目的 比较两种面神经解剖方法在腮腺浅叶良性肿瘤切除术中的临床疗效.方法 选择手术治疗的腮腺浅叶良性肿瘤患者62例,随机分成两组.观察组(32例)选择沿下颌缘支的逆行法解剖面神经并切除肿瘤,对照组(30例)选择顺行法解剖面神经并切除肿瘤.比较两组患者的手术时间、术中失血量、术后面神经麻痹、涎瘘、Frey综合征、耳周麻木及面部凹陷畸形的发生率.结果 观察组手术时间、术中失血量、术后面神经麻痹、涎瘘、Frey综合征、耳周麻木及面部凹陷畸形的发生率分别为(33.57±21.44)min、(31.14±28.36)ml、6.25％、12.50％、15.63％、6.25％和6.25％,对照组分别为(47.31±18.52)min、(44.22±23.82)ml、6.67％、10.00％、20.00％、16.67％和6.67％.与对照组比较,观察组手术时间短,术中失血量少,术后耳周麻木的发生率低,差异有统计学意义(P<0.05),而术后面神经麻痹、涎瘘、Frey综合征及面部凹陷畸形,差异无统计学意义(P>0.05).结论 在腮腺浅叶良性肿瘤切除术中,沿下颌缘支的逆行法相比顺行法可缩短手术时间,减少术中失血量,降低术后耳周麻木的发生率.

目的 分析鼻内镜下高选择性翼管神经切断术对中重度持续变应性鼻炎(AR)的疗效和安全性.方法 选取2018年1月—2019年9月华中科技大学协和深圳医院就诊的伴中重度持续性AR的鼻中隔偏曲患者60例为研究对象,依据随机数字表法分成对照组(26例)和治疗组(34例).对照组患者采取鼻内镜鼻中隔矫正术治疗鼻中隔偏曲,治疗组在鼻中隔矫正基础上开展高选择性翼管神经切断,包含鼻后神经及翼管神经咽支切断术,术后1、3、6个月对患者进行定期随访,分别对两组患者手术前后鼻炎用药评分(TRMS)、视觉模拟量表(VAS)、鼻结膜炎生活质量量表(RQLQ)评分进行评估,并记录患者局部、全身不良反应出现情况.结果 随访6个月,对研究终止时随访成功且临床资料完整的46例患者进行分析,其中治疗组26例,对照组20例.两组患者术前TRMS、VAS及RQLQ评分比较差异无统计学意义(P＞0.05);两组患者术后1、3、6个月VAS及RQLQ评分与治疗前比较差异具有统计学意义(P＜0.05),且治疗组术后1、3、6个月VAS及RQLQ评分评分低于对照组,术后3、6个月TRMS评分低于对照组(P＜0.05).两组患者术后1个月的TRMS评分对比差异无统计学意义(P＞0.05).对照组手术前后TRMS评分对比差异无统计学意义(P＞0.05),治疗组术后3、6个月TRMS评分低于术前(P＜0.05).治疗组并发症发生和对照组比较差异无统计学意义(P＞0.05).结论 鼻内镜下高选择性翼管神经切断术是治疗中重度持续性AR 一种安全、有效的手术方式.

目的 探讨耳内镜下颞骨解剖在耳鼻咽喉科住院医师规范化培训中的应用意义.方法 选取2019级广东省耳鼻咽喉科住院医师规范化培训的36名住培医师随机分为两组,实验组采用耳内镜下颞骨解剖练习方式学习颞骨解剖,对照组采用耳科手术示教方式,两组既往参与基础理论课、轮转耳科时间及授课老师均相同.结束后分别对两组医师进行解剖名词、解剖空间方位、解剖标志认识、内镜下操作能力、对授课方式主观评价等方面进行考核并统计分析.结果 两组医师在解剖名词考核成绩上无明显差异,实验组医师在解剖空间方位、解剖标志认识、内镜下操作能力、对授课方式主观评价等方面考核的成绩明显优于对照组,差异具有统计学意义(P＜0.05).结论 耳内镜下颞骨解剖应用在耳鼻咽喉科住院医师规范化培训中,有助于激发学生学习兴趣并提高学习效率,减少对晦涩解剖知识学习的抵触和恐惧,提高耳内镜操作能力,有助于推广耳内镜外科技术.

