鼻内镜经泪前隐窝入路手术治疗累及上颌窦含牙囊肿

目的:研究累及上颌窦含牙囊肿患者采用鼻内镜经泪前隐窝入路手术治疗的可行性和疗效。方法:选择于我科住院治疗的上颌窦含牙囊肿患者14例,并在术前对所有患者行鼻内镜、CT以及口腔全景片检查。术中先将上颌窦自然口扩大借以对上颌窦内病变情况进行评估,进而切开下鼻甲头端鼻腔外侧壁,将鼻泪管下端游离出来,使之形成下鼻甲瓣-膜性鼻泪管,将其向前固定后形成上颌窦入路,最后通过0度鼻内镜进行上颌窦内大部分囊壁的切除以及异位牙的取出。手术完毕后将下鼻甲以及鼻泪管复位并将切口缝合。观察所有患者术中情况和术后临床效果。结果:在鼻内镜直视下,所有患者的上颌窦各壁均能良好地显露,并最大程度地将囊肿壁清除,顺利地将异位牙取出。术后全部患者均无鼻腔出血、坏死、鼻甲萎缩、鼻泪管损伤、鼻腔干燥、溢泪以及面部感觉障碍等并发症。随访6-36个月,全部患者术后临床症状慢慢消退,上颌窦自然口无堵塞,引流通畅,下鼻甲形态良好未见异常,均未见囊肿复发。结论:经鼻内镜泪前隐窝入路具有视野好、创伤少,并发症少,是一种治疗累及上颌窦含牙囊肿患者的理想手术路径。     

不同手术方式治疗慢性鼻-鼻窦炎对上颌窦黏膜纤毛传输功能的影响

目的:比较不同手术方式治疗慢性鼻-鼻窦炎的疗效及其对上颌窦黏膜纤毛传输功能的影响,为临床制定治疗慢性鼻-鼻窦炎的优选术式提供参考依据。方法:选取2013年9月-2014年12月于本院耳鼻咽喉科就诊的160例确诊为慢性鼻-鼻窦炎的患者作为研究对象,将其随机分为4组,分别为治疗组1~4,每组各60例。治疗组1接受上颌窦自然开口扩大术,治疗组2接受上颌窦开窗术,治疗组3接受经泪前隐窝上颌窦开放术,治疗组4接受上颌窦口球囊扩张术。观察和比较4组患者的术后鼻腔黏膜的覆盖、水肿、囊泡形成、骨质暴露、瘢痕形成等情况,上颌窦窦腔内分泌物性状、蓄积情况以及术后3个月和6个月时行上颌窦腔糖精实验及窦口周黏膜活检情况。结果:四组手术后均取得较好临床疗效,而组4的临床总有效率显著高于其他三组(均P0.05)。术后3、6个月,组4Lund-Kennedy评分和MMT时间均明显低于其他三组(均P0.05);在上颌窦黏膜活检方面:术后炎性细胞数量及状细胞和黏膜下腺体细胞形态及黏膜下结构水肿改善程度亦在中组四最为显著(P0.05)。结论:上颌窦窦球囊扩张术治疗慢性鼻-鼻窦炎疗效较高,可有效改善状细胞和黏膜下腺体细胞形态及鼻窦黏膜水肿、窦口通畅引流等作用,且安全性高。     

鼻内镜技术用于鼻腔鼻窦良恶性肿瘤的治疗

目的:评估鼻内镜手术对于鼻腔鼻窦良恶性肿瘤的治疗效果及应用价值.方法:收集我科采用鼻内镜或鼻内镜辅助手术治疗的鼻腔鼻窦良恶性肿瘤共109例,并进行回顾性分析.结果:经随访12-60个月,本组109例患者中,应用单纯鼻内镜下治疗的4例鼻腔鼻窦肿瘤患者术后出现复发,1例失访,复发率为5％;鼻内镜联合柯陆氏入路手术的16例患者中未出现术后复发;2例鼻内镜辅助鼻侧切开手术治疗的恶变内翻乳头状瘤患者术后1年出现局部复发及广泛脑膜侵犯死亡;鼻内镜辅助鼻侧切开手术中的2例恶性黑色素瘤其中1例术前已出现颊部及颈部淋巴结转移,于术后8个月-1.5年中出现远处转移后死亡.结论:鼻内镜手术已经逐渐成为多种鼻腔鼻窦良性肿瘤以及部分恶性肿瘤的首选治疗方式.     

