1000例鼻窦内窥镜手术疗效分析

为了评价鼻肉镜鼻窦手术的疗效，对１９９１年１１月－１９９５年１月间实施鼻内镜手术并完成术后随访的１０００例慢性鼻窦炎，鼻息肉患者进行了疗效分析。１０００例有前期手术史７５４例，最多２５次，平均３．７次。术前ＣＴ检查采用冠状位及水平位骨窗扫描。治愈率为８４．０％，其中Ⅰ期治愈５５７例，延期治愈２８３例；延延炎症１６０例。     

318例经鼻内窥镜鼻窦手术的疗效分析

目的：为了进一步讨论经鼻内窥镜鼻窦手术的效果，总结了经鼻内窥镜鼻窦手术３１８例患者的临床资料。方法：手术使用直径４ｍｍ，０ｏ、３０ｏ和７０ｏ硬管鼻内窥镜，采用Ｍｅｓｅｒｋｌｉｎｇｅｒ术式。结果：一期治愈２０７例（６５．１％），延期治愈４７例（１４．８％），迁延期治愈４６例（１４．５％），无变化１８例（５．７％）。并发症共１５例（４．７％）。结论：经鼻内窥镜鼻窦手术的操作技术的熟练程度固然重要，术前应用类固醇激素对提高血小板、减少术中出血十分必要，确定适当的手术范围有利提高疗效，加强术后处理和药物雾化吸入有助于巩固和提高手术效果。     

内窥镜鼻窦手术1268例临床分析

目的 探讨鼻内窥镜手术治疗慢性鼻窦炎和鼻息肉的疗效及影响手术疗效的相关因素。方法 对１９８９－１９９７年完成随访的１２６８例内窥镜鼻窦手术进行临床分析。１２６８例中１型３６６例（２８．９％）２型为６４６例（５０．９％）３型为２５６例（２０．２％）其中１２６２例在局部麻醉辅以静脉强化麻醉下完成。同期行鼻中隔矫正术１８２例。术后随访９－４２个月,平均１５个月。结果 Ｉ型治愈率为９３．７％,２型治愈率为     

经鼻内窥镜垂体腺瘤切除术

目的探讨鼻内窥镜在垂体腺瘤手术中的应用价值和适应证。方法开展了２４例经鼻内窥镜垂体腺瘤切除手术。２４例垂体腺瘤患者中２０例为经鼻蝶窦进路，４例为经鼻中隔蝶窦进路。结果２０例经鼻蝶窦进路瘤组织得到了完全切除，手术所需时间较经鼻中隔蝶窦进路显微外科手术明显缩短。４例经鼻中隔蝶窦进路中３例瘤组织完全切除，１例非分泌性腺瘤（Ⅴ期）患者因瘤组织侵犯鞍旁及海绵窦，仅行大部分切除。所有患者术后头痛、视力障碍和闭经泌乳等症状均有改善。１６例次术前血清泌乳素（ＰＲＬ）水平异常（２３．０～１２５．０μｇ／Ｌ，平均６４．９±４３．７μｇ／Ｌ）的患者，术后血清ＰＲＬ水平恢复正常。９例次术前血清生长激素（ＧＨ）水平异常（５０．０～７２．０μｇ／Ｌ，平均６２．１±１１．４μｇ／Ｌ）的患者，术后血清ＧＨ水平低于５．０μｇ／Ｌ。上述患者术后随访２～７２个月（平均１８±２１个月）无复发。术后均未见颅内出血、视神经损伤、脑脊液鼻漏、脑膜炎及垂体功能低下等并发症。结论经鼻内窥镜垂体腺瘤切除术是一个简便、安全、有价值的外科技术，只要正确地掌握好此类手术的适应证，可以获得满意的治疗效果。     

鼻内窥镜下泪囊鼻腔造孔术及影响预后的因素分析

总结一组应用鼻内窥镜鼻窦手术技术，即在鼻内窥镜监视下经鼻行泪囊鼻腔造孔术治疗的馒性泪囊炎患者５９例（６９例眼）的临床随访结果，随访３～１３个月，治愈率８１．３％，好转率８．７％，无效１０．０％。总有效率９０．Ｏ％，与传统手术无差异，但治愈率高于传统方法。本文着重从慢性泪囊炎疾病特点及经鼻实施手术的角度探讨影响预后的诸多因素。     

同期鼻内窥镜手术与鼻中隔偏曲矫正术(附52例分析)(摘要)

１９９４年７月～１９９８年４月间共完成鼻内窥镜手术２５２例,包括内窥镜鼻窦手术２２１例,鼻腔泪囊造孔术３１例,其中同期行鼻中隔偏曲矫正术５２例,占２１％,取得了满意疗效。术后结合窦腔冲洗,定期复查,随访０．５～３年,内窥镜鼻窦手术疗效按中华医学会耳鼻...     