目的 探讨打鼾儿童睡眠监测各参数的相关性及差异,提高家长和社会对儿童鼾症的认识.方法 回顾性分析1761例打鼾儿童便携式睡眠监测结果,以呼吸暂停低通气指数(AHI)进行诊断分级及分组,对不同组间儿童生长发育、血氧及心率等指标进行相关性及差异的比较.结果 比较所有入组儿童:①不同组儿童体质量指数达标率在统计学上存在显著差异(F=9.2,P＜0.05);AHI与体质量指数相关性显著(r=0.051,P＜0.05).②AHI与最长呼吸暂停和低通气时间、氧减指数、血氧饱和度＜90％百分比呈正相关(r=0.30、0.65和0.36,P均＜0.05),与平均动脉血氧饱和度、最低动脉血氧饱和度呈负相关(r=-0.34和-0.57,P均＜0.05);AHI与氧减指数相关性最大.③打鼾儿童的平均心率差异有统计学意义(r=0.193,P＜0.05).结论 儿童睡眠呼吸障碍与生长发育、氧减指数、最低动脉血氧饱和度及平均心率均密切相关,家长和社会应高度重视本疾病.

目的 分析螨过敏类变应性鼻炎(AR)患儿行粉尘螨滴剂舌下含服不同疗程的疗效情况.方法 回顾性分析2013年以来就诊于华中科技大学协和深圳医院(南山医院)耳鼻喉科的螨过敏AR患儿共120例,随访资料齐全且已完成4年疗程舌下含服免疫方法(SILT),治疗前、治疗期间间隔3个月开展随访就结束治疗后分别评估鼻炎症状评分(TNSS)、鼻炎用药评分(TRMS)、视觉模拟量表(VAS)及鼻结膜炎生活质量量表(RQLQ)评分以及不良反应情况.结果 与治疗前相比,SLIT治疗1年结束时TNSS、TRMS、VAS评分、RQLQ评分均有显著改善(P<0.05);与SLIT 1年疗程相比,SLIT治疗2年结束时TNSS、TRMS、VAS、RQLQ评分均有显著改善(P<0.05).与SLIT 2年疗程相比,SLIT治疗3年结束时VAS、RQLQ评分均有显著性改善(P<0.05).与SLIT 3年疗程相比,SLIT治疗4年结束时TNSS、TRMS、VAS、RQLQ评分差异均无统计学意义(P>0.05).治疗1、2、3年及4年结束时,患儿的不良反应发生率对比差异无统计学意义(P>0.05),所有患儿均未出现严重不良反应.结论 螨过敏AR患儿开展超过2年粉尘螨滴剂舌下含服疗效较1年更佳,3年疗程VAS及RQLQ评分改善较2年更明显,因此患儿至少需坚持2年治疗,3年是最佳疗程.

目的 探讨表皮生长因子受体(EGFR)靶向性磁共振成像(MRI)探针的制备及其与鼻咽部鳞状细胞癌(NSCC)细胞靶向结合的研究.方法 利用NSCC表面EGFR作为靶受体,构建一种具有EGFR靶向性MRI探针,检测探针的性质,将探针与NSCC和正常鼻咽细胞孵育,进行普鲁士蓝染色、间接免疫荧光及MRI,观察铁染色、荧光染色及T2WI信号强度变化,并计算信号强度变化率.结果 EGFR靶向性MRI探针的粒径为(77.0±1.5)nm,超顺磁性氧化铁(SPIO)负载率为(306.0±4.9)μg/ml,阿霉素(DOX)负载率为(103.3±3.1)μg/ml,弛豫率为(110.4±2.9),提示EGFR靶向性MRI探针制备成功.EGFR靶向性MRI探针与NSCC细胞共孵育后,细胞内可见不同量的蓝色铁Fe颗粒,随着SPIO浓度的升高而增加;EGFR靶向性MRI探针与正常鼻咽细胞共孵育,细胞内未见明显铁颗粒存在.西妥昔单抗(阳性对照)对NSCC细胞膜有强烈的绿色荧光表达,阴性对照呈现很微弱的绿色荧光表达,EGFR靶向性MRI探针与DOX荧光强度相近.随浓度5、10、20、40和80 mg/ml梯度增高,EGFR靶向性MRI探针T1信号基本无变化,EGFR靶向性MRI探针T2信号强度逐渐减弱,EGFR靶向性MRI探针在20、40和80 mg/ml 3个时间点比较,T2信号强度明显下降,其中80 mg/ml时T2信号强度下降最显著.EGFR靶向性MRI探针与NSCC细胞共孵育后MRI信号在T2WI上有不同程度的降低(P<0.05),SPIO浓度越高MRI信号强度降低越明显(P<0.05).结论 EGFR靶向性MRI探针的粒径小,可降低MRI的T2信号强度,具有高度的靶向性.

