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我院自1998年1月~2003年4月对常规治疗不能控制的9例难治性鼻出血患者采用数字减影血管造影(digital subtruction angiography,DSA)诊断并栓塞治疗,取得了满意疗效,现报道如下. 相似文献
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激光治疗喉癌前病变 总被引:3,自引:0,他引:3
目的在手术治疗喉癌前病变的同时,最大限度的保留和恢复喉的正常发音功能。方法应用激光外科手术治疗喉癌前病变77例,其中采用声带黏膜上皮层切除术治疗声带黏膜白斑及轻度不典型增生23例;采用声带黏膜剥脱术治疗中、重度不典型增生44例;激光切除成人型喉乳头状瘤10例。结果23例声带黏膜白斑及轻度不典型增生者术后2个月发音恢复正常;44例中、重度不典型增生者术后3~5个月发音逐渐恢复正常;10例喉乳头状瘤患者术后发音明显优于经颈进路手术的发音。结论嗓音显微外科手术既能分层切除声带病变,又能最大限度的保留和恢复喉的发声功能,是治疗喉癌前病变首选的微创性方法。 相似文献
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目的:探讨软骨-软骨膜复合体修补鼓膜穿孔后其软骨厚度及软骨膜内血管密度的变化。方法45只雄性豚鼠随机分为A、B、C三组,每组15只,每只豚鼠分别于左侧耳制作鼓膜穿孔模型后立即采用同侧耳甲腔软骨-软骨膜复合体植入修补鼓膜,植入前先测量并记录植入复合体的厚度,分别观察术后2周(A组)、6周(B组)及12周(C组)植入复合体的厚度、软骨膜内血管密度;另取B组5只豚鼠的右耳(对照组)行鼓膜穿孔造模,不行鼓膜修补术。结果 A、B、C三组豚鼠左耳鼓膜穿孔平均愈合时间为3.8±0.84天,对照组鼓膜穿孔自愈时间为7.2±0.84天;A、B、C三组软骨-软骨膜复合体植入前厚度分别为0.199±0.023、0.198±0.017、0.193±0.021mm ,三组间差异无统计学意义( P>0.05),而植入后2周(A组)植入体厚度为0.227±0.024mm ,较植入前增厚,植入后6周(B组)植入体厚度为0.191±0.016mm ,较植入前无变化( P>0.05),但较植入后2周(A组)变薄( P=0.016),植入后12周的C组植入体厚度为0.169±0.017mm ,较植入前明显变薄( P<0.05),且较植入后2周(A组)、6周(B组)厚度变薄(P=0.00);植入后第2、6周,软骨膜单位面积中血管数量分别为13.28±2.49、7.71±2.49个,第2、6周时重建鼓膜的组织学结构为鳞状上皮层、纤维-软骨膜层、软骨层、粘膜层,第12周时为鳞状上皮层、软骨层及粘膜层。结论耳廓软骨-软骨膜复合体重建鼓膜的愈合时间短于鼓膜自行愈合的时间;植入后复合体的厚度较植入前先增厚再变薄,软骨膜层血管数量表现为先增加后减少;重建鼓膜最终组织学分层与正常鼓膜组织学结构相似。 相似文献
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通过家系调查、临床检查和遗传学特征分析,对一个鳃-耳-肾综合征家系的临床表型及致病原因进行系统研究。该家系表现为常染色体显性遗传,4位先证者均表现为听力损失、鳃裂瘘管、耳前瘘管、肾异常中的两种及以上的混合症状,症状轻重不等。遗传性耳聋基因芯片检测未发现常见的耳聋基因突变,sanger法基因检测结果显示4位先证者的EYA1基因c.889C>T(p.R297X)突变,为无义突变且均为杂合变异,根据美国医学遗传学与基因组学学会(American College of Medical Genetics and Genomics,ACMG)指南初步判定为致病性变异,现结合文献报道如下。 相似文献
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目的分析行开放性手术下咽癌患者生存时间的影响因素。方法回顾性分析2010年12月~2018年12月行开放性手术的64例下咽癌患者临床资料,根据2010AJCC TNM分期:T1期3例(4.7%),T2期11例(17.2%),T3期15例(23.4%),T4期35例(54.7%)。随访所有患者术后生存情况;Kaplan Meier法进行单因素生存分析并行Log rank检验,Cox回归模型对生存预后影响因素进行多因素分析。结果64例患者失访3例,随访率95.3%。27例死亡患者中病理淋巴结阳性者23例(85.2%),术后咽瘘者10例(37.0%),淋巴结复发者18例(66.7%);34例存活患者中病理淋巴结阳性者17例(50%),术后咽瘘者6例(17.6%),淋巴结复发者1例(3.0%)。单因素分析显示淋巴结转移、咽瘘及淋巴结复发是影响下咽癌患者术后生存时间的因素差异具有统计学意义(P<0.05);Cox回归模型多因素分析显示术前淋巴结转移及术后放/化疗是影响下咽癌患者术后淋巴结复发的危险因素差异具有统计学意义(P<0.05)。结论下咽癌早期临床症状不明显,发现时多已处于中晚期,预后较差,对影响下咽癌患者术后生存时间因素的淋巴结转移、咽瘘以及淋巴结复发应予以重视,淋巴结转移及术后同步放化疗是淋巴结复发的影响因素。 相似文献
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病例导入式教学法是在教师的指导下,以学生为主体,以病例为核心进行研究性学习的教学方法。它改变了以往以教为主、学为辅的局面,而是教与学相辅相承。它不但会增加学生对课本知识的理解,提高教学质量,还可以培养学生创新和实践能力。病例导入法在耳鼻咽喉科教学中的应用,可以提高教学质量。 相似文献
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Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy. 相似文献
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目的 探讨数字减影血管造影(DSA)及栓塞在鼻咽部血管纤维瘤诊断和治疗中的价值.方法 对16例鼻咽部血管纤维瘤进行DSA检查和选择性栓塞肿瘤供血动脉.栓塞后2~7天行鼻内镜下肿瘤切除.结果 DSA检查使鼻咽血管纤维瘤获得明确的诊断,所有病例均主要由同侧的颌内动脉供血,咽升动脉参与供血1例,同侧颈内动脉参与供血1例,16例患者均栓塞成功.鼻内镜下肿瘤全切除者15例,大部分切除者1例,术中出血明显减少,术中及术后无严重并发症.结论 鼻咽血管纤维瘤的数字减影血管造影能显示病变的范围、血供情况及其特征.栓塞有助于减少术中出血,提高手术安全性及全切率,为内镜下手术的必备条件. 相似文献