鼻内窥镜加柯-陆手术联合进路治疗慢性鼻窦炎

目的：探讨提高慢性鼻窦炎疗效的方法。方法：对１０４例伴有上颌窦病变的慢性鼻窦炎患者行鼻内窥镜和柯－陆手术联合进路鼻窦手术,彻底清除病变。结果：术后随访６～１２个月（平均９个月）,治愈８５例（８１．７％）,好转１５例（１４．４％）,无效４例（３．８％）,总有效率９６．１％。结论：该方法可彻底清除上颌窦病变,恢复上颌窦的生理性引流通道,防止复发,弥补了经鼻内窥镜鼻窦手术在处理上颌窦病变时的局限性。     

肾上腺素在鼻内镜手术中应用的体会

肾上腺素在鼻腔鼻窦内镜手术中的应用广泛，其主要作用是收缩鼻腔以扩大术野；收缩血管以减少术中出血。但由于肾上腺素有加快心率、导致心律失常、升高血压等副作用，绝大多数鼻科学医生对术中使用肾上腺素非常慎重，一般１％丁卡因２５～３０ｍｌ中使用０．１％肾上腺素不超过３．０ｍｌ。我们在鼻内镜手术中对增加肾上腺素的使用量进行了尝试，并做了比较研究。 将手术病例分为２组，甲组为实验组（病例数５０例）：ｌ％地卡因 ３０ｍｌ加０．１％肾上腺素７．０ｍｌ；乙组为对照组（病例数４０例）：１％丁卡因３０ｍｌ加０．１％肾上腺…     

鼻内窥镜下鼻窦鼻息肉手术75例疗效观察

目的：观察鼻内窥镜下鼻窦鼻息肉手术治疗的效果。方法：对75例（125侧）慢性鼻窦炎鼻息肉患者行鼻内窥镜下手术，术后随访1年。结果：治愈48例（64.0%），好转20例（26.7%），无效7例（9.3%），总有效率90.7%。术后并发症主要为鼻腔黏连。结论：鼻内窥镜下鼻窦鼻息肉手术治疗具有良好的疗效，术中正确处理中、下鼻甲及鼻中隔，术后定期随访可提高治愈率，减少并发症。     

依据功能性鼻窦手术原则在普通额镜照明下鼻窦手术的体会

参照功能性鼻内窥镜鼻窦手术原则，自１９９３年１０月至１９９４年７月，为２５例（３５侧）鼻窦炎患者做了额镜照明下的功能性鼻窦手术。其中２０例（２９侧）有３至６月以上的追踪复查。治愈率６９．０％（２０／２９），疗效较为满意。优于传统鼻窦手术。本文探讨了额镜照明下功能性鼻窦手术的注意事项。     

New bone formation in unilateral rhinosinusitis

BACKGROUND: Computed tomography (CT) frequently shows abnormal bone thickening in patients with chronic rhinosinusitis. The sinus bone may be not in a static state, and remodeling occurs in response to chronic inflammation. METHODS: Ostiomeatal unit CT scans were reviewed in 29 patients with unilateral rhinosinusitis (URS) undergoing endoscopic sinus surgery. We defined new bone formation (NBF) as a remarkable bone thickening or hyperostosis of the intrinsic sinus walls in comparison with the normal side. Bony CT scores of sinus walls were expressed by the Hounsfield unit (HU) and soft tissue CT scores were measured by the Lund-Mackay system. RESULTS: Almost all of the NBF was located at the maxillary and anterior ethmoid sinuses (83.7%), and it was significantly increased in patients with higher Lund-Mackay scores (p = 0.043). The HU values were significantly different between NBF and non-NBF contralateral sides (p < 0.05). CONCLUSION: The HU may be helpful to diagnose and quantify the bone remodeling in URS.     