Objective To investigate the anatomic corridors,landmarks and dissection method of the skull base surgery via endoscopic inferolateral orbital wall approach (EILOWA) by cadaveric dissection.Methods 5 cadaveric heads (10 sides) were dissected.Step-by-step dissection via EILOWA was performed to identify the anatomic corridors,vital landmarks and boundaries.Results The study defined 5 corridors for EILOWA,including corridors through trigeminal nerve,foramen lacerum,cavernous sinus,petrous and posterior cranial fossa,and middle cranial fossa.The crucial anatomic landmarks and boundaries as well as dissection passage,step and method of each corridor were identified and analyzed.Conclusions EILOWA provides the surgeon with a direct route to lateral areas of the ventral skull base,and middle cranial fossa,even posterior cranial fossa and partial lateral skull base.In addition,it allows an optimal view of the intracranial and extracranial portions of the maxillary and mandibular nerves.Further anatomic and clinical studies are needed to validate this approach in surgical practice.

Objective To discuss the clinical efficacy and safety of nasal glucocorticoid-assisted endoscopic adenoidectomy in the treatment of adenoidal hypertrophic snoring in children. Methods Ninety-eight cases of children with adenoidal hypertrophic snoring were randomly divided into control and observation groups, with 49 cases in each group. While patients in the control group were treated with endoscopic adenoidectomy, Cefaclor Granules by oral administration, dexamethasone by inhalation, and other conventional treatments, patients in the observation group were treated with a nasal glucocorticoid. The treatment efficiency, incidence of adverse events, A /N of nasopharynx lateral radiograph, apnea-hypopnea index, sleep quality, and levels of immune and inflammatory factors before and after treatment were compared between the two groups. Results The total effective rate of treating adenoidal hypertrophic snoring was noted to be 89.80％ (44 /49) and 73.47％ (36 /49) for the observation and control group respectively. This rate in the observation group was significantly higher than that in the control group (χ2 = 4.356, P = 0.037). There was 1 case of nasal bleeding and 1 case of nasal vestibule dryness sensation reported in the observation group, with a 4.08％ incidence rate of adverse reactions in this group. On the contrary, no nasal bleeding and nasal vestibule dryness was reported in the control group and there was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05). Before treatment, there were no significant differences in A /N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality between the two groups (P>0.05). After treatment, the A /N of nasopharynx lateral radiograph, apnea-hypopnea index, and sleep quality of the two groups were all improved, and there was a significant difference between the two groups (P<0.05). Before treatment, there were no significant differences in IgE, LTE4, TNF-α, IL-6, and IL-8 levels between the two groups (P>0.05). After treatment, the levels of IgE, LTE4, TNF-α, IL-6, and IL-8 in the two groups decreased, and there was a significant difference between the two groups (P<0.05). Conclusion This study reported that nasal glucocorticoid-assisted endoscopic adenoidectomy inhibited the inflammatory factors and reduced snoring, nasal congestion, and other clinical symptoms, with little risk and improved sleep quality, in children with adenoid hypertrophy snoring and can be worth popularizing.

OBJECTIVE:The aim of this study is to investigate the expression of phosphofructokinase 1 and it's enzyme activity in nasopharyngeal carcinoma biopsy samples.METHOD:Sixty-one biopsy samples were detected, including 41 tissues from patients with nasopharyngeal carcinoma as experimental group and 20 tissues from patients with chronic nasopharyngitis as control group. Phosphofructokinase 1 protein was detected by Western blot and it's enzyme activity was detected.RESULT:It was observed that the expression levels of phosphofructokinase 1 protein and it's enzyme activities in the experimental group were higher than that in the control group (P < 0.01). In the experimental group, the expression levels of phosphofructokinase 1 protein and it's enzyme activities in patients with lymph node metastasis were higher than that in patients without lymph node metastasis (P < 0.01).CONCLUSION:Phosphofructokinase 1 may be a marker in occurrence and metastasis of nasopharyngeal carcinoma.

OBJECTIVE:The aim of this study is to investigate the expression and clinical significance of 6-phosphofructo-1-kinase in nasopharyngeal carcinoma biopsy samples.METHOD:Sixty-one biopsy samples were detected, including 41 tissues samples from patients with nasopharyngeal carcinoma and 20 tissues samples from patients with chronic nasopharyngitis as control group. 6-phosphofructo 1 kinase mRNA expression was detected by RTPCR.RESULT:It was observed that the expression levels of 6 phosphofructo-1-kinase mRNA in nasopharyngeal carcinoma tissues were higher than in the chronic inflammatory tissues. And the expression levels in patients with lymph node metastasis were higher than without lymph nod metastasis.CONCLUSION:6-phosphofructo-1-kinase may be a marker in occurrence and metastasis of nasopharyngeal carcinoma.

