，综合性医院的耳鼻咽喉科医师虽然已开始承担头颈外科工作，     

灌流技术在耳内镜中的应用

孔维佳: 近5年耳内镜技术在国内蓬勃开展,在前两期圆桌论坛中我们围绕耳内镜起步阶段(手术的优势劣势、耳内镜手术的适应证和禁忌证、耳内镜手术的准入与发展)[1]以及耳内镜发展阶段(手术技巧及经验与教训)[2]进行了讨论,一经发表即受到读者及耳科同道的欢迎,得到较高的关注和引用.     

微创外科技术在耳外科中的应用

人类永远没有停止对于微创治疗更高层面的追求和探索。“Minimally invasive surgery”和“minimal access surgery”直译为微小侵袭外科或微小径路外科。从有创到微创，最终到达无创，是整个医学发展的全过程，耳外科也不例外。微创手术理念提倡的是以最小的组织创伤换取最好的治疗效果和心里感受，即与传统的手术技术相比较，在提高和不降低手术疗效的前提下，     

鼻内镜鼻窦手术技术教学体会

鼻内镜外科是鼻科学领域划时代的变革，随着基础研究的深入及临床技术的成熟，其应用范围已延伸到耳鼻咽喉头颈外科整个领域，推动了学科整体快速发展。现代鼻内镜外科的内涵应该是：在鼻内镜直视下，清除病灶，改善和重建鼻腔、鼻窦通气引流功能，并尽可能保留鼻腔、鼻窦正常解剖结构和功能，从而达到治愈鼻窦炎目的的鼻外科技术。单从技术角度     

耳内镜中耳外科手术体系的建立

耳内镜技术的出现为中耳外科领域的发展提供了新的动力,随着耳内镜器械和设备的持续改进和创新,更多的耳内镜实用手段被应用于中耳外科手术中,一些传统中耳外科的方法和理念也被重新审视和再认识.在此过程中,一些耳内镜手术的实用理念逐渐清晰,手术方法渐渐成熟,形成了具有特色的耳内镜中耳外科手术体系.耳内镜中耳外科手术体系的建立,不...     

耳内镜在耳科临床的应用

目的探讨耳内镜在耳科的临床应用价值。方法回顾性分析耳内镜分别在外耳道疾病、外伤性鼓膜穿孔、分泌性中耳炎、慢性化脓性中耳炎（包括单纯型、骨疡型、胆脂瘤型）等疾病治疗及诊断中的应用价值。结果在耳内镜下对分泌性中耳炎的患者行鼓膜切开引流和置管，对鼓膜紧张部中央性穿孔的患者行鼓膜修补术是最值得提倡的；在耳显微镜下行单纯乳突开放、清除病变后，再在耳内镜下观察中耳各个部位，予以彻底清除病变，可以更好的完成不同类型的鼓室成型术。结论耳内镜具有图像清晰、操作简便、不同视角，损伤小等优点，有利于耳科疾病的诊治；但耳内镜目前尚不能完全取代耳显儆镜，两者联合应用可以更好的完成各种耳科手术。     

鼻内镜外科技术分级和准入制度及培训体系

中华医学会耳鼻咽喉科学分会和中华耳鼻咽喉头颈外科杂志编委会于2005年4月22-25日在广西省北海市召开全国鼻科中青年专家论坛，会议包括两部分内容：专家讲座和专题论坛。本次论坛的目的是提高我国鼻科领域的诊疗水平，紧跟国际鼻内镜外科领域的最新进展，充分发挥中青年同仁在鼻科学专业中的学术潜力及学术影响力，力争成为本学科的学术带头人，促进本学科的发展；同时也为2006年修订1997年海口制订的“慢性鼻窦炎鼻息肉临床分型分期及内窥镜鼻窦手术疗效评定标准”做准备。召开中青年专家论坛这是第一次尝试，会议开得很成功，达到了预期的目的。今后将再次召开相关专科或其他专题的中青年论坛，充分发挥中青年学者作为学科中坚力量、承前启后的作用，推动耳鼻咽喉头颈外科整体学术水平的发展。本论坛讨论的4个重点专题是：①鼻内镜外科技术分级、准入制度和培训体系；②鼻内镜颅底外科及额窦外科；③鼻内镜手术适应证、并发症及围手术期的处理；（多慢性鼻-鼻窦炎的定义、病理机制、分类及治疗原则。与会专家就以上4个专题展开广泛讨论，发言热烈，各抒己见，有基础理论知识，也有临床经验，与会者受益颇多。虽然我国鼻内镜手术开展已10多年，手术的规模、范围和疗效等方面取得很大进展，提高了鼻科疾病的整体治愈率，但也存在一些必须引起大家注意的问题，如盲目扩大手术适应证、手术粗暴、忽视围手术期处理和鼻内镜手术中呼吸道变应性疾病的存在和处理，因此达不到预期的手术效果，甚至不可避免地发生多种并发症。与会者同意应在以下几方面作出改进：建立鼻内镜手术技术分级和准入制度；逐步建立比较完善的培训体系；争取制订鼻内镜手术的适应证和禁忌证。手术者应掌握相关的基础知识（如应用解剖学、病理学特点等），重视相关疾病（如变应性疾病、免疫缺陷病、阿司匹林耐受不良、不动纤毛综合征等）的诊断和治疗，这样才可能使鼻内镜外科技术取得优良效果，逐步达到功能性微创外科的目的。此次论坛的部分内容已在本刊2005年第7期上刊出。现将论坛上部分专家的发言内容按4个专题归纳整理后刊出，以供大家学习、参考。需要说明的是这些发言内容仅代表专家个人的意见和经验，并不是论坛的共识，更不代表编委会的意见。本刊一贯坚持“百花齐放、百家争鸣”的学术方针，发表不同的学术观点，促进学术交流是本刊的宗旨。     