鼻内镜动力切削术对鼻前庭囊肿患者CRP、TNF-α、IL-6及IL-8的影响

目的:探讨鼻内镜下动力切削系统治疗对鼻前庭囊肿患者CRP、TNF-α、IL-6和IL-8的影响。方法:选取2012年6月至2013年1月我院收治的鼻前庭囊肿患者163例,随机分为两组。实验组(80例)行鼻内镜下动力切削系统行囊肿切除术,对照组(83例)给予微波治疗。观察并比较两组患者手术前后血清CRP、TNF-α、IL-6和IL-8水平的变化情况,并比较两组患者手术情况、术后并发症及远期疗效。结果:与对照组比较,实验组手术时间较长,术中出血量较多,差异具有统计学意义(P0.05),实验组术后感染率较低,术后复发率较低;术后CRP、TNF-α、IL-6和IL-8水平升高,与对照组相比,实验组各项指标较高(P0.05)。结论:鼻内镜下动力切削系统治疗鼻前庭囊肿具有较好的临床治疗效果,且复发率低,值得临床推广。     

真菌球型上颌窦炎鼻内镜下两种手术路径的临床研究

目的:比较鼻内镜下中鼻道联合下鼻道小视窗双路径术和单独下中鼻道开窗术治疗真菌球型上颌窦炎的临床疗效。方法:采用前瞻性随机对照试验,将2013年8月~2015年5月在我院择期行手术治疗的50例真菌球型上颌窦炎患者分为观察组与对照组,每组25例,对照组行鼻内镜单独下中鼻道开窗术,观察组在对照组的基础上联合下鼻道小视窗术。术前及术后6个月采用鼻腔鼻窦结局测试20条量表(SNOT-20)对两组患者进行评分,术后6个月对鼻黏膜纤毛清除功能及疗效进行评估,比较两组手术时间及术中出血量。结果:术后6个月两组SNOT-20量表评分显著低于术前,且观察组显著低于对照组(P0.05)。术后6个月观察组粘膜纤毛传输时间(MTT)显著低于对照组(P0.05)。两组总有效率、手术时间及术中出血量比较,差异均无统计学意义(P0.05)。结论:鼻内镜下以上两种手术路径治疗真菌球型上颌窦炎的疗效相近,但鼻内镜下中鼻道联合下鼻道小视窗双路径术更有利于减轻患者症状及促进鼻黏膜纤毛清除功能恢复。     

鼻内镜手术合并大环内酯类抗生素治疗鼻窦炎43例

目的:评价鼻内镜手术治疗合并术后利用大环内酯类抗生素治疗鼻窦炎的疗效,探讨鼻窦炎患者治疗前后血清中IL-17及其受体的表达及血清中总IgE的变化。方法:鼻窦内窥镜行病侧上颌寞自然口扩大及下鼻道开窗双进路,彻底清除鼻腔、鼻窦病变组织,术后采用大环内酯类抗生素治疗;采用酶联免疫法检测30例患者治疗前后血清中IL-17,IL-17R及IgE的含量。结果:治疗30例,其中术后病理证实鼻寞真菌球20例,治愈20例;曲霉菌感染23例,治愈10例,6个月随访无复发;与只治疗前相比,手术治疗后鼻窦炎患者血清IL-17,IL-17R及IgE的含量均明显降低。结论:鼻内镜手术是治疗真菌性鼻一鼻窦炎的主要方法,IL-17和IL-17R均参与鼻窦炎的发病过程,可作为诊断鼻窦炎的新指标,鼻内镜术后使用大环内酯类抗生素进一步巩固治疗,可降低复发率。     