Objective To explore the curative effect of combination therapy of low-temperature plasma radiofrequency ablation and nasal endoscopy for chronic nasal sinusitis. Methods From January 2010 to January 2012,98 patients with chronic nasal sinusitis in our hospital were ramdomly divided into observation group and control group. The observation group (49 cases) received plasma radiofrequency ablation at low temperature combined nasal endoscopic treatment. The control group (49 cases) were performed only nasal endoscopic treatment. The curative effect of the 2 groups were compared. Results After 1 month and 1 year, the total effective rate of the observation group were 91. 84% and 89. 80%, the total effective rate of the control group were 77. 55% and 73. 47% respectively. To compare the total effective rate of 2 groups were compared,there were statistically significant differences(P<0. 05). Conclusion Curative effect of plasma radiofrequency ablation at low temperature and nasal endoscopy is distinct,it is worthy of being widely applied in clinic.

Objective To explore the expression and significance of transcription factor SOX 11 in nasopharyngeal carci-noma .Methods By the prospective study method ,26 cases of nasopharyngeal carcinoma organization specimens and 20 cases of nasopharyngitis organization specimens were selected .Expression of SOX11mRNA of the 2 groups were detected by polymerase chain reaction (PCR).Results SOX11mRNA level of nasopharyngeal carcinoma group and nasopharyngitis group were com -pared,the difference had statistical significance (P<0.05);SOX11mRNA level was related to T stage ,clinical stage,lymph node metastasis,pathology differentiation,and was not related to age,sex and course.Conclusion Transcription factor SOX11 may play a direct or indirect role in tumorigenesis ,tumor cell differentiation and cell proliferation process .

目的 研究NADPH氧化酶(NADPH oxidase,NOX)在D-半乳糖诱导的老化大鼠外周听觉系统耳蜗和中枢听觉系统听皮层组织中的表达,探讨老年性耳聋氧化性损伤的发生机制.方法 48只1个月龄雄性Spragua-Dawley大鼠按数字随机法分成两组,每组各24只.D-半乳糖组:每日颈背部皮下注射D-半乳糖(500 mg/kg),连续8周;对照组:每日颈背部皮下注射同体积的生理盐水,连续8周.造模完成后,取两组大鼠外周听觉系统耳蜗和中枢听觉系统听皮层组织,利用免疫组织化学法检测DNA氧化损伤生物标记物8-羟基-2-脱氧鸟苷(8-hydroxy-2-deoxyguanosine,8-OHdG);利用实时定量PCR检测线粒体DNA(mitochondrial DNA,mtDNA)普遍缺失(common deletion,CD)和NOX基因的表达;利用Western blot检测NOX蛋白表达;应用Taqman PCR检测mt DNA CD.所有实验数据采用两样本的t检验进行分析.结果 D-半乳糖组和对照组大鼠相比较,D-半乳糖诱导的老化大鼠8-OHdG的表达在耳蜗和听皮层组织中明显增多,两组比较差异具有统计学意义(t分别为6.341、10.589,P均＜0.05);NOX3基因和蛋白的表达在耳蜗组织中明显增强,两组比较差异具有统计学意义(t分别为8.491、18.983,P均＜0.05);NOX2基因和蛋白的表达在听皮层组织中明显增强,两组比较差异具有统计学意义(t分别为3.548、8.219,P均＜0.05);mtDNA CD的累积在耳蜗和听皮层组织中明显增多,两组比较差异具有统计学意义(t分别为9.796、7.901,P均＜0.05).结论 在听觉系统老化过程中,NOX是活性氧的重要来源,可能是导致老年性耳聋氧化性损伤发生的重要原因.

目的:探讨鼻内镜治疗鼻窦真菌病的临床效果。方法:本院治疗的鼻窦真菌病患者62例,均给予鼻内镜手术治疗,观察患者的治疗效果。结果:62例患者中,41例治愈,占66.13%;17例有效,占27.42%;4例无效,占6.45%。临床总有效率为93.55%。患者治疗后症状明显好转(P<0.05)。结论:鼻内镜治疗鼻窦真菌病具有十分良好的治疗效果,值得临床推广。