Radiological-audiological correlation in type II tympanoplasty with glass ionomer cement

AimTo assess the CT scan aspect of cement bridges used to repair incudostapedial joint discontinuity (ISD) and correlate these observations to audiometric data over time.Material and methodsA retrospective study in 12 patients with cement rebridging for ISD compared pre- and post-operative pure-tone average thresholds, Hounsfield units (HU), and bridge size and position on postoperative CT scans.ResultsMean pre- and post-operative air-bone gap (ABG) was 24.5 and 16 dB, respectively. HU did not vary over time post-surgery, with no significant correlation between HU and time to postoperative CTnscan up to 24 months (p = 0.219). However, a “suggestive” correlation was found between postoperative ABG and HU (p = 0.004, r = −0.7). High cement density correlated with good functional outcome: HU < 500 indicating functional failure and > 1000 indicating ABG closure.ConclusionImmediate cement polymerization quality (high HU) was stable over time and a marker of ossiculoplasty success, correlating with good functional outcome. Particular care should be taken in preparing the cement, and solidification needs to be on dry mucosa-free ossicles.     

Usefulness of computed tomography Hounsfield unit density in preoperative detection of cholesteatoma in mastoid ad antrum

Purpose

This study was performed to evaluate the usefulness of Hounsfield unit (HU) to better distinguish cholesteatoma from other inflammatory conditions in the mastoid ad antrum before primary mastoid surgery.

Materials and methods

We enrolled 82 patients who underwent tympanomastoidectomy for treatment of chronic otitis. Forty-one patients were pathologically diagnosed with cholesteatoma, whereas the others were diagnosed with inflammatory granulation. These lesions were confirmed, and HU was measured in preoperative computed tomography. The difference in HU between cholesteatoma and non-cholesteatoma tissues was analyzed, and the improvement in the diagnosis of cholesteatoma after inclusion of HU data was calculated.

Results

The HU was calculated as 42.68 ± 24.42 in the cholesteatoma group and 86.07 ± 26.50 in the non-cholesteatoma group. The differences between the 2 groups were statistically different (Student t test, P < .01). By applying the HU, the sensitivity (51.2%-80.5%), specificity (80.5%-87.8%), positive predictive value (72.4%-86.8%), and negative predictive value (62.3%-81.8%) to diagnose cholesteatoma improved.

Conclusions

The HU density was found to be statistically different between cholesteatoma and inflammatory granulation tissue in mastoid antrum. An improved diagnosis of cholesteatoma was achieved after adjusting for the HU.     

Zur Hapten-Vorbehandlung bei der Dextran-Therapie von Erkrankungen im HNO-Fachgebiet

Summary With different ENT disorders (e. g., sudden hearing loss, facial-nerve paralysis) 114 patients were pretreated with an i.v. injection of a 20 ml solution 15% of monovalent haptendextran (dextran 1, ¯M_w: 1000, Pharmacia AB, Sweden) 2 min prior to the first infusion of dextran 40 (dx40, M_w: 40,000). The mechanism of action of pretreatment with haptendextran is considered to consist in the neutralization of circulating dextran-reactive antibodies (DRA), which have been shown to be the cause of rare dextran-induced anaphylactic reactions (DIAR), sometimes with a fatal outcome. Out of the 114 patients no DIAR was observed.These results are part of a prospective multicenter study demonstrating the effectiveness of prophylaxis with 20 ml haptendextran in 24,513 patients. In the total study no fatal reaction with cardiac or respiratory arrest was observed. As the individual risk for a patient to suffer a DIAR from a dextran solution, can not be estimated in advance, the i.v. prophylaxis with 20 ml haptendextran is strongly recommended before each first infusion of a dextran solution. However, one should be aware that individuals with extremely high DRA-titers may still develop a mild anaphylaxis in spite of the routine pretreatment with 20 ml haptendextran; a high dose of 30 or 40 ml haptendextran would be necessary to prevent these reactions too.     

