目的:探讨针状电刀结合可吸引单极电凝在儿童扁桃体切除术中的应用效果.方法:将2019年2月-2019年12月60例行双侧扁桃体切除的患儿按同体异侧的方法随机分为两组,一侧扁桃体用针状电刀结合可吸引单极电凝切除(A组,n=30),另一侧用传统的扁桃体剥离术方法切除(B组,n=30).比较单侧手术所需的时间、术中出血量、术后患儿咽部疼痛情况及出血情况.结果:A组手术时间和术中出血量均明显低于B组,分别为[(7.0±1.6)min vs(15.6±3.5)min]和[(7.8±1.3)ml vs(26.1±4.7)ml],P均<0.05;A组术后5 d内疼痛指数均明显低于B组,P均<0.05);两组术后出血发生次数无明显差异.结论:与传统方法比较,针状电刀结合可吸引单极电凝法具有手术时间短、损伤小、术中出血少、术后疼痛轻等优点.

Objective:This project aimed to study the dynamic change of the cytokines associated with specific immunotherapy(SIT) pre- and post-SIT.Searching for immune regulatory indicators would used in SIT.Method:One hundred cases who had accepted SIT were enrolled in the project.Data of serum specific IgE and cytokines were statistically analyzed.In the three periods,pre-SIT,17 weeks post-SIT,57 weeks post-SIT,the levels of the eight kinds of cytokines(IL-4,IL-5,IL-8,IL-10,IL-13,IL-17,IFN-γ and TNF-α)were detected,and the dynamic change of the nasal symptoms score were analyzed.Result:The six kinds of cytokines(IL-5,IL-8,IL-10,IL-13,IL-17 and TNF-α)had no significant difference before and after SIT.The level of house dust mite sIgE level was positively correlated with serum IL-5 when the SIT pre-treatment and 57weeks (P<0.05).Pre-treatment and in 17 weeks after treatment,serum IL-5,IL-17 content difference and reduce the magnitude of nasal symptom scores were positively correlated (P<0.01).In 17 weeks of treatment and 57 weeks of treatment,difference of serum IL-10,IL-13,TNF-α levelsand the difference of nasal symptom scores were negatively correlated(P<0.01).Pre- treatment and 57 weeks,difference of serum IL-13,IL-17,TNF-α and the difference of nasal symptom scores were positively correlated (P<0.05),serum IL-10 levels of difference between the nose ministry of magnitude lower symptom scores were negatively correlated (P<0.01).Conclusion:The cytokines (IL-4,IL-5,IL-8,IL-10,IL-13,IL-17,IFN-γ and TNF-α) associated with the SIT play an important role in allergy and can objectively reflect the immune status during SIT.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行保留悬雍垂的改良腭咽成形术(H-UPPP)后放置鼻咽通气管缓解上气道阻塞的作用,探讨其临床应用价值.方法 对比观察鼻咽通气管组(Ⅰ组)和普通组(Ⅱ组)患者行H-UPPP术后24 h内的最低血氧饱和度(LSaO2)、血流动力学、咽部疼痛不适等指标并进行评价.结果 鼻咽通气管组与普通组术后24 h咽部疼痛比较,二者差异有统计学意义(P＜0.05).术后24 h血液动力学指标,包括心率(HR)、收缩压(SBP)、舒张压(DBP)对比发现鼻咽通气管组患者的HR、SBP、DBP均低于普通组,两者差异具有统计学意义(P＜0.05);术后24 hLSaO2鼻咽通气管组高于普通组,两者差异具有统计学意义(P＜0.05).结论 H-UPPP术后留置鼻咽通气管,可有效预防呼吸道阻塞或窒息的发生,是气道安全保证的有效措施之一.

Objective To compare the outcomes of temperature-controlled radiofrequency-assisted endoscopic partial tonsillectomy and adenoidectomy(A) and conventional tonsillectomy and adenoidectomy(B) in elder children with obstructive sleep apnea-hypopnea syndrome(OSAHS).Method 65 children(6-12 year old) with OSAHS are studied.There are 32 patients underwent A and 33 patients underwent B.Data of surgery time,bleeding volume were collected and analysed.Casesof OSAHS were monitored with polysomnography(PSG),and the parameters obtained before operation and 12 months after operation were analyzed.Results Surgery times ofAare statistically shorter than those of B,bleeding volumes ofAare significantly less than those of B.Two groups are effective in curative effect.Conclusion Temperature-controlled radiofrequency-assisted endoscopicoperation can reduce bleeding volume and shorten surgery time and the effect is satisfactory.

<正>资料患者女性,21岁。因左鼻腔反复鼻塞、流脓涕、涕中带血2周余于2011年12月5日入院。体格检查:一般情况良好,血压正常,浅表淋巴结均未触及。专科检查:外鼻无畸形,左侧中鼻甲明显肿大,表面黏膜呈暗红色、光滑,触之不易出血,对麻黄碱无收缩反应;中鼻道无法显露;下鼻道见少量脓性分泌物;鼻咽部未见新生物。鼻窦增强CT扫描提示:①左鼻腔、鼻窦占位性病变;②左侧上颌窦、筛窦炎;③泡性中鼻甲(图1)。入院后全身应用抗生素,做好术前准备。在全身麻醉下行鼻内镜手术。术中剪开中鼻甲黏膜,有大量咖啡色液体溢出。中鼻甲呈囊壁样改变,其内为一大的空腔。充分去除残壁,切除部分中鼻甲,中鼻道及筛窦可见灰白色新生物。切除

目的 对比分析H-UPPP及等离子辅助的H-UPPP治疗阻塞性睡眠呼吸暂停低通气综合征术后疼痛情况,探索治疗OSAHS的有效术式.方法 用H-UPPP及等离子辅助的H-UPPP2种术式分别治疗OSAHS患者39例及27例,采用10cm的视觉模拟尺(VAS)评价术后的疼痛程度,并观察记录术后0.5、2、4、8、12、24、48h的评分.结果 同时记录呼吸频率度(f)、血氧饱和度(SPO2)及不良反应情况,比较术后2组疼痛情况.结果 VAS评分等离子辅助的H-UPPP组好于H-UPPP组2种术式术后疼痛情况差异有统计学意义(P＜0.05),结论 等离子辅助的H-UPPP术式较H-UPPP术式术后疼痛明显减轻.

我科于2002年10月以来,于局麻药中加立止血以预防扁桃体术后出血,效果满意.报告如下.