[目的]通过检测变应性鼻炎患者皮下特异性免疫治疗前后外周血CD4+T淋巴细胞表面CD25表达情况的变化及观察相关指标,探讨皮下特异性免疫治疗的机制,评价其远期疗效.[方法]将90例确诊变应性鼻炎患者随机分为免疫治疗组和药物治疗组,每组45例.通过症状评分、使用药物评分和鼻结膜炎相关生活质量调查问卷等评价临床疗效,同时通过流式细胞仪检测外周血CD4+T淋巴细胞表面CD25表达情况.[结果]随着特异性免疫治疗的进行,免疫治疗组与药物治疗组症状评分无统计学差异;而免疫治疗组药物评分要明显低于药物治疗组,鼻结膜炎相关生活质量调查问卷评分要高于药物治疗组,差异有统计学意义.变应性鼻炎患者外周血CD4+CD25+T淋巴细胞比例要低于健康对照组,免疫治疗组治疗3年后比例较治疗前升高,差异有统计学意义.而药物治疗组的比例没有明显提高.[结论]经过3年的特异性免疫治疗后,患者症状控制理想,对症治疗的药物明显减少,生活质量明显提高.这可能与影响CD4+CD25+T调节细胞的功能有关.

Objective:To investigate efficacy of titanium artificial ossicles and autologous tissue in the open tympanic hearing reconstruction.Methods:120 cases of patients who underwent open tympanic forming surgery in our hospital from July 2008 to July2012 were retrospectively analyzed.They were randomly divided into control group and treatment group in accordance with the number of parity method,and they were treated with autologous bone tissue therapy and the titanium ossicular artificial treatment respectively.Hearing statistics were calculated based on the difference between the rating of 0.5,1.0,2.0 and 4.0 kHz gas Island.Results:The air conduction and air-bone difference were not statistically significant in the control group before and after surgery(P0.05),and they had a significant statistical difference in the observation group before and after surgery(P0.01),and there was a statistical difference between the control group and the observation group after surgery(P0.05).Conclusions:The titanium artificial ossicles with autologous tissue showed significantly better curative effect in the open tympanoplasty for hearing reconstruction than the treatment of autologous bone tissue,and it should be promoted and applied.

OBJECTIVE:To investigate the therapeutic effect of intralesional bleomycin-A5 with dexamethasone injection under pedestal laryngoscope for huge laryngopharyngeal and laryngeal hemangiomas.METHOD:Intralesional bleomycin-A5 with dexamethasone injection under pedestal laryngoscope was performed in huge laryngopharyngeal and laryngeal hemangiomas.RESULT:The injection frequencies were 3 times in 4 cases, 4 times in 3 cases, and 5 times in 9 cases. Twelve cases (75%) were cured, and 4 cases (25%) were improved.CONCLUSION:Intralesional bleomycin-A5 with dexamethasone injection under pedestal laryngoscope is a safe, effective and minimally invasive therapeutic method for huge laryngopharyngeal and laryngeal hemangiomas.

目的探讨内镜鼻窦开放术后使用纳吸绵鼻腔填塞止血材料的临床疗效观察。方法将98例鼻腔鼻窦手术患者随机分为两组，一组采用纳吸绵止血材料填塞止血；另一组采用Merocel高膨胀材料填塞止血，比较两组患者在术后48h内、抽取填塞物时的临床症状及取出填塞物后鼻腔的局部表现。结果使用纳吸绵组术后48h内头痛、鼻痛及鼻渗/出血发生率低于Merocel高膨胀材料组（P＜0.05），抽取鼻腔填塞物时疼痛率及出血率明显低于Merocel高膨胀材料组（P＜0.01），术后鼻腔恢复通气天数、术腔上皮化时间较短，发生鼻腔粘连数、术腔肉芽、囊泡数均比Merocel高膨胀材料组少（P＜0.05）。结论纳吸绵疗效确切，不良反应少，病人痛苦少，是理想的鼻腔填塞材料。

Objective: To analyze the clinical effect of endoscopic surgery for sinusitis,nasal polyps.Methods: Analyzed data of 110 patients retrospectively that used endoscopic surgery for sinusitis and nasal polyps,and then compared the efficacy of different types of patients.Results: The cure rate and total effective rate of type Ⅰwas significantly higher than type Ⅱ and Ⅲ,with statistically significant differences(P0.05);The cure rate and total effective rate of typeⅡwas significantly higher than type Ⅲ,with statistically significant differences(P0.05).Conclusion: Endoscopic surgery for sinusitis and nasal polyps has the advantage of less trauma and pain in pre or post operations.Especially,it is worth promoting the techniques for operations.

<正>目前针对恶性肿瘤的主要治疗方法是放疗和化疗。尽管随着医学科学技术的进步,放疗设备及技术、化疗药物及方法不断更新,但很多恶性肿瘤患者的治愈率及生存质量还是没有得到明显提高,其根本原因是恶性肿瘤的的发病机制还远未阐明。