大肠息肉高频电切术并发症98例临床分析

目的通过回顾性分析大肠息肉高频电切术术后并发症的防治措施,探讨减少大肠息肉高频电切术后并发症的方法.方法将采用高频电切术的196例结肠息肉患者随机分为治疗组和对照组,每组各98例,治疗组采用术前、术中、术后防治等方式防治并发症,对照组采用普通对症处理方式进行防治,比较两组患者术后并发症恢复情况.结果治疗组有2例(2.04%)出现轻微腹痛,1例(1.02%)发生延迟性出血,经积极处理后,患者均恢复正常.对照组中有5例(5.10%)出现腹痛症状,6例(6.12%)发生延迟性出血.治疗组效果优于对照组(P0.05),差异具有统计学意义.结论高频电切手术目前已成为治疗大肠息肉的首选,具有安全、有效、创面小、可反复使用等优点,积极有效的术后并发症防治措施可以避免外科剖腹手术的痛苦,降低并发症发生率,提高患者的生命质量,值得临床推广应用.     

鼻内窥镜下鼻窦鼻息肉手术78例临床观察

目的观察鼻内窥镜下进行鼻窦鼻息肉手术的临床疗效。方法治疗组78例采用鼻内窥镜下对鼻窦鼻息肉患者行手术治疗,对照组49例采用常规方法进行鼻窦鼻息肉进行手术,术后均随访1年。结果治疗组与对照组比较治愈率有明显提高(P<0.05)。结论鼻内窥镜下鼻窦鼻息肉手术治疗具有良好的疗效。提高鼻内窥镜手术操作技术以及术后综合处理是提高鼻内窥镜手术疗效的两个重要环节。     

癌胚抗原对直结肠偶发高代谢灶良恶性判断

探讨肿瘤标记物癌胚抗原(CEA)测定对~(18)F-FDG PET/CT发现直结肠FDG局灶性高代谢灶癌变判断的临床价值。回顾性分析56例意外探测到结直肠局灶性高摄取灶病例,同时行血清CEA测定,将肠镜及病理结果作为标准分组。各组血清CEA水平数据汇总后行单因素方差分析及计算血清CEA水平测定的诊断效率。结果表明:56例结肠局灶性高代谢病灶中,结肠镜及病理检查出结肠癌及腺瘤共43例,阳性预测值(PPV)为76.8%;其中直结肠癌26例,腺瘤17例,其余13例(23.2%)为炎性及生理性改变。结肠癌组、腺瘤组及良性病变组(炎性和生理性摄取)的血清CEA水平分别为(15.0±17.1)μg/mL,(2.23±0.96)μg/mL,(2.51±0.90)μg/mL,恶性病变组与腺瘤组及正常组之间具有显著性差异,F=8.277,P=0.001。结肠癌组与癌前病变组及生理及炎性组之间P值分别为0.001和0.001。血清CEA水平探测局灶性浓聚灶结肠癌变的敏感性、特异性和准确率分别为:84.6%、83%和83.9%。说明~(18)F-FDG PET/CT偶然发现结肠局灶性高摄取病灶中癌前病变和恶性病变阳性率很高,血清CEA水平对局灶性直结肠偶发FDG浓聚灶的恶变诊断具有高的诊断价值。     

结肠息肉内镜下治疗的体会

目的:探讨结肠息肉内镜下治疗的各种方法及效果.方法:通过肠镜检查8 024例确诊的各种形态、大小息肉1 326例共1 637颗,对于不同大小、形态的息肉,采用单一和联合的内镜治疗.结果:1 326例结肠息肉内镜治疗1 637颗,其中有4例因基底癌变转外科治疗,发生迟发性出血9例,再次内镜下止血成功;穿孔2例,1例钛夹修补成功,1例钛夹修补失败转外科治疗,并发症发生率为0.82%.结论:结肠息肉内镜下治疗是一种安全有效的方法.     