帕瑞昔布联合曲马多对胸腔镜下肺叶切除术患者围术期疼痛和炎性因子的影响

目的:探讨帕瑞昔布联合曲马多镇痛对胸腔镜下肺叶切除术患者围术期疼痛和炎性细胞因子的影响。方法:选取我院2013年4月至2016年4月收治的60例胸腔镜下肺叶切除术患者,按照随机数字表法分为A组和B组,每组者30例。A组患者采取帕瑞昔布镇痛;B组患者采取帕瑞昔布联合曲马多镇痛,采用视觉模拟评分(VAS)评价患者术后30 min、8 h、12 h、24 h镇痛效果以及T0(麻醉诱导前)、T1(手术完成)、T2(术后2 h)、T3(术后6 h)、T4(术后24 h)血清IL-6、IL-8水平的变化。结果:术后30 min、8 h、12 h、24 h,A组VAS评分均高于B组同期,差异具有统计学意义(P0.05);B组患者T1、T2、T3、T4时血清IL-6、IL-8水平均明显低于A组患者(P0.05),两组血清IL-6、IL-8水平均在T3时刻达到最高值;A组不良反应发生率为13.3%,高于对照组的10.0%,但差异无统计学意义(P0.05)。结论:帕瑞昔布联合曲马多镇痛可提高镇痛质量,抑制炎症反应。     

等离子低温射频消融术联合鼻内镜对慢性鼻窦炎患者嗅觉功能及血清炎症介质的影响

目的:探讨等离子低温射频消融术联合鼻内镜对慢性鼻窦炎(CRS)患者嗅觉功能及血清炎症介质的影响。方法:选取2016年3月～2018年7月期间我院收治的CRS患者127例,根据手术方式的不同将患者分为A组(n=62,鼻内镜手术)和B组(n=65,等离子低温射频消融术联合鼻内镜手术),术后随访1年,比较两组患者临床疗效、症状评分、嗅觉功能、血清炎症介质及并发症情况。结果:B组术后1年的临床总有效率为87.69%(57/65),高于A组的72.58%(45/62)(P0.05);术后3个月B组的嗅觉功能分布优于A组(P0.05);两组患者术后3个月鼻塞、头面部胀痛、流脓涕、鼻涕倒流、头痛等症状评分均降低,且B组低于A组(P0.05)。两组患者术后1周血清白介素-5(IL-5)、白介素-17(IL-17)以及肿瘤坏死因子-α(TNF-α)均降低,且B组低于A组(P0.05)。两组术后并发症发生率比较无差异(P0.05)。结论:CRS在鼻内镜的基础上联合等离子低温射频消融术治疗的疗效显著,能够有效改善患者嗅觉功能和临床症状,抑制机体炎性反应的同时不增加并发症发生率。     

地佐辛联合小剂量右美托咪定辅助全身麻醉对功能性鼻内镜鼻窦手术患者氧化应激水平和炎性因子的影响

目的:观察地佐辛联合小剂量右美托咪定辅助全身麻醉对功能性鼻内镜鼻窦手术患者氧化应激水平和炎性因子的影响。方法:选取2013年6月到2018年6月期间于我院接受功能性鼻内镜鼻窦手术的患者130例,根据信封抽签法将患者分为对照组(n=65,单纯全身麻醉)和实验组(n=65,地佐辛联合小剂量右美托咪定辅助全身麻醉),对比两组血流动力学、氧化应激和炎性因子水平,记录两组苏醒期躁动情况及呛咳发生率。结果:两组插管前(T1)~拔管后5 min(T4)心率(HR)、平均动脉压(MAP)呈升高后降低趋势,血氧饱和度(SpO2)呈降低后升高趋势(P<0.05),且实验组HR、MAP低于对照组,SpO2高于对照组(P<0.05)。两组术后1d、术后3d超氧化物歧化酶(SOD)较术前升高,且实验组高于对照组(P<0.05);丙二醛(MDA)较术前降低,且实验组低于对照组(P<0.05)。两组术后1d、术后3d白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)呈降低趋势,且实验组低于对照组(P<0.05)。两组拔管时~拔管后10 min Riker镇静躁动评分(SAS)评分呈降低趋势,且实验组低于对照组(P<0.05)。实验组的呛咳发生率较对照组低(P<0.05)。结论:地佐辛联合小剂量右美托咪定辅助全身麻醉用于功能性鼻内镜鼻窦手术患者,减少苏醒期躁动,预防呛咳发生,使血流动力学维持平稳,减轻机体氧化应激反应和炎性应激反应。     

