经尿道膀胱肿瘤电切术与膀胱部分切除术治疗膀胱肿瘤的效果对比

目的：探讨经尿道膀胱肿瘤电切术和膀胱部分切除术治疗膀胱瘤的临床效果。方法选取2012年7月~2014年7月在本院治疗的44例膀胱肿瘤患者作为研究对象,根据手术类型将其分为对照组(12例)和观察组(32例)。对照组行膀胱部分切除术,观察组行经尿道膀胱肿瘤电切术。比较两组术中、术后的各项指标以及并发症发生率。结果观察组术中出血量显著少于对照组,手术时间、术后膀胱冲洗时间、尿管留置时间和住院时间显著短于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率为6.25%,显著低于对照组的41.67%,差异有统计学意义(P<0.05)。结论经尿道肿瘤电切术治疗膀胱肿瘤可减少术中出血量,降低术后并发症发生率。     

颈段气管袖状切除术的临床分析

目的：总结颈段气管袖状切除术的经验,以提高颈段气管肿瘤的治疗效果。方法：回顾性分析1985-01～2006—12颈段气管袖状切除术治疗的12例患者,其中腺样囊性癌6例,鳞状细胞癌4例,腺癌1例,颈段气管软化塌陷1例。气管切除长度3～6cm,其中气管切除长度≥5cm5例,喉体松解术7例,甲状腺次全切除术3例。用正常甲状腺组织包绕气管及吻合口9例,未包绕3例。结果：所有患者喉功能均得以保留,发声正常,吻合口生长良好,受到分离的气管段色泽红润。3年生存率为85．37％,5年生存率为56．61％。结论：颈段气管袖状切除术符合气管肿瘤的治疗原则。改进的术式有利于气管吻合口的愈合,有利于更干净、彻底地切除气管肿瘤。     

复发性鼻腔及鼻窦恶性黑色素瘤的治疗

目的 探讨鼻腔及鼻窦恶性黑色素瘤复发的原因和治疗方法.方法 回顾性分析1993～2003年我科收治的11例复发性鼻腔及鼻窦恶性黑色素瘤患者的临床资料.结果 临床误诊或误治引起的复发患者4例,病理明确手术治疗后复发7例,其中5例为单纯手术后复发,2例为手术加术后放疗后复发.11例复发病例中,局部复发局限于鼻腔及鼻窦7例;局部复发侵犯眼眶、颅底、软腭及硬腭1例;局部复发侵犯腮腺和皮肤1例;面部、眼眶及颅底广泛侵犯者1例;颈部淋巴结转移复发1例.首次复发时间最短为治疗后10个月.所有病例再次手术治疗后的累积生存率为:1年生存率72.7%,2年生存率18.2%,3年生存率9.1%.结论 减少误诊,选择适当的治疗方法是提高复发性鼻腔及鼻窦恶性黑色素瘤治愈的主要手段.     

中-重度不典型增生喉癌癌前病变的治疗探讨

目的提高对中-重度不典型增生喉癌癌前病变的认识,选择恰当的方法治疗中-重度不典型增生喉癌癌前病变。方法选取经病理证实的29例喉中-重度不典型增生癌前病变患者,其中26例采用喉内镜下声带黏膜剥脱术治疗,3例采用喉裂开下喉部分切除术治疗。所有患者术后均随访3年以上,若出现恶变者则至恶变时为此研究随访结束时间。结果 17例一次性治愈;2例复发,采用喉裂开下喉部分切除术治愈;10例癌变,此患者之后按肿瘤分期分别行开放性手术。结论病理为中-重度不典型增生的喉癌癌前病变恶变率高,采用支撑喉镜下声带黏膜剥脱术治疗喉癌癌前病变仍有较高的治愈率,但术后必须严格随诊。     

SKP2及MRP-1/CD9在声门癌及癌旁组织中的表达及其临床意义

目的:观察声门癌及癌旁组织中SKP2及MRP-1/CD9蛋白的变化意义及其对声门癌手术安全切除范围的指导意义。方法:用免疫组织化学SP法检测38例声门鳞状细胞癌组织及距癌组织边缘2、5、10mm的组织中SKP2及MRP-1/CD9蛋白的表达,并取10例声带息肉组织作对照。结果:SKP2蛋白产物异常表达按息肉黏膜组织、癌旁组织(2、5、10mm)及癌组织的顺序依次递减,差异有统计学意义(均P<0.05);MRP-1/CD9蛋白产物异常表达按息肉黏膜组织、癌旁组织(2、5、10mm)及癌组织的顺序依次递增,差异有统计学意义(均P<0.05)。结论:SKP2及MRP-1/CD9均可作为判断喉癌生物学特性的参考指标,声门癌手术安全切缘以距肿瘤≥5mm的标准较为适宜。     