Vocal fold nodule vs. vocal fold polyp: answer from surgical pathologist and voice pathologist point of view

Vocal fold polyps and nodules are caused by inflammation caused by stress or irritation. Our study involved looking retrospectively at 30 patients. A clinical diagnosis was established by an otolaryngologist and voice pathologist through videostroboscopic analysis. Histological sections after removal of the vocal fold lesion were available for microscopic examination. All of these cases have also been previously evaluated and photographed. A clinical diagnosis of either a polyp or a laryngeal nodule have been made and documented. Two pathologists made the histological evaluation separately initially unaware of the clinical diagnosis. Their impression was recorded. After the clinical diagnosis become available and comparison between the clinical and pathological diagnosis were made, a retrospective review of the tissue was attempted to reconcile the differences. In conclusion, after careful histological evaluation, no definitive histological distinction can be made between laryngeal nodules and polyps. Our data showed no distinction between the two entities when compared for the presence of edema, fibrin, inflammation, and amyloid-like material. A statistically significant difference was found in the size of the specimen and the presence of telangiectasias. Based on our data, a biopsy larger than 0.3 cm could be a polyp and a biopsy less than 0.3 cm could be a nodule.     

Vocal Fold Impact Stress Analysis

Vocal fold impact stress (force/area) has been implicated as a factor possibly contributing to the formation of nodules and polyps. The force of impact of a moving body is related to its acceleration. Since the mass of the folds is relatively constant, one expects impact force to be directly proportional to acceleration. A measure that reflects the relative displacement of the vocal folds is photoglottography (PGG). The velocity and acceleration of the folds are easily obtained by calculating the first and second derivatives of the PGG displacement waveform. This study, therefore, compared the second derivative of the PGG signal with simultaneously measured impact stress in an excised canine larynx model. Glottal transillumination (PGG) was measured with a subglottic transducer. A miniature force transducer placed in the midline between the vocal folds measured impact stress at the midglottal position. For nine different larynges, there was a positive and linear relationship between the second derivative of PGG and impact stress. The statistically significant results support the hypothesis that the second derivative of PGG m ay provide a use fulnoninvasive way to estimate relative vocal fold impact stress.     

HO-1在慢性鼻-鼻窦伴鼻息肉患者鼻息肉组织中的表达及调节机制研究

目的探讨血红素氧合酶1(HO-1)在慢性鼻-鼻窦伴鼻息肉患者鼻息肉组织中的表达及调节机制.方法 50例慢性鼻-鼻窦伴鼻息肉患者为鼻息肉组织组,30例单纯鼻中隔偏曲患者的钩突黏膜组织为对照组.采用实时荧光定量RT-PCR、免疫组化、Western blot检测鼻息肉和钩突黏膜组织中HO-1表达情况.另取钩突黏膜组织体外培养,检测不同细胞因子(IL-17A,TGF-β1)和地塞米松(DEX)刺激鼻黏膜组织中HO-1 mRNA的调节作用.结果HO-1 mRNA在鼻息肉组织中表达水平明显高于钩突黏膜组织,差异具有统计学意义(P0.05).鼻息肉组织中HO-1阳性细胞多分布于黏膜下腺体、上皮细胞、炎性细胞;HO-1阳性细胞数明显多于对照组,差异具有统计学意义(P0.05).鼻息肉组织中HO-1蛋白表达水平明显高于对照组,差异具有统计学意义(P0.05).IL-17A可明显提升HO-1 mRNA表达水平;TGF-β1,DEX可明显降低HO-1 mRNA表达水平;且IL-17A,TGF-β1,DEX刺激具有浓度依赖性.DEX与IL-17A联合刺激组和DEX与TGF-β1联合刺激组的HO-1 mRNA表达量均明显低于IL-17A单独刺激组,差异具有统计学意义(P0.05).结论 HO-1作为拮抗氧化剂在鼻息肉组织氧化应激过程中被反馈性诱导上调,而糖皮质激素可抑制其表达上调.     

46例经鼻内窥镜鼻窦手术失败原因分析

目的：为提高经鼻内窥镜鼻窦手术疗效。方法：分析经鼻内窥镜治疗慢性鼻窦炎、鼻息肉病例335例，其中疗效欠佳或无效病例46例（67侧），总结失败的原因。结果：比较常见的经鼻内窥镜手术疗效不佳或失败的原因有术腔粘连14例（19侧）、术后随访和换药不及时13例（21侧）、术中病灶除不彻底8例（11侧）、相关病变没有处理9例（12侧）、原因不明2例（4侧）。结论：提高手术疗效的3个关键是①根据慢性鼻窦炎、鼻息肉发生的病理机制和鼻腔、鼻窦解剖学理论来指导手术；②规范内的内窥镜围手术期处理；③鼻腔局部和全身系统用药。