氨甲环酸对体外循环术后炎症因子的影响

目的观察氨甲环酸(TA)对体外循环(CPB)围术期炎症因子的影响。方法将40例行体外循环心脏手术的患者随机分为实验组(A组)20例和对照组(B组)20例。A组在麻醉诱导后、体外循环结束时、手术结束时3个时段每次给予TA 10mg/kg;B组给予等量生理盐水。观察两组术前(T1),CPB停机时(T2),术后6h(T3)、12h(T4)和24h(T5)血IL-6、IL-8和CRP的计数水平。结果实验组血清中的IL-6和IL-8水平在CPB停机时、术后6h和12h均显著升高,术后24h均呈下降趋势,并显著低于对照组(P<0.05);CRP水平在术后12h显著升高,术后24h对照组较实验组显著升高(P<0.05)。结论氨甲环酸能减少CPB术后炎症因子的释放,减轻全身炎性反应。     

The term "lateral recess" and craniofacial pneumatization in old world monkeys (Mammalia, Primates, Cercopithecoidea)

The primate superfamily Cercopithecoidea (or Old World monkeys) is characterized by a widespread lack of the maxillary sinus, a paranasal pneumatic space found in most other eutherian mammals. Previous discussions of the distribution of pneumatization in the group, however, have been ambiguous and contradictory, and have been further complicated by discussion of a poorly defined structure named the "lateral recess," linked implicitly to the maxillary sinus. Computed tomography (CT) was applied to dry crania of all cercopithecoid genera to evaluate the morphological relevance of the term "lateral recess." Results suggest that the "lateral recess" is a structural consequence of changes in skull form unrelated to pneumatization. Thus, the term should be abandoned. All Old World monkeys (except the genus Macaca) are found to lack the maxillary sinus, but a previously undescribed bulla, only separated from the nasal cavity anteriorly, was discovered in the Chinese golden monkey Rhinopithecus. If this bulla is related to the paranasal sinuses, it suggests that the initial change in cercopithecoid cranial evolution was a suppression of pneumatic development, which may have been subsequently reversed twice in the history of the group, in Macaca and Rhinopithecus.     

Acoustic rhinometry in humans: accuracy of nasal passage area estimates, and ability to quantify paranasal sinus volume and ostium size.

A comprehensive study that compared acoustic rhinometry (AR) data to computed tomography (CT) data was performed to evaluate the accuracy of AR measurements in estimating nasal passage area and to assess its ability of quantifying paranasal sinus volume and ostium size in live humans. Twenty nasal passages of 10 healthy adults were examined by using AR and CT. Actual cross-sectional areas of the nasal cavity, sinus ostia sizes, and maxillary and frontal sinus volumes were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage. Nasal cavity volume (from nostril to choana) calculated from the AR-derived area-distance curve was compared with that from the CT-derived area-distance curve. AR measurements were also done on pipe models that featured a side branch (Helmholtz resonator of constant volume but two different neck diameters) simulating a paranasal sinus. In the anterior nasal cavity, there was good agreement between the cross-sectional areas determined by AR and CT. However, posterior to the sinus ostia, AR overestimated cross-sectional area. The difference between AR nasal volume and CT nasal volume was much smaller than the combined volume of the maxillary and frontal sinuses. The results suggest that AR measurements of the healthy adult nasal cavity are reasonably accurate to the level of the paranasal sinus ostia. Beyond this point, AR overestimates cross-sectional area and provides no quantitative data for sinus volume or ostium size. The effects of paranasal sinuses and acoustic resonances in the nasal cavity are not accounted for in the present AR algorithms.     