Tolerance of salivary gland botulinum toxin A injection under local anesthesia for the treatment of sialorrhea in children: An observational study

ObjectivesThe main objective of this study was to assess tolerance of botulinum toxin A injection into the salivary glands under local anesthesia in a pediatric population. Secondary endpoints comprised efficacy and side-effects.Material and methodsA retrospective observational study included children treated between January 2013 and March 2020 for sialorrhea and/or pharyngeal salivary congestion. Children were identified from the botulinum toxin A injection database. The study included 162 injection sessions in 55 children. Injections were performed under local anesthesia with nitrous oxide, after clinical location of the site. Epidemiological and clinical data, injection tolerance on the FLACC scale, treatment response and complications were recorded.ResultsFor submandibular gland injections, pain was absent in 81 cases, mild in 64, moderate in 4 and intense in 1. In parotid gland injections, pain was absent in 45 cases, mild in 89, moderate in 17 and intense in 1. Injection tolerance was significantly poorer (P < 0.005) in parotid than submandibular glands. Seventy-seven percent of the injections had a positive effect on sialorrhea. Fifteen patients presented transient adverse events: mainly dysphagia and paradoxical increase in sialorrhea.ConclusionSalivary gland botulinum toxin A injections in under local anesthesia were well-tolerated, safe and effective for children with sialorrhea and/or pharyngeal salivary congestion.     

Effect of low-dose lidocaine on MEPs in patients undergoing intracranial tumor resection with propofol anesthesia: A randomized controlled trial

Objective:To investigate the effect of low-dose lidocaine on motor evoked potentials (MEPs) in patients undergoing intracranial tumor resection with propofol anesthesia.Methods:Forty patients who underwent intracranial tumor resection and required MEP monitoring were selected. They were randomly divided into the lidocaine group (group L, n = 20) and the control group (group C, n = 20) by computer-generated randomization. All patients were given propofol anesthesia under the guidance of the bispectral index. In group L, 1 mg/kg of lidocaine was injected intravenously during anesthesia induction. Then, lidocaine was continuously pumped at a speed of 1 mg/kg/h until the operation started. Group C was given an equal volume of normal saline. Heart rate (HR), mean artery pressure (MAP), and bispectral index were recorded before anesthesia induction (T0), 2 minutes after tracheal intubation (T1), and 35 minutes (T2), and 50 minutes (T3) after anesthesia induction. The amplitude and latency of MEP at T2 and T3, the total dosage of propofol after anesthesia induction, and adverse events before T3 were recorded.Results:Compared with those in group C, HR and MAP were significantly decreased at T1 in group L. No significant differences were observed in HR and MAP at T0, T2, and T3 between group L and group C. The total dosage of propofol and the incidence of adverse events were significantly lower in group L than in group C before T3. There were no significant differences in the amplitude and latency of MEP between the 2 groups at each time point.Conclusions:Low-dose lidocaine has no obvious effect on MEP in patients undergoing intracranial tumor resection. However, it increased hemodynamic stability, reduced propofol use, and decreased the incidence of adverse events.     

TURP联合膀胱造瘘 peel-away大通道弹道碎石治疗BPH并发多发膀胱大结石

目的：探讨一期腔内治疗BPH并发膀胱结石的有效、快捷治疗方法。方法：采用TURP联合肾镜下气压弹道碎石、清石术治疗BPH并发膀胱结石30例。结果：30例均一次手术成功,元输血、TufuP综合征及严重感染等并发症发生。术后复查KUB、膀胱内均未见残石,清石率迭100％。住院7—9d,最大尿流率较术前明显改善。结论：TURP联合膀胱造瘘peel—away大通道肾镜下气压弹道碎石、清石术治疗BPH并发膀胱结石,创伤小、手术时间短、恢复快、安全高效,是治疗BPH并发膀胱结石的理想方法。     

Masson's vegetant hemangioendothelioma: case report and literature review

Masson's vegetant intravascular hemangioendothelioma has only been reported intracranially in 12 patients. The pathological diagnosis is important given its benign natural history. We report the 13th case in a woman who presented with headaches and dysphasia. A thorough literature review is presented and an appropriate management strategy is proposed.