耳内镜侧颅底外科的现状和未来

作为颅底外科中的一个重要分支,侧颅底外科领域与耳外科和神经外科联系紧密,成为众多交叉学科中合作最为成功的典范之一。内镜技术在近20年内的快速发展,让其在显微镜占统治地位的侧颅底外科中拥有了一席之地。随着内镜技术和理念的不断成熟,内镜在侧颅底外科中也扮演越来越重要的角色,如何更好地发挥内镜的优势、优化手术流程、选择手术适应症是众多学者热议和研究的话题。     

耳内镜技术在中耳胆脂瘤手术中的应用策略

中耳胆脂瘤的手术方式在经历了对中耳生理学、胆脂瘤的生物学特性的不断了解和认识,经由一代又一代耳科医生的修正和改良过程后,日臻成熟与完善。但仍有不尽如人意之处。例如,避免开放式手术的同时,如何提高病灶清除率;如何降低术后胆脂瘤复发率等核心问题。耳内镜技术,与显微镜技术相比,有其独一无二的优势,将耳内镜技术引入中耳胆脂瘤外科治疗过程中是必然的趋势,它的介入有助于清除隐匿病灶和保留耳道内正常结构。本文主要针对耳内镜技术在中耳胆脂瘤外科治疗中的使用方法和手术治疗策略进行简要的概述和介绍。     

Usefulness of Virtual Endoscopic Three-dimensional Reconstructions of the Middle Ear

This work uses a new programme for producing 3D radiological images acquired by means of CT which enables the internal surfaces of the examined structures to be visualized. This new method, which is able to navigate inside organs in a similar way to fibreoptic endoscopy, is known as virtual endoscopy. CT examinations of the temporal bone were carried out using spiral equipment and endoscopic 3D processing was carried out on a separate workstation equipped with a volume-rendering programme. Once the technical parameters necessary for obtaining a representation of the internal surfaces had been defined, a simulation of a virtual otoscopy was conducted by moving the virtual endoscope from the external auditory canal through the annulus to the tympanic cavity. The simulation can be obtained either by moving the endoscope by hand, using the mouse, or by defining a path along which the software automatically creates an endoscopic 3D reconstruction. The images thus obtained are projected sequentially to give a ''movie'' effect, i.e. a continuous progression of the endoscope. The average time required to conduct the procedure ranges from 20 to 30 min. A virtual endoscopic visualization of the middle ear was obtained which, in particular, generated images of the tympanic cavity with the ossicular chain. In our experience, virtual otoscopy shows the anatomy of the structures of the tympanic cavity in excellent detail and may be considered complementary to CT, providing useful images enabling better visual representation and understanding of this complex structure. Although clinical applications of the technique remain to be defined it may have a role to play in presurgical diagnostic evaluation of the ossicular chain, epitympanum and retrotympanum.     

Endoscopic ear surgery

ObjectivesThis article reviews the advantages and disadvantages of endoscopic ear surgery (EES).MethodPubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “endoscopic ear surgery”, “ear surgery” and “endoscopy” to identify the literature needed for the review.ResultsEndoscopes allow for enhanced surgical visualisation. The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area. Transcanal endoscopic techniques have transformed the external ear canal (EAC) into an operative gateway. The benefits EES can offer include wider views, enhanced imaging capabilities and increased magnification, and ways to see otherwise poorly visualisable portions of the middle ear. EES permits surgeons to operate using minimally invasive otological techniques. When compared with microscope-assisted surgery, endoscopic tympanoplasty has been shown to require a shorter operating time in some instances. There are a number of drawbacks to EES, however, which include the fact that it is a single-handed technique, that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.ConclusionEES is a safe and effective technique. The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.     

Endoscopic and minimally-invasive ear surgery: A path to better outcomes

The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.