鼻内镜手术合并大环内酯类抗生素治疗鼻窦炎43例

目的：评价鼻内镜手术治疗合并术后利用大环内酯类抗生素治疗鼻窦炎的疗效,探讨鼻窦炎患者治疗前后血清中IL-17及其受体的表达及血清中总IgE的变化。方法：鼻窦内窥镜行病侧上颌寞自然口扩大及下鼻道开窗双进路,彻底清除鼻腔、鼻窦病变组织,术后采用大环内酯类抗生素治疗;采用酶联免疫法检测30例患者治疗前后血清中IL-17,IL-17R及IgE的含量。结果：治疗30例,其中术后病理证实鼻寞真菌球20例,治愈20例;曲霉菌感染23例,治愈10例,6个月随访无复发;与只治疗前相比,手术治疗后鼻窦炎患者血清IL-17,IL-17R及IgE的含量均明显降低。结论：鼻内镜手术是治疗真菌性鼻一鼻窦炎的主要方法,IL-17和IL-17R均参与鼻窦炎的发病过程,可作为诊断鼻窦炎的新指标,鼻内镜术后使用大环内酯类抗生素进一步巩固治疗,可降低复发率。     

鼻内镜动力切削术对鼻前庭囊肿患者CRP、TNF-alpha、IL-6 及IL-8 的影响

目的：探讨鼻内镜下动力切削系统治疗对鼻前庭囊肿患者CRP、TNF-alpha、IL-6 和IL-8 的影响。方法：选取2012 年6 月至2013 年1 月我院收治的鼻前庭囊肿患者163 例,随机分为两组。实验组（80 例）行鼻内镜下动力切削系统行囊肿切除术,对照组（83 例）给予微波治疗。观察并比较两组患者手术前后血清CRP、TNF-alpha、IL-6 和IL-8 水平的变化情况,并比较两组患者手术情况、术 后并发症及远期疗效。结果：与对照组比较,实验组手术时间较长,术中出血量较多,差异具有统计学意义（P＜0.05）,实验组术后 感染率较低,术后复发率较低;术后CRP、TNF-alpha、IL-6 和IL-8水平升高,与对照组相比,实验组各项指标较高（P<0.05）。结论：鼻内 镜下动力切削系统治疗鼻前庭囊肿具有较好的临床治疗效果,且复发率低,值得临床推广。     

功能性鼻内窥镜手术治疗鼻窦炎与鼻息肉的疗效分析

目的:探讨功能性鼻内窥镜手术治疗鼻窦炎与鼻息肉的疗效。方法:选取350例鼻窦炎与鼻息肉患者,按随机数字表法分为两组,对照组(164例)给予综合疗法,观察组(186例)给予功能性鼻内窥镜手术联合综合疗法。通过观察并记录疗效,治疗前,治疗后3个月患者体内IL-1,IL-8水平,SF-36量表评分,评价功能性鼻内窥镜手术治疗鼻窦炎与鼻息肉的疗效。结果:经手术和药物治疗,观察组有效率明显高于对照组(P0.05),治疗前,两组IL-1和IL-8水平无统计学差异(P0.05),治疗后3个月,两组IL-1和IL-8水平均明显下降,且观察组IL-1和IL-8水平低于对照组(P0.05),治疗前,两组SF-36各项评分无统计学差异,治疗后3个月,两组SF-36评分均明显增加(P0.05)。观察组在躯体疼痛和总体健康2项评分明显高于对照组(P0.05),其余6项评分相比无统计学差异(P0.05)。结论:功能性鼻内窥镜手术对鼻窦炎与鼻息肉具有较好的疗效,能显著减轻炎症反应,改善患者生活质量,值得临床推广使用。     

Ontogeny and homology of the paranasal sinuses in Platyrrhini (Mammalia: Primates)

