颈段食管癌的治疗进展

近年来耳鼻咽喉—头颈外科在治疗颈段食管癌方面积累了一定的经验并取得了很大进展 ,现就颈段食管癌的生物学行为特点、手术治疗、放疗、化疗及预后进行综述 ,着重阐述各种皮瓣、喉气管瓣、胃、结肠、游离空肠等不同重建方法的应用及特点。     

2006国际耳鼻咽喉-头颈外科学术研讨会在山东大学齐鲁医院成功举行

3月25-29日，由山东大学齐鲁医院耳鼻咽喉科承担的国家级继续医学教育项目“2008国际耳鼻咽喉-头颈外科学术研讨会”在山东济南成功举办。     

治疗复发性喉乳头状瘤的新术式——喉造口激光切除术

治疗复发性喉乳头状瘤是临床上颇为棘手的问题.长期以来,人们多采用喉裂开术或支撑喉镜手术进行治疗,但多次行喉裂开术对息者损伤较大,支撑喉镜手术由于对病变暴露不够充分,术后可很快复发.     

累及双侧喉腔的T2声门癌的手术治疗

目的探讨累及双侧喉腔的T2声门癌的手术方法和临床疗效.方法对22例累及双侧喉腔的T2声门癌患者行额侧喉部分切除术,以会厌、双蒂接力肌甲状软骨膜瓣、颈阔肌皮瓣、胸骨舌骨肌筋膜瓣、甲状软骨膜瓣、胸锁乳突肌骨膜瓣等修复组织缺损并重建喉功能.结果全组病例3年生存率为90.9%(20/22),5年生存率为88.9%(16/18).喉功能全恢复(吞咽保护、呼吸、发声)为90.9%(20/22),喉功能部分恢复(吞咽保护、发声)9.1%(2/22).结论额侧喉部分切除术是治疗累及双侧喉腔的T2声门癌的较好方法,肿瘤切除彻底,喉功能恢复良好.     

结肠上徙治疗良性咽、食管狭窄

报道咽、颈段食管良性狭窄１４例,６例伴有喉狭窄,均用带血管蒂的结肠上徙整复,其中１３例经胸骨后,１例经胸骨前上提结肠,并且一期整复喉狭窄。１３例一期整复成功,１例失败。术后功能恢复良好,无手术并发症。利用带蒂结肠上徙治疗良性咽、食管狭窄是一种理想方法。     

激光照射家兔鼻粘膜上皮修复的实验研究

应用半导体激光和Ｎｄ：ＹＡＧ激光照射１０ 只家兔的鼻腔粘膜,用光镜和扫描电镜观察粘膜上皮修复情况。结果表明,术后２４、７２ｈ 以炎性反应为主,术后７ｄ 开始修复,术后２ 个月粘膜基本修复,重新覆盖纤毛柱状上皮,恢复鼻腔生理功能。半导体激光比Ｎｄ：ＹＡＧ激光损伤轻,易控制,操作方便,对临床应用有指导意义     

聚丙烯网状材料与颈前皮瓣联合重建气管的实验研究

OBJECTIVE: Canine model established for tracheal defect reconstruction, to investigate the outcome of tracheal reconstruction with combination of polypropynene and flap. METHODS: About 3.5 to 4 centimeter cervical trachea was resected and replaced with artificial trachea made from monofilament knitted polypropylene and surgical flap. Covered stent was implanted postoperatively. Survival period and quality of life were recorded, bronchofibroscopy, X-ray films and HE sections were perfomed. RESULTS: Six dogs survived well and another two died. The causes of death were respiratory failure in 1 and infection in another. Stenosis of anastomosis in 1 was recorded during survival period. The dogs started drinking and eating on the second postoperative day, no dyspnea was found. The animals were sacrificed at 2, 4, 8 weeks and 6 months after surgery. Soft tissue growth was found in polypropynene net 2 weeks after surgery and more at 4 weeks. The polypropynene net was covered completely with soft tissue at 8 weeks and 6 months postoperatively, the hardness and sustentation degree were enhanced following the growth and fibrosis of soft tissue. The squamous epithelium and columnar epithelium were observed healing well by HE staining method. CONCLUSIONS: One-stage operative artificial trachea made from monofilament knitted polypropylene which has good histocompatibility and surgical flap is the closer artificial trachea to native trachea. It has a promising prospect in clinical use.     

晚期甲状腺癌累及上纵隔手术成功1例报告

患者男,71岁,因发现右颈部包块5a,明显肿大伴发热、憋气20d,声音嘶哑伴饮水呛咳7d于2005年7月20日入院。查体颈前及右颈部可触及一约10cm×8cm大小的肿物,质硬,有压痛,固定,喉体及颈段气管受压向左侧移位,右侧胸锁乳突肌后缘上份深面可触及4枚质硬的肿块,最大直径3cm,固定,有压痛。颈部强化CT检查示右甲状腺占位,右颈部淋巴结转移。入院后查血糖为13.80mmol/L,1周后降为7mmol/L。术前考虑有肿瘤与其他组织粘连紧密无法彻底切除的可能,请胸外科、心内科、麻醉科共同会诊,做好了充分准备,于2005年8月1日手术,完整切除了肿瘤,清扫了颈部淋巴…     

鼻内镜下鼻咽纤维血管瘤切除术

目的：探讨鼻内镜下鼻咽纤维血管瘤切除的可行性及手术方法。方法：报告鼻咽纤维血管瘤1例。采用鼻内镜经鼻腔完整切除肿瘤，总结治疗此例的经验。结果：用鼻内镜顺利切除了鼻咽纤维血管瘤，术后5个月随访肿瘤无复发。结论：经选择的鼻咽纤维血管瘤病例，采用鼻内镜进行切除是一种安全微创的手术方法。     

睡眠呼吸暂停综合征患者外周血白细胞介素-6和肿瘤坏死因子-α水平的变化

目的:探讨阻塞型睡眠呼吸暂停综合征(OSAS)患者外周血白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平的变化在发病机制中的作用。方法:①采用放射免疫法检测24例OSAS患者及20例正常人血浆IL-6、TNF-α水平,比较其组间差异,并分析OSAS患者血浆IL-6、TNF-α水平与睡眠呼吸紊乱指数(AHI)和最低血氧饱和度(SaO2)的相关性;②OSAS组患者进行持续气道正压通气(CPAP)治疗,3个月后复查上述各项指标,比较治疗前后血浆中IL-6、TNF-α水平的变化。结果:①OSAS组血浆IL-6和TNF-α水平较对照组升高〔(25.92±4.48)pg/ml vs(13.21±1.97)pg/ml,(11.27±2.60)pg/ml vs(5.83±0.99)pg/ml,P均<0.05〕。OSAS患者血浆IL-6和TNF-α水平与AHI呈正相关(r分别为0.456、0.464,P均<0.05),与其最低SaO2呈负相关(r分别为-0.495、-0.483,P均<0.05);②OSAS患者用CPAP治疗后,血浆IL-6、TNF-α水平较治疗前减低〔(25.92±4.48)pg/ml vs(15.37±1.78)pg/ml,(11.27±2.60)pg/ml vs(6.79±0.87)pg/ml,P均<0.05〕。结论:OSAS患者外周血IL-6、TNF-α水平升高与其低氧血症有关;CPAP可改善OSAS患者缺氧状态,降低外周血IL-6、TNF-α水平。