喉狭窄治疗进展

就喉、气管狭窄的发病、临床表现、诊断及治疗的国外资料进行综述,认为喉、气管狭窄的治疗应根据病变的不同选择恰当的治疗方法。手术扩张及修复仍是主要治疗手段。     

老年人慢性鼻窦炎鼻内镜围手术期处理

慢性鼻窦炎、鼻息肉是老年人的常见病,保守治疗往往效果欠佳,但因老年人多体质差,常伴有心、肺等并发症,且传统的鼻窦手术方法创伤较大,手术治疗较为棘手,故常放弃手术.     

238例鼻内镜微创手术治疗体会

目的 探讨鼻内镜微创手术治疗鼻窦炎的体会。方法 对1996年6月-2002年4月应用本术式治疗并随访半年以上的238例鼻窦炎资料，按海口标准进行疗效分析。结果 治疗结果，本组病例治愈率86．1％，好转率10．0％，无效3．8％。结论 鼻内镜微创手术中，尽量保留组织，有利于功能保存与恢复。再辅以综合治疗及中药治疗，可取得良好疗效。     

鼻窦手术前后应用鼻渊舒口服液的疗效观察

目的探讨鼻渊舒口服液在鼻窦手术前后的辅助治疗作用.方法1 24例病例随机分为治疗组和对照组.治疗组74例.对照组50例,治疗组手术前后除给常规抗生素、激素和粘液溶解、排除剂等治疗外,给鼻渊舒口服液治疗对照组单纯给常规抗生素、激素和粘液溶解、排除剂等治疗,对照比较两组病例的疗效.结果治疗组治愈率86.5%;对照组治愈率72.0%,经x2检验,x2=4.0112,P＜0.05.两组疗效有显著性差异;此外术中治疗组鼻腔鼻窦分泌物较对照组稀薄,量少,粘膜水肿轻,出血量少柯-陆氏手术进路的病例,治疗组面部肿胀程度轻,消退快,术腔上皮化时间短.结论鼻渊舒口服液不但可以提高和巩固鼻窦手术的疗效,而且可以减少抗生素、激素等药物的疗程,无药物毒、副作用及不良反应.     

鼻内镜下激光、射频及等离子系统治疗肥厚性鼻炎

目的探讨提高治疗慢性肥厚性鼻炎疗效的方法。方法分析300例慢性肥厚性鼻炎患者接受鼻内镜下Nd：YAG激光、射频与等离子手术系统治疗，术后随访半年，比较3种治疗方法疗效及不良反应发生率。结果3组方法对慢性肥厚性鼻炎均有明显作用，比较术后不良反应的发生率，射频治疗组及等离子组在鼻血性分泌物、嗅觉减退、暂时性体温升高、头痛、鼻腔干燥等方面显著低于Nd：YAG激光治疗组（P〈0．01）；等离子治疗组在头痛、鼻腔干燥等方面显著低于射频治疗组。结论我们认为鼻内镜下双极等离子治疗慢性肥厚性鼻炎具有较好的临床应用价值。     

自发性脑脊液鼻漏的诊断与治疗

目的 探讨自发性脑脊液鼻漏的诊断和治疗方法.方法 回顾性研究17例自发性脑脊液鼻漏的诊断程序、内科治疗方法和鼻内镜下手术修补的效果.结果 17例自发性脑脊液鼻漏患者,经鼻腔溢出物糖定性定量检测、鼻内镜检查和CT、MRI影像学检查而得到确诊,保守治疗愈合2例,余15例经手术治疗而全部愈合.结论 鼻腔溢出物糖定性定量检测和CT、MRI检查是诊断自发性脑脊液鼻漏的主要方法,鼻内镜下经鼻进路手术修补漏口是最适合的治疗方法.     

外伤性面瘫手术治疗11例

我院1986—2004年共收治外伤性面瘫9例，前后共采用3种手术方法进行治疗，报告如下。     

显微外科技术在颅底手术的应用

耳鼻咽喉－头颈外科的学科领域已经涉及颅底外科。本文就前颅底、中颅氏及后颅底相关肿瘤的显微外科治疗文献资料进行综述，以供同道在临床实践中参考。     

早期声门型喉癌治疗方式的评价与选择

早期声门型喉癌（early glottic cancer，EGC）通常是指Tis-T2病变且无颈淋巴及远处转移者。放疗与手术治疗，包括开放性手术、支撑喉镜下激光手术（简称激光手术）和非激光手术等，均是EGC的有效治疗手段，并具有相近的治疗效果。由于尚缺少理想的前瞻性随机对照研究，还没有足够的证据表明哪种治疗方式对EGC具有更好的治疗效果，对其治疗方式的选择亦缺少统一的意见，现将国内外的主流意见总结如下。     

复发性鼻窦炎鼻息肉的修正性鼻内镜手术治疗

目的探讨复发性鼻窦炎鼻息肉的修正性鼻内镜手术治疗的临床疗效。方法采用Messerklinger技术对64例复发性鼻窦炎鼻息肉患者进行修正性手术治疗。结果治愈40例(6 2.5%),好转1 5例(2 3.4%),无效9例(1 4.1%)。并发眼眶血肿3例,大出血3例,术后溢泪2例,鼻腔粘连5例。结论修正性鼻内镜手术能有效治疗复发性鼻窦炎鼻息肉,对改善术腔粘连、堵塞有较好疗效。选择具有定向定位作用的解剖参照点是手术安全的关键。术中结合术前CT扫描及鼻内镜检查可以减少并发症的发生。     

The efficacy of group communication treatment in adults with chronic aphasia.