In vivo measurements of temporal bone on reconstructed clinical high-resolution computed tomography scans

PURPOSE: To retrospectively assess the accuracy of measurements of temporal bone anatomy made from reconstructed clinical high-resolution computed tomography (HRCT) scans. METHODS: Nine HRCT scans were performed on unselected clinical cases in which the subjects had a temporal bone study judged to be normal. The orbitomeatal line was prescribed for the direct axial sections. Variations in head position (rotation at the neck and lateral bending of the neck) were corrected by using the software supplied by the manufacturer. All measurements were done on standard 1-mm axial sections and axial reconstructions obtained from 1-mm coronal slices. The images were viewed at 4000 Hounsfield units (HU) window width and 1000 HU window level. Measurements (n = 3) made on 1-mm direct axial HRCT scans were compared with the measurements made on reconstructed axial HRCT images from the same nine patients. These values were also compared with published cadaver data. RESULTS: The measurements obtained from axial reconstructed and direct HRCT series approximated each other in each of the nine individual studies and also fell within the range of published cadaver values. They demonstrated the expected normal temporal bone variability between individuals. CONCLUSION: Useful anatomic approximations can be measured in vivo from reconstructed clinical HRCT images. Pitfalls are improper window settings, head tilt, and rotation. This protocol is widely available and can be implemented retrospectively from clinical HRCT scans.     

Computed tomography and histopathological evaluation of osteitis in rabbit models with rhinosinusitis

Conclusions: There is clear correspondence between HU and histopathological evaluation of osteitis. It is feasible to evaluate bone remodeling in rabbit models with rhinosinusitis by measuring the HU.

Objective: The objective of this study was to determine whether the HUs of rabbit CRS models can be used to objectively evaluate the degree of osteitis.

Methods: Sixty rabbit models were inoculated with staphylococcus aureus. The rabbits were divided into three groups. Each group was divided into a medication administration team and a control team. The HU of the bone in each image was measured. All of the animals were executed after the CT exam. The samples for the mucous and bone changes using light microscope observation were scored. These scores and the HU measurements were compared to the actual bone remodeling over time to examine whether we could evaluate bone remodeling by measuring the HU.

Results: The average HU scores in Groups A, B, and C were significantly higher than those of normal rabbits (p?p?=?.042, 0.002). HU correlated with the mucous and bone scores in rabbit models with rhinosinusitis (coefficient r?=?.830, 0.641, 0.586, p?=?.000).     

Temporal bone density measurements using CT in otosclerosis

OBJECTIVE: To assess the bone density around the bony labyrinth in otosclerosis patients and to compare it to that of a control population. MATERIAL AND METHODS: This was a prospective case-control study. Ten patients with otosclerosis (mean age 42 years; range 24-55 years) and 33 control patients with vestibular schwannoma (mean age 46 years; range 20-71 years) were included. All patients underwent a clinical examination, audiometry and a CT scan comprising axial and coronal views of both temporal bones. In the otosclerosis group, audiometry showed unilateral involvement in six patients and bilateral hearing loss in four. The bone density was measured at the fissula ante fenestram (FAF) and at five other anatomical points on the bony labyrinth. RESULTS: In the control group, the bone density was similar at the six anatomical points. In the otosclerosis patients, the mean bone density at the FAF was lower than that in control patients (1649+/-99.1 vs 2049+/-13.4 HU; p < 0.01). For patients with FAF bone densities < 2000 HU, a correlation was observed between hearing threshold and FAF bone density. CONCLUSION: FAF bone density appears to be a good indicator of disease progression, and could serve as a follow-up and prognostic parameter.     

Preoperative embolization and postoperative complications of carotid body tumors

Carotid body tumors are uncommon neoplasms that arise at the bifurcation of the common carotid artery. Surgical resection is generally recommended, but entails an inherent risk of cranial nerves injury and excessive blood loss. Preoperative embolization has been reported to decrease blood loss and shorten resection time. In this study, we analyzed the benefits of preoperative embolization and the postoperative complications when preoperative embolization was performed. Six patients with seven tumors were treated between 1990 and 2005. Each patient's preoperative evaluation included CT, MRI, US, and angiography, and preoperative embolization was performed in four patients with five tumors. Blood loss, in the patients who underwent preoperative embolization, ranged from 20 ml to 900 ml (mean: 291ml), and operation time ranged from 4 hours 34 minutes to 6 hours 40 minutes (mean: 4 hours 55 minutes). In the group that did not undergo preoperative embolization, blood loss ranged from 642 ml to 1390 ml (mean: 1016 ml), and operation time ranged from 9 hours 48 minutes to 10 hours 45 minutes (mean: 10 hours 17 minutes). Five patients had postoperative cranial nerve dysfunction, and it involved cranial nerve IX in one patient (14.3%), cranial nerve X in two patients (28.5%), and cranial nerve XII in five patients (71.4%). Resection of bilateral carotid body tumors in one patient resulted in baroreflex failure syndrome. In conclusion, preoperative embolization tends to decrease blood loss and shorten operation time, resulting in lower postoperative neurologic morbidity.     

