鼻眼相关疾病 32 例临床分析

目的探讨鼻眼相关疾病的诊断和治疗,以降低其误诊、漏诊的发生率。方法对我院2003年1月－2013年1月32例鼻眼相关疾病患者进行回顾性分析。结果32例鼻眼相关疾病患者中,9例首诊于眼科,23例以鼻塞、头痛、鼻部创伤等症状首诊于耳鼻咽喉科。29例治愈或好转,3例恶性肿瘤,2例突眼、复视、溢泪等症状减轻,1例症状未见好转。结论鼻眼相关疾病临床上属于眼科学与耳鼻咽喉科学的交叉疾病,临床医师对该病认识不足易致误诊、漏诊;临床工作中,CT对鼻眼相关疾病的早期诊断、指导临床治疗及观察预后均有很大帮助。     

State-of-the-Art computed tomography of primate skulls — Comparison of different scan-protocols

To evaluate the image quality of different scanprotocols on 3 different CT-scanners for data acquisition of skulls of apes and monkeys with special respect on imaging the paranasal sinuses, we compared CT image quality in 452 skulls on either the Philips “Mx8000” Multi-Slice CT, the “Aura” Spiral CT or the “TomoscanM” CT scanner. Therefore, we used sequential and volume scanning as well as different slice thickness, table feed, voltage and X-ray current intensity. Representative axial scans of the anonymized studies as well as three-dimensional reconstructions were independently analyzed by an experienced radiologist and an anthropologist, using a study protocol covering relevant anatomical findings. Low-Dose protocols at 40 mAs demonstrated an equal diagnostic value with better CT-performance due to lower overheatening of the X-ray tube in all studies. Resolution, especially in small anatomical structures, was best with multi-slice CT. On both single-slice scanners resolution was significantly better with sequential-protocols (slice 2–5 mm; feed 1:1) than with volume-protocols. Volume scans are required for 3D-reconstruction. Best 3D results were achieved with “Mx8000” due to its better spatial resolution, followed by the “Aura” scanner. Multi-slice CT (MSCT) was found to be the superior method for the radiographic evaluation of small anatomical structures. However, there is no significant loss of information with thin sequential scans in LD technique on a single-slice spiral CT scanner. Volume-data aquisition is required for 3D reconstruction.     

Sinonasal and Laryngeal Sarcoidosis—An Uncommon Presentation and Management Challenge

Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.     

Progesterone Receptor Expression in Angioleiomyoma of the Nasal Cavity

In recent years sex steroid receptors have been identified in several types of human neoplasia. Angioleiomyoma of the nasal cavity and paranasal sinus is an extremely rare benign neoplasm which is more common in females (3.75:1 female:male ratio). To the best of our knowledge, only &#44 25 cases have been described. We describe a new case of angioleiomyoma of the nasal cavity that was found to be progesterone-receptor positive and oestrogen-receptor negative on immunohistochemical analysis. We suggest that the growth of this tumour may be hormone-dependent.     

鼻腔、鼻咽、副鼻窦纤维组织的肿瘤CT表现及鉴别

目的：探讨鼻腔，鼻咽，副鼻窦几种常见纤维组织肿瘤的CT诊断和鉴别。方法：对经手术和病理证实的41例[纤维瘤5例，纤维肉瘤3例。神经纤维瘤7例（含恶性神经纤维瘤1例），神经血管瘤20例，骨化纤维瘤6例]病人的临床，病理及CT表现进行分析对照。CT扫描采用轴位，层厚及间隔5mm，部分病例用静脉团注增强后扫描，测量增强前后肿瘤的平均CT值。结果：4种良性肿瘤的不同病理改变决定了各自不同的CT特征。它们在好发部位，病变大小，形态，钙化，增强等均有不同，两种恶性肿瘤则有相同的CT表现。结论：（1）根据CT表现可将这4种良发表中瘤进行诊断和鉴别。（2）纤维肉瘤和恶性神经纤维瘤的CT表现相同且与该部位 其它恶性肿瘤无法鉴别。     

增殖细胞核抗原和p27在鼻内翻性乳头状瘤中的表达

目的 检测鼻内翻性乳头状瘤(nasal inverted papilloma,NIP)组织中增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)和p27蛋白表达,从细胞增殖状况和细胞周期调控方面探讨NIP发生、生长机制.方法 应用免疫组织化学LSAB法检测47例NIP、49例鼻息肉、43例鼻鳞状细胞癌、11例正常鼻黏膜组织中PCNA和p27蛋白的表达.结果 NIP组PCNA标记指数(labelling index,LI)高于鼻息肉组及正常鼻黏膜组(P＜0.001),与鼻鳞状细胞癌组差异无统计学意义(P＞0.05),NIP中初发组与复发组之间差异无统计学意义(P＞0.05);p27蛋白在各实验组中均有部分表达,各组间差异无统计学意义(P＞0.05).结论 PCNA指数可以反映NIP的增殖状况,但其与NIP的复发无明显关系;而p27在NlP发展过程中的作用尚需进一步探讨.     