We examined the effects of group communication treatment on linguistic and communicative performance in adults with chronic aphasia. Participants were randomly assigned to two treatment and two deferred treatment groups. Groups were balanced for age, education level, and initial aphasia severity. Twenty-four participants completed the 4-month treatment trial. While in the treatment condition, all participants received 5 hours of group communication treatment weekly, provided by a speech-language pathologist. The focus of treatment included increasing initiation of conversation and exchanging information using whatever communicative means possible. While awaiting group communication treatment, participants in the deferred treatment groups engaged in such activities as support, performance, or movement groups in order to control for the effects of social contact. Linguistic and communicative measures were administered to all participants at entry, after 2 and 4 months of treatment, and following 4 to 6 weeks of no treatment. In addition, participants in the deferred treatment groups received an additional administration of all measures just before their treatment trial. Results revealed that participants receiving group communication treatment had significantly higher scores on communicative and linguistic measures than participants not receiving treatment. In addition, significant increases were revealed after 2 months of treatment and after 4 months of treatment. No significant decline in performance occurred at time of follow-up.     

中医序贯疗法联合FESS治疗慢性鼻窦炎的临床研究

目的观察中医序贯疗法联合功能性内镜鼻窦手术(FESS)治疗慢性鼻窦炎的临床疗效。方法将符合纳入条件的80例慢性鼻窦炎Ⅱ型患者,常规行FESS,术后按1:1随机分为对照组及治疗组,比较两组治疗前、治疗后3月、治疗后6月症状体征积分、鼻黏膜纤毛传输速率指标的差异。结果两组患者症状体征积分、鼻黏膜纤毛传输速率(MTR)治疗后3月、治疗后6月与治疗前比较差异均有显著性(P<0.05)、治疗后6月与治疗后3月比较差异有显著性(P<0.05),两组间治疗后3月、治疗后6月比较差异有显著性(P<0.05);治疗组与对照组疗效相比,差异均有显著性(P<0.05),治疗组疗效优于对照组。结论中医序贯治疗能促进鼻窦炎术后黏膜上皮化、有效预防术后复发。     

Effectiveness of hyperbaric oxygen on sudden sensorineural hearing loss: prospective clinical research

The role of hyperbaric oxygen (HBO) treatment in sudden sensorineural hearing loss (SSNHL) is still controversial. In this study, 80 patients were treated for SSNHL. Fifty-five patients who received HBO and medical treatment and 25 patients who received medical treatment only were studied. There was a statistically significant difference between the HBO and medical treatment group and the medical treatment group for hearing gain and the degree of hearing loss after treatment (p<.05). In the HBO and medical treatment group, patients with tinnitus showed the highest hearing improvement. The patients who had tinnitus had a statistically significant difference for hearing gain in the HBO and medical treatment group (p<.05) but not in the medical treatment group (p>.05). In the HBO and medical treatment group, average hearing gain on each audiometric frequency was better than in the medical treatment group (p<.05).     

颌骨放射性骨坏死的临床分期和治疗程序

颌骨放射性骨坏死是头颈恶性肿瘤放射治疗的严重并发症,临床治疗十分困难。本文系统地总结了22例颌骨放射性骨坏死病例,提出临床分期和三阶段治疗程序。22例中3例因肿瘤局部复发停止治疗;5例经第一阶段治疗达到临床治愈;14例经三阶段的系统治疗后4例好转,10例临床治愈。作者认为,对颌骨放射性骨坏死的手术治疗应持积极态度,为保证手术的成功,术前术后有计划的进行高压氧治疗是必不可少的;手术成功的关键在于扩大截骨术,截骨范围应包括硬化区;抗感染＋高压氧治疗－扩大截骨术－术后高压氧治疗是颌骨放射性骨坏死较合理的治疗程序。     

重复经颅磁刺激治疗慢性前庭综合征疗效评价

目的 探讨重复经颅磁刺激(rTMS)治疗慢性前庭综合征(CVS)的疗效.方法 慢性前庭综合征(CVS)患者60例,随机数字法分为对照组和治疗组各30例,两组均进行垂直方向和水平方向的平稳跟踪眼动练习,治疗组另加以rTMS治疗4周.以治疗前后两组患者的头晕评价量表(DHI)评分、冷热试验单/双侧半规管反应减退(UW)值为...     