慢性鼻窦炎鼻息内显微镜下手术中出血控制的观察

OBJECTIVE: To explore the results of bleeding control in sinonasal surgery. METHODS: Between Jan 1998 and Jun 2000, 82 patients (144 sides) were observed and studied for the relationship between mental tension and bleeding. The effect of blood pressure control and operative time reduction was also observed. 58 sides were of type III, 71 sides of type II (among them, 56 sides belonged to stage II, 15 sides belonged to stage III), 15 sides were type I (among them, 4 sides belonged to stage I, 11 sides belonged to stage II). Of them, 60 patients had been operated for two times. All patients with sinusitis received micro-intranasal ethmoidectomy and 140 sides had had polyps removed. Sixteen patients received correction of deviated septum at the same time. 31 patients received resection of the inferior turbinate bone. Twenty-one patients were given Dridol' 5 mg and Dolantin 50 mg intravenously to control hypertension. Bleeding amount was compared between 21 hypertensive patients who used intravenous drugs and 57 hypertensive patients who did not use intravenous drugs during operation. To reduce operation time, the operation was simplified. RESULTS: The bleeding was limited to 10 ml in 99 sides(69%), the mean bleeding amount was controlled to (18.7 +/- 24.4) ml in 78(54%) sides of patients with hypertension. In 66 sides (46%) of patients with normal blood pressure, the mean bleeding amount was (13.2 +/- 16.8) ml (P < 0.05). In 21 patients in whom the hypertension was controlled, the mean bleeding amount was (13.0 +/- 6.7) ml. In 10 patients, the bleeding amount was (30.5 +/- 21.8) ml at the first operation with hypertension uncontrolled, the bleeding amount was only (11.0 +/- 8.2) ml at second operation when the blood pressure was controlled to normal (P < 0.05). After 6 months follow-up, 104 sides (72%) were cured, 32 sides (22%) improved, and 8 sides (6%) without improvement. CONCLUSION: Mental tension in operation can induce hypertension and increase bleeding, suitable sedation is necessary. With correct use of topical anesthesia and reduced operation time, the bleeding amount can be controlled to less than 10 ml in 69% of patients.     

Sealing of the round and oval window niches with triamcinolone-soaked fascia as salvage surgical therapy in sudden sensorineural hearing loss

Conclusions: Triamcinolone-soaked fascia seems to show better hearing improvement when added to tympanotomy for sudden idiopathic sensorineural hearing loss (SSHL), compared to fascia round window occlusion without triamcinolone.

Objectives: To analyse if adding triamcinolone to sealing the round and oval window niches with fascia results in improved audiological outcome for acute SNHL.

Methods: Fifty-three patients (27m:43?±?12 years, 26f:45?±?14 years) with acute SSHL ≥50dB over 3 frequencies, who failed primary therapy, underwent transcanal tympanotomy. Twenty-five patients (Group A;cortisone:14m, 11f:46?±?9 years) received sealing of the round and oval window with fascia soaked in triamcinolone (1ml; 40mg/ml) and 28 controls (Group B;no-cortisone:13m, 15f, 42?±?12 years) without triamcinolone. Frequency specific and pure tone average (PTA =500–1000–2000–3000Hz) results were compared between Group A and B pre- and postoperatively.

Results: In Group A the PTA improved by ≥10dB in 21/25(83%) cases; in Group B 18/28(63%). Group A showed a statistically significantly better improvement across all frequencies, while linear regression revealed a significant decrease of posttherapeutic PTA to 94.96% of the initial PTA (p?=?.037). The overall PTA improved by 24dB. Group A improved from 73dB to 41dB(-32dB) PTA, Group B improved from 76dB to 56dB PTA (-20dB) (p?p?相似文献