Objective:To investigate the predictive value of parathyroid hormone levels and decreases for postoperative hypocalcemia after total thyroidectomy. Method:We reviewed 71 consecutive patients who underwent total thyroidectomy, measured postoperative hypocalcemia, parathyroid hormone (PTH) values within 24 hours after surgery, divided them into subgroups accroding to hypocalcemia symptom. Combining with postoperative serum calcium，postoperative PTH values and decreases (△PTH), we used the receiver operating characteristic curve (ROC) analysis to assessment of predictive value. Result:The mean value of postoperative serum calcium, postoperative PTH and △PTH between subgroups have a significant difference (P<0.01). ROC area under the curve (AUC) of △PTH is 0.9706, with cutoff value 0.7366. AUC of postoperative PTH is 0.9580, with cutoff value 14.82 ng/L. Conclusion:The postoperative PTH and △PTH is a reliable indicator to judging postoperative hypocalcemia after total thyroidectomy.

目的 探讨一种新的兔食管良性狭窄模型构建方法——自制内镜注射针经喉镜注射氢氧化钠(NaOH)构建食管良性狭窄模型,为支架置入体内相关介入研究提供实验基础.方法 自制注射针:将一次性胃镜注射针外层导管去除,取含针头端长约70 mm内芯导管,将针头剪至2 mm长并磨成斜坡状,去除针柄及部分塑料管,然后接上内芯导管无针头端.选择2～3 kg健康兔10只,3％戊巴比妥(1 ml/kg)经耳缘静脉注射麻醉,左侧卧位固定于DSA操作台;透视下将泥鳅导丝插入胃腔,8 mm×40 mm球囊置于食管下段贲门处,喉镜下距球囊近端约l cm处选取环周4个点,经自制内镜注射针分别注入1.5％NaOH 0.25 ml.术后2周和4周分别作喉镜及造影检查;术后4周处死实验兔,取材作组织病理学检查.结果 术后2周喉镜检查显示食管中下段溃疡形成,无明显狭窄;造影显示食管中下段管壁不光整.术后4周喉镜显示食管中下段瘢痕形成、食管狭窄;造影显示食管中下段局部狭窄;组织病理学检查提示局部溃疡、黏膜下层增厚、瘢痕形成.食管管径狭窄率为平均49.54％ (44.89％～56.65％);狭窄长度造影测量为平均18.0 mm(14.6～22.8 mm),标本测量为平均16.3 mm(13.1～21.1 mm).结论 自制内镜注射针经喉镜注射1.5％ NaOH可成功构建兔食管良性狭窄模型,方法简单易行,狭窄程度和部位易控.

[目的]探讨PET/CT和MRI在鼻咽癌早期诊断中的价值。[方法]回顾性分析2010年1月至2012年5月经确诊的21例早期鼻咽癌和1l例鼻咽部炎性肿块患者的临床资料,所有患者均行鼻咽部PET/CT、MRI检查及鼻内镜下取材病理检查确诊。依据病理组织活检和临床随访分别评价PET/CT和MRI对鼻咽癌早期诊断的灵敏度、特异性、准确率,并对两者的结果比较。[结果]MRI和PET/CT诊断鼻咽癌灵敏度分别为84.09%和97.67%;特异性分别为69.23%和57.14%;准确率分别为80.70%和87.72%;PET/CT在灵敏度方面较MRI有明显优势(P<0.05)。[结论]PET/CT和MRI在鼻咽癌诊断中均有较高的价值,两种诊断方法有各自的优缺点,应将两者结合起来,以提高早期诊断鼻咽癌的准确率。

目的通过手术致鼻腔粘连,已达到缩小鼻腔改善症状之目的 ,观察其对萎缩性鼻炎的疗效。方法对15例萎缩性鼻炎患者施行鼻内镜手术致其鼻腔粘连,随访半年,按萎缩性鼻炎治疗分度标准进行疗效评估。结果患者主观症状缓解,治疗有效率90%。结论鼻腔粘连术可用于治疗萎缩性鼻炎,且术式简单易行,创伤小,疗效满意。

Objective To explore the change of the children' s bone Conduction hearing threshold with secretory otitis media(SOM). Methods Retrospectively analyzing 80 SOM patients (158ears)whose age from 2 to 16 years old, and chose 38 kids within the same age (53 ears)to contrast the difference:The degree of hearing loss, the frequency specificity and the relevant factors such as gender course etc. Results SOM can cause the children' s hearing loss, the threshold of Bone Conduction weuld be 16 dBHL(he threshold of Bone Conduction ＞ 20 dBHL was 21 cases, about 26%), there is not Statistics differences between the gender, the left or right ear and the course time (P＜ 0. 05). But in the different frequency, the curve of hearing loss was different. Conclusion SOM can cause the children hearing loss, some probably be sensorineural hearing loss(SNHL).

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)常见合并上气道多平面阻塞,包括鼻腔和鼻咽平面、口咽平面和下咽平面等.重度OSAS患者因长期低氧血症,多伴有高血压、心脑血管疾病,甚至有发生猝死的危险.常用手术方法有悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)、舌缩小成形术、下颌骨切开和髂骨移植术等,其中UPPP已在临床上广泛应用.据报道[1],40%的OSAS患者伴有下咽平面阻塞,又称舌源性阻塞,单纯实施UPPP疗效不佳.为提高OSAS的手术效果,我们在进行解除其他平面阻塞的基础上,采用舌骨悬吊术治疗因舌源性阻塞引起的重度OSAS,取得了明显效果,报道如下.

Objective To observe diagnosing value of HRCT and spiral CT image on chronic otitis media reconstruction technology.Methods 50 patients with chronic otitis media were examined with high resolution CT(HRCT) and be contrasted with operative findings.20 patients with chronic otitis media were examined with CT image technology,high resolution CT(HRCT),surface shaded display(SSD),multi-planner reformation(MPR) for the ossicle and the curved face reconstruction(CPR) for the facial nerve and semicircular cannal,which were contrasted with operative findings.Results The overall ossicle,the sensitivity and specificity of MPR were much better than that of SSD and HRCT.About reflecting the overall ossicle,MPR was more clear and accurate than that SSD and HRCT.Conclusion The diagnostic value to stapes of the three image technology is not better enough and MPR is better than SSD and HRCT;

Objective:Inquiry into the relevant factor of secretory otitis media(SOM)in the child.Method:Retrospectively analyzing 114 cases(214 ears)of the clinical data and its related factor of SOM in children.Result:About 74.56% children with SOM suffering from nasopharygeal or otopharygeal diseases in 114 cases.The others,7.89% following after the cold,4.39% with congenital hearing loss and 13.16% without obvious reason.Conclusion:To SOM,the nasopharygeal or oropharygeal disease should be emphasized for the clinical doctor,treating the relevant diseases can prevent the occurrence of SOM and reduce the rate of the SOM to relapse.

患者,男,23岁.以右耳疼痛、耳堵塞感,伴听力下降1年为主诉入院.患者1年前无明显诱因出现右耳持续性胀痛,且渐进性加重,继而出现听力下降及持续性耳鸣,口服药物无好转.无眩晕恶心及呕吐,无外耳溢液及流血.

良性及恶性神经鞘瘤同属周围神经外胚层肿瘤.发生于气道的良性神经鞘瘤不多见,恶性神经鞘膜瘤较罕见,我科诊治一例神经鞘瘤,经过两次手术,术后病理报告分别为良性和恶性,现报告如下.