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Objective To observe the effect of immediate topical application of chitosan on preventing anterior giottic stenosis (AGS) after microsurgical resection of both vocal fold with CO<,2> laser , including the anterior commissure, in a canine model. Methods Sixteen canine larynges were injured by microresecting procedure of both vocal folds with CO<,2> laser. The dogs were randomly divided into two groups, chitosan group and control group. The chitosan and isotonic sodium chloride solution(control) were used for 5 minutes immediately after surgery. One week after the initial surgery, three dogs in each group were randomly selected , ultrastructure of fibroblast were examined with transmission electronic microscope and expression of basic fibroblast growth factor(bFGF) and traansforming growth factor betal (TGF-β1) were evaluated by enzyme-linked immunosorbent assay(ELISA). Three weeks after surgery, the rest dogs' glottic web were lysed and repeatedly treated with chitosan and isotonic sodium chloride solution respectively. The glottic wound healing and AGS formation were examined every week, and all larynges were harvested and examined histologically six weeks after the initial surgery. Results Transmission electronic microscope examination of the ultrasmcture of fibroblast indicated that chitosan inhibited the proliferation of fibroblast. Chitosan increased the expression of bFGF and TGF-β1, and bFGF and TGF-β1 in chitosan group, which was significantly higher than that in control group (z = -2.887 and -2.005, P =0.002 and 0.041). Chitosan decreased the extent of AGS formation. Three weeks after the surgery, the AGS lesion in the control group affected mean 49% of the length of the vocal folds from the anterior commissure to the vocal process, while chitosan group affected mean 7%, which was significantly less than the extent of web formation in the control group, (z = - 2. 619, P = 0. 008). The grade of collagen content in chitosan group was significantly lower than that in control group (P = 0. 003). Conclusion Chitosan is effective in preventing AGS after CO<,2> laser cordectomy. 相似文献
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目的分析声带任克水肿术后的病理特征。方法选择手术治疗的110例声带任克水肿患者的病理资料进行分析,其中男性88例,女性22例,年龄38~79岁,平均53.0岁,中位年龄52岁,单侧病变者1例,双侧病变者109例。吸烟者76例(69%),无吸烟史者34例(31%),所有患者均在全麻支撑喉镜下遵循嗓音外科原则行手术治疗,术中尽量清理黏膜下胶冻样物,切除病变组织,保留适量正常黏膜覆盖声带术后创面,将切除的组织送病理检查。结果中年以后为任克水肿的好发年龄,吸烟是其重要发病原因。喉镜下主要表现为声带鱼腹样改变,有时合并息肉或角化。110例患者病理结果中24例具有鳞状上皮增生,8例轻度不典型增生,1例中度不典型增生,12例合并鳞状上皮角化或角化不全。结论吸烟是引起声带任克水肿重要的致病因素。部分声带任克水肿患者伴有不典型增生或角化等病理改变,其可能为喉癌前病变之一。 相似文献