鼻咽癌放疗中的垂体屏蔽技术

目的：研究在鼻咽癌放射治疗中对两侧耳前野进行垂体屏蔽前后垂体的剂量分布变化，以了解该技术对保护垂体功能的意义。材料与方法：采用治疗计划系统分析计算鼻咽癌放疗中采用两侧耳前野垂体屏蔽技术后垂体的受量分布，与不采用者进行比较，并用胶片法测量结果加以验证。结果：①治疗计划系统计算结果显示采用两侧耳前野垂体屏蔽技术后垂体在鞍底及垂体中平面剂量约为不采用者的一半，且屏蔽后垂体的容积剂量较不屏蔽者减少。②胶片法测定结果显示采用屏蔽技术后垂体在鞍底部位受量约为５０％。结论：初步研究认为本文采用的垂体屏蔽技术降低了垂体受量，相同剂量水平下的垂体受照射体积亦有明显减少，它可以起到保护垂体功能的作用。     

Anatomic and magnetic resonance imaging bases for the naso-maxillo-cheek flap technique

A transfacial approach to the deep cranio-maxillo-facial areas by the naso-maxillo-cheek flap technique (NMCF) is indicated for the treatment of some bulky tumors of the naso-pharynx. The procedure requires precise preoperative imaging. This study presents the morphologic bases of this surgical access and the reasonable limits of the excision preoperatively determined by magnetic resonance imaging (MRI). 18 facial and skull specimens were submitted to surgical facial dismantling by the NMCF technique according to Curioni’s method. The clinical application in a 66-year-old patient suffering from a neuroblastoma of the olfactory nerve extended into the naso-pharynx is presented. Pre- and postoperative MRI correlations were made in transverse, sagittal and frontal acquisitions. Several structures were preserved in the procedure: facial reliefs, inferior orbital rim and orbital floor, posterior wall of the maxillary sinus covering the pterygopalatine fossa, lateral and medial pterygoid plates and pterygopalatine ganglion with its branches, lateral facial neurovascular pedicle, teeth and soft palate. Other structures were sacrificed: arteries and nerves located at the sites of skin and mucosal incision, and at the sites of osteotomies, ie the infraorbital nerve, the distal part of the greater palatine nerve, the nerves supplying the naso-pharynx, the nasal septum and the nasal conchae, nasolacrimal groove and lacrimal canal. The NMCF technique gives wide access to the deep nasal and nasopharyngeal areas. It is essential to preserve the lateral facial neurovascular pedicle to prevent necrosis of the midface structures. Preservation of the bony architecture surrounding the osteotomy sites is of great importance to allow precise final bone reassembly. Preoperative MRI appears of paramount importance to determine the borders of the lesion and the possibility of block resection.     

鼻内镜下鼻窦手术的术前术后护理

目的探讨鼻内镜下鼻窦炎手术的护理特点。方法总结389例鼻窦炎手术术前术后的护理特点。结果389例手术，385例治愈（99．9％），4例发生粘连（0．1％），其中2例发生眶周肿胀，1例发生眶周淤血。结论有效的术前护理和术后严密观察病情，注意出血情况，保持鼻腔通畅，预防感染是鼻窦内镜手术成功的关键，是提高手术治愈率的重要环节。     

Naso Alveolar Molding in Early Management of Cleft Lip and Palate

Cleft lip and palate is a congenital anomaly occurring at birth. This article describes about the construction of feeding plate which is also used for naso alveolar molding (NAM). The main objective of this treatment is that this procedure minimizes the extent of surgery that should be done on newborns. Two infants with unilateral and bilateral cleft lip and palate are treated by making feeding plate and which is also used for NAM. Both the infants had favorable results, better in case of unilateral cleft lip patient; we hope that it will minimize the extent of surgery and the resultant scarring.     

Sindrome di Binder: caso clinico

Objectives

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissues. The authors report the case of a 10-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine hypoplasia.

Materials and Methods

The patient was initially treated with a TSME (Transverse Sagittal Maxillary Expander) to correct the maxillary hypoplasia and subsequently with a fixed appliance therapy to achieve esthetic goals. At the end of the orthodontic treatment, a maxillofacial surgery was performed to correct the nasal hypoplasia.

Conclusions

A multidisciplinary approach, including also the orthodontic treatment, is necessary to solve the alterations occurring in Binder syndrome.     

鼻饲母乳在新生儿缺氧缺血性脑病治疗中的应用

目的 :探讨鼻饲母乳治疗新生儿缺氧缺血性脑病 (HIE)的价值。方法 :随机将轻、中度HIE新生儿 85例分为A、B两组。两组在相同常规综合治疗的同时 ,A组鼻饲母乳 ,B组经口喂养 ,治疗 5d后比较两组的总蛋白、血浆白蛋白、尿素氧、胆红素与血糖水平 ,以及平均住院日及住院期间并发症发生的情况。结果 :A组患儿血胆红素水平、血糖、住院期间败血症的发生率低于B组。结论 :鼻饲母乳对HIE新生儿予以营养支持能取得满意疗效     

中西医结合治疗鼻后滴漏综合征所致慢性咳嗽疗效观察

目的观察中西医结合治疗鼻后滴漏综合征所致慢性咳嗽的临床疗效。方法将102例鼻后滴漏综合征随机分为2组,治疗组59例治疗前行鼻咽部电子纤维镜检查,予中医辨证论治结合常规西医治疗;对照组38例单纯采用西医治疗。2组均2周为1个疗程,观察临床疗效,并于疗程结束后1个月随访。结果治疗组治疗前风热犯肺、脾虚痰盛、肾阳不足3种证型电子纤维镜下表现不同。疗程结束后治疗组总有效率94.92%,临床控制率67.79%;对照组总有效率89.47%,临床控制率47.37%。2组临床控制率比较差异有统计学意义(P0.05),治疗组高于对照组。疗程结束1个月随访,治疗组总有效率91.53%,临床控制率67.79%;对照组总有效率68.42%,临床控制率31.58%。2组总有效率和临床控制率比较差异均有统计学意义(P0.05),治疗组疗效优于对照组。结论中西医结合治疗鼻后滴漏综合征所致慢性咳嗽疗效优于单纯西医常规治疗,且疗效稳定。     

十二指肠镜治疗胆胰系统疾病120例分析

目的：探讨十二指肠镜技术在胆胰系统疾病中的应用和价值。方法：接受经内镜逆行胰胆管造影术(ERCP)检查的病人,胆总管结石者行内镜乳头切开术(EST),胆总管肿瘤者行内镜胆道内支架置入术(ENBD)。结果：52例胆总管结石患者,51例结石排净;12例胆总管和6例胆管肿瘤者黄疸消退,控制胆管炎。结论：十二指肠镜技术创伤小、安全、有效,对胆总管结石和胆管肿瘤病人疗效显著,应广泛应用。     

鼻泪道插管术治疗慢性泪囊炎

目的 探讨鼻泪道插管术治疗慢性泪囊炎的疗效。方法 采用改进的鼻泪道插管术治疗慢性泪囊炎患者47例54眼,其中观察了37眼的远期（1～4年）随访结果。结果 在随访37眼中,治愈27眼（泪道冲洗通畅）,占72.97%,10眼泪道冲洗不通,占27.03%。手术后早期定期随访行泪道冲洗将使手术远期疗效提高。结论 鼻泪道插管术具有操作简单,损伤小,非破坏性特点（相对泪囊摘除）,掌握一定技巧,有望取得较好疗效,可作为治疗一些慢性泪囊炎患者的首选方法。