康柏西普联合激光治疗急进性早产儿视网膜病变

目的 观察康柏西普、激光单独及联合治疗急进性早产儿视网膜病变(ROP)的临床效果。 方法 采用等距随机抽样法将2016年2月至2017年12月收治的63例(126眼)ROP患儿随机分为激光治疗组、康柏西普治疗组、康柏西普联合激光治疗组,每组21例(42眼)。对比3组临床疗效,观察视网膜电流图相关分析指标及等效球镜度、散光度数变化,并分析治疗期间并发症发生情况及随访结果。 结果 激光治疗组、康柏西普治疗组、康柏西普联合激光治疗组患者疾病控制率分别为71.43%、66.67%、95.24%(H=5.694, P=0.058)。在闪光视网膜电图(F-ERG)反应振幅上,视杆反应b波、最大混合反应a、b波,3组比较差异均有统计学意义(P均<0.05)。在F-ERG反应潜伏期,视锥反应a、b波,3组比较差异均有统计学意义(P均<0.05)。3组患者近视、高度近视、散光、高度散光发生率比较,差异均有统计学意义(P均<0.05)。激光治疗组、康柏西普治疗组、康柏西普联合激光治疗组患者并发症发生率分别为23.80%、19.04%、14.28%(χ2=0.618, P=0.432)。随访期间,激光治疗组、康柏西普治疗组、康柏西普联合激光治疗组患者ROP复发率为33.33%、28.57%、4.76%,激光治疗组、康柏西普治疗组ROP复发率均高于康柏西普联合激光治疗组(P均<0.05)。 结论 康柏西普联合激光治疗ROP临床疗效较好,安全性较高。     

高压氧治疗突发性聋的再评价

目的 观察突发性聋高压氧（ｈｙｐｅｒｂａｒｉｃ ｏｘｙｇｅｎａｔｉｏｎ,ＨＢＯ）治疗前后血清脂质过氧化物代谢产物丙二醛（ｍａｉｏｎｄｉａｌｄｅｈｙｄｅ,ＭＤＡ）和超氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅ ｄｉｓｍｎｔａｓｅ,ＳＯＤ）的浓度变化及对高压氧治疗效果的影响。方法 ６０例７９耳突发性聋的患者,随机分为综合组３０例４３耳和单纯组（单纯高压氧组）３０例３６耳,另有３０名健康志愿者做正常组。治疗前后     

针刺、中药、直流电联合治疗“阴虚火旺”型湿性年龄相关性黄斑变性的临床观察

目的探讨针刺、中药、直流电离子导入中西医结合治疗“阴虚火旺”型湿性年龄相关性黄斑变性的疗效及安全性。方法回顾性分析2018年10月至2020年6月就诊于辽宁中医药大学附属第二医院眼科的“阴虚火旺”型湿性年龄相关性黄斑变性患者30例,10d一疗程,共3个疗程,所有患者均给予针灸、直流电血栓通离子导入、生蒲黄汤合滋阴降火汤加减口服,比较治疗前及分别治疗1个疗程、2个疗程、3个疗程后的黄斑中心凹视网膜厚度(CMT)、黄斑区视网膜全层容积、最佳矫正视力(BCVA)及眼底变化情况,观察治疗后效果及不良反应。结果患者各疗程CMT、黄斑区视网膜全层容积、BCVA较治疗前均有所改善,且治疗后各疗程较上一疗程的各项指标均有所改善差异均具有统计学意义(均P<0.05)。结论针刺+中药+直流电离子导入的中西医结合治疗方案在治疗“阴虚火旺”型湿性年龄相关性黄斑变性时可以显著提高患者视力,促进黄斑区水肿的吸收,改善视功能,且治疗期间患者无明显不良反应,疗效确切。     

Efficacy of early combined high-dose steroid + PGE1 treatment for sudden deafness

The efficacy of combined high-dose steroid and PGE1 treatment initiated immediately after the onset of sudden deafness was analyzed with the outcome of 174 patients begun on treatment within 7 days of the onset of sudden deafness. Four potential prognostic factors (days from onset to treatment, age, initial hearing level, presence of vertigo) and hearing outcome were examined with a multiple logistic regression analysis. Days from onset to treatment and age significantly correlated with hearing improvement. The efficacy of the treatment of patients begun on treatment within 3 days of the onset was significantly better than that of patients on treatment 4-7 days after the onset (p < 0.001). In the examination of patients younger than 50 years, the efficacy of the treatment of patients begun on treatment within 3 days of the onset didn't differ significantly from that of patients on treatment 4-7 days after the onset. On the other hand, in the examination of patients aged 50 years and older, the efficacy of the treatment of patients begun on treatment within 3 days of the onset was significantly better than that of patients on treatment 4-7 days after the onset (p < 0.001). These results suggest that significant efficacy may be expected from the combined high-dose steroid + PGE1 treatment, if its use is started within 7 days of the onset of sudden deafness, and started within 3 days of the onset of sudden deafness in patients 50 years old and older.     

针药结合治疗突发性聋的临床观察

目的观察西药配合辨证针刺治疗突发性耳聋的治疗效果。方法将60例患者随机分为治疗组30例(采用西药配合针刺辨证论治),对照组30例(单纯西药治疗),观察和比较治疗后不同时期两组患者的听力变化。结果治疗组总有效率达86.67%,对照组总有效率达60%,经统计学处理,P<0.05,差异有统计学意义。结论药物配合辨证取穴治疗突发性耳聋疗效优于单纯药物治疗。