The identity and taxonomic distribution of paranasal sinuses among living platyrrhines has remained a contentious issue (e.g., Cave [1967] Am J Phys Anthropol 26:277-288 vs. Hershkovitz [1977] Chicago: University of Chicago Press) largely because the ontogenetic data required for their detection and identification (e.g., Cave [1967]; Maier [2000] Cambridge, UK: Cambridge University Press, 99-132.) were not attainable without sacrificing valuable juvenile and subadult specimens. Non-invasive computed tomography (CT) scanning of ontogenetic series of skulls for 10 platyrrhine genera demonstrates the presence of maxillary and ethmoid sinuses, as well as homologs of the human sphenoid and frontal sinuses. Differences in the latter two sinuses between platyrrhines and hominoids highlight the need for early developmental data in establishing sinus homology. In particular, the identification of homologous recesses in the cartilaginous nasal capsule, from which sinuses later develop, emerges as the critical step. This developmental approach also reveals that the anterior and posterior ethmoid sinuses are each sets of serial homologs, a point which reconciles previous difficulties in establishing sinus homologies across mammalian orders (e.g., Paulli [1900] Gegenbaurs Morphol Jahrb 28:147-178, 179-251, 483-564).     

Enigmatic Diversity of the Maxillary Sinus in Macaques and Its Possible Role as a Spatial Compromise in Craniofacial Modifications

Understanding the evolutionary significance of morphological diversity is a major goal of evolutionary biology. Paranasal sinuses, which are pneumatized hollow spaces in the face, have attracted attention from researchers as one of the most intriguing traits that show unexpected variations. Macaques are one genus of primates that have accomplished adaptive radiation and therefore present an excellent opportunity to investigate the phenotypic diversification process. Using the large data set of computed tomography images of macaques (172 specimens from 17 species), we applied geometric morphometrics and multivariate analyses to quantitatively evaluate the maxillary sinus (one of the largest paranasal sinuses), the outer craniofacial shape, and nasal cavity. We then applied phylogenetic comparative methods to test their morphological interactions, phylogenetic, and ecogeographical significances. The results showed that the relative maxillary sinus size was significantly associated with the relative nasal cavity size and with the zygomaxillary surface shape. The relative nasal cavity size had ecogeographical correlations and high phylogenetic signal, whereas the zygomaxillary surface shapes were ecogeographically and phylogenetically irrelevant. The significant interactions with multiple surrounding traits that have experienced different evolutionary processes probably enable the maxillary sinus to show enigmatic diversity, which is independent of phylogeny and ecology. The pliable nature of the maxillary sinus, which is positioned between the nasal airways and the outer face, may play a role as a spatial compromise in craniofacial modifications.     

血清PCT、CRP以及T淋巴细胞亚群的动态变化及与胃癌患者术后感染性并发症的关系

目的:探讨血清降钙素原(PCT)和C反应蛋白(CRP)以及T淋巴细胞亚群的动态变化及与胃癌患者术后感染性并发症的关系。方法:选取2014年1月到2017年10月期间在中国人民解放军联勤保障部队第967医院接受治疗的胃癌患者163例,根据患者术后是否出现感染性并发症将其分为感染组和未感染组,其中感染组83例,未感染组80例,计算感染组患者各种术后感染性并发症的构成比例,检测术前、术后1d、术后3d血清PCT、CRP以及T淋巴细胞亚群的动态变化。采用ROC曲线分析PCT、CRP对感染性并发症的预测价值。结果:胃癌患者术后感染性并发症种类主要为肺部感染和手术部位感染,其次为腹腔感染和十二指肠残端瘘。术后1d、术后3d两组患者血清中PCT、CRP的水平明显高于术前(P0.05),术后1d、术后3d感染组患者血清中PCT的水平高于未感染组(P0.05),术后3d感染组血清中CRP的水平较未感染组升高(P0.05);经ROC曲线分析显示,术后3d血清PCT对胃癌患者术后感染性并发症的曲线下面积(AUC)为0.90,高于CRP的0.81;术后1d、术后3d两组患者的CD3~+、CD4~+、CD4~+/CD8~+均明显低于术前,术后1d、术后3d感染组患者的CD8~+明显高于术前(P0.05);术后3d感染组患者的CD3~+、CD4~+、CD4~+/CD8~+均明显低于未感染组(P0.05)。结论:血清PCT、CRP以及T淋巴细胞亚群的动态变化与胃癌患者术后感染性并发症密切相关,且PCT对胃癌患者术后感染性并发症的预测价值高于CRP。