射频等离子止血技术在修正性鼻内窥镜鼻窦手术中的应用

目的观察射频等离子技术在修正性鼻内窥镜鼻窦手术中止血的疗效。方法14—69岁102例Ⅲ型慢性鼻窦炎患者在鼻内窥镜鼻窦手术中使用射频等离子技术止血。结果102例患者在修正性鼻内窥镜手术中出血量控制在100～150ml，平均出血120ml，没有因大出血而输血的病例。结论修正性鼻内窥镜手术中最常见的并发症是出血，而术中使用射频等离子技术进行创面止血可以获得良好的视野、准确到达出血部位、避免损伤周围正常组织，此种方法可以有效地减少术中出血量，保证手术顺利完成。     

Huge extracranial asymptomatic frontal invasive meningioma: a case report

Meningioma is a well-recognized tumor of the central nervous system, but it rarely appears as an extracranial tumor secondarily extended into the paranasal sinuses. Meningiomas arise from arachnoid cap cells that form the external membrane of the brain. Most meningiomas are slow growing and are usually not associated with substantial underlying brain edema; they cause symptoms by the compression of adjacent neural structures. An interesting natural history of a neglected meningioma with extracranial extension is described. The diagnosis of meningioma was established by CT imaging, finally based on the histopathology and immunochemistry. The meningioma cells in our male patient were positive for progesterone receptors. The patient underwent surgical treatment and recovered without complications. On follow-up 1 year later there were no signs of process expansion.     

原发性鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤2例并文献复习

目的 分析原发性鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤的发病特点,为该病的诊疗提供参考。 方法 回顾性分析2014年3月至2019年7月收治入院的2例鼻腔鼻窦骨外尤文肉瘤/外周原始神经外胚层肿瘤患者的临床资料,并检索2006年至2021年国内外相关文献,共48例(含本文2例)患者纳入研究,总结临床表现、治疗方法及预后。 结果 本组患者7~83岁、中位数26岁,男女比例1∶1.5,以鼻部症状为主,鼻塞16/28(57.1%)、鼻出血/涕中带血12/28(42.9%)、头痛3/28(10.7%)、嗅觉减退3/28(10.7%)。病变侵犯部位:鼻腔32/48(66.7%)、上颌窦24/48(50.0%)、筛窦27/48(56.3%)、蝶窦8/48(16.7%)、额窦3/48(6.3%),侵袭眼眶17/48(35.4%)、颅底6/48(12.5%)。单因素分析:综合治疗(P=0.009)、放疗(P=0.014)可明显改善患者预后,病变侵犯蝶窦(P=0.027)、颅底(P=0.002)提示患者预后不良,多因素COX回归分析示侵犯颅底为预后的独立危险因素(P=0.008),与未侵犯颅底的患者相比,侵犯颅底的患者死亡风险更高,HR=8.940(95%CI:1.756~45.506)。 结论 鼻腔鼻窦骨外尤文肉瘤(Extra-skeletal Ewing Sarcoma, EES)好发于青年女性,症状以鼻塞、鼻出血/涕中带血多见,病变范围主要累及鼻腔、上颌窦、筛窦,可侵及眼眶、颅底,病变侵犯颅底为死亡的独立危险因素,治疗以化疗联合放疗的综合治疗为主。     

鼻腔及鼻窦肿瘤性病变的CT诊断与临床及病理分析

目的：分析、探讨这类肿瘤的CT表现及临床、病理特点，以提高对这类肿瘤的认识和诊断水平。材料与方法：对36例已知或高度怀疑鼻腔及鼻窦肿瘤性病变的病人，采取头部横断加冠状、平扫加增强的扫描检查。结果：36例均获病理证实，其中鳞状细胞癌13例，腺癌7例，囊腺癌6例，内翻乳头状瘤2例，鼻息肉6例，鼻窦炎2例。CT对鼻腔及鼻窦肿瘤的检出的敏感性为100％(28／28)，准确性为93．3％(26／28)。结论：CT扫描检查对准确估计病变程度、范围、预测预后及确定手术方案有肯定价值。