目的 探讨小钳口 LigaSure在腮腺深浅叶良恶性肿瘤切除术中的应用.方法 前瞻性的纳入西安交通大学第二附属医院耳鼻咽喉头颈外科病院2016年1月—2018年12月行腮腺来源肿瘤接受手术的47例患者,分为利用LigaSure切除(A组)27例及电刀结合传统刀片切除(B组)20例.对两组间的手术时间、术中出血量、术后48 h引流量及术后并发症进行比较.结果 A组的手术时间(85.56±43.94)min与B组(123.00±44.14)min相比,明显缩短(P＜0.05);两组术中出血量[(46.67±42.34)mLvs(75.00±49.92)mL]比较,差异具有统计学意义(P＜0.05);两组术后引流量[(38.15±17.16)mL vs(63.25±21.59)mL]比较,差异有统计学意义(P＜0.05);两组间术后并发症各参数无统计学差异.浅叶切除中A组和B组手术时间[(70.00±17.54)min vs(104.00±25.58)min],术中出血量[(33.81±21.79)mL vs(54.67±19.32)mL]及术后引流量[(32.62±11.36)mL vs(54.33±8.84)mL]比较,差异均具有统计学意义(P均＜0.05).腮腺全切(包括扩大切除)术中使用LigaSure的患者手术时间,术中出血量及术后引流量与对照组比较,差异均无统计学意义(P均＞0.05).结论 小钳口 LigaSure在切除腮腺良恶性肿瘤的应用是安全的,与传统手术方式相比尤其在浅叶手术中LigaSure有出血少,手术时间短等优势.

Objective:To establish a new method for detecting vestibular function by testing cervical vestibular-evoked myogenic potential induced by galvanic vestibular stimulation in normal population. Method:Twenty normal ears were tested for cervical vestibular evoked myogenic potential induced by galvanic vestibular stimulation. SPSS 18.0 software was used to analyze the obtained data. Result:In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was（11.52±3.05） ms. The latency of n23 was（15.31±3.38） ms. The amplitude of p13-n23 was（40.55±27.93） μV. The interval of p13-n23 was（3.53±1.38） ms. The interaural asymmetry ratio（AR, %） of p13, n23 latency, the amplitude and interval were respectively（6.96±6.79）%, （6.47±5.93）%, （28.08±26.42）% and （16.61±11.11）%. There was no significant difference in all parameters between the right and left ears of all subjects. Conclusion:The value of cervical vestibular-evoked myogenic potential induced by galvanic vestibular stimulation in normal subjects can be established to explore methods for diagnosis, treatment and researching mechanism of auditory neuropathy and vestibular neuropathy.

目的 探究慢病毒介导的Jagged1 RNA干扰通过抑制肥大细胞的迁移,浸润和脱颗粒对变应性鼻炎小鼠炎症的影响.方法 32只BALB/c小鼠随机分为4组:对照组、AR组、sh-NC组和sh-Jagged1组,每组各8只.卵清蛋白(OVA)联合氢氧化铝制备变应性鼻炎小鼠.RT-PCR检测小鼠Jagged1 mRNA表达;Western blot法检测小鼠Jagged1蛋白表达;鼻部症状评分评估小鼠变应性鼻炎症状;ELISA检测小鼠组胺、类胰蛋白酶、前列腺素D2(Prostaglandin D2)和IgE含量;HE染色观察鼻黏膜病理学变化;电子显微镜观察小鼠鼻黏膜纤毛结构变化;甲苯胺蓝染色观察小鼠鼻黏膜肥大细胞浸润.结果 与对照组比较,AR组和sh-NC组小鼠的Jagged1表达、症状评分升高和IgE表达升高(P<0.01).与sh-NC组比较,sh-Jagged1组小鼠Jagged1表达、症状评分降低和IgE表达降低(P<0.01).与对照组比较,AR组和sh-NC组小鼠的鼻中隔黏膜基膜破碎,黏膜下血管出现明显扩张、充血现象,炎性细胞浸润和肥大细胞数量增加(P<0.01),纤毛大面积减少、排列紊乱,组胺、类胰蛋白酶和PGD2水平明显升高(P<0.01).sh-Jagged1可改善AR小鼠鼻黏膜和纤毛损伤,抑制炎性细胞浸润、肥大细胞数量、组胺、类胰蛋白酶和PGD2水平(P<0.01).结论 慢病毒介导的sh-Jagged1通过抑制肥大细胞的迁移,浸润和脱颗粒减轻变应性鼻炎小鼠炎症.

Objective To study the application value of 5S management for the instrument management in ENT department.Methods Totally 20 instrument nurses in ENT department implementing 5S management were enrolled into an observation group,and another 20 nurses using conventional management method were involved in a control group.The two groups were compared on instrument management quality and instrument nursing management satisfaction.Results The observation group had the qualification rate of sampled sterile items,qualification rate of instrument packaging,qualification rate of instrument cleaning,efficiency of instrument application,instrument preparedness,standardized instrument allocation,intact rate of prepared instrument as well as the familiarity with instrument management and operation significantly better than those in the control group (P＜0.05).The time consumed for adding instrument,finding instrument,environment arrangement and finding expired goods in the observation group was statistically shorter than that in the control group (P＜0.05).The times of instrument set repeated disinfection in the observation group was obviously less than those in the control group (P＜0.05),and the satisfaction over nursing management in the observation group was also significantly better than that in the control group (P＜0.05).Conclusion 5S management gains high application values for instrument management in ENT department,and thus is worthy promoting clinically.

慢性硬膜下血肿是神经外科常见疾病,手术治疗效果明显,以往手术方法多样,复发率高,并发症较多.我院2007年8月~2010年8月共收治慢性硬膜下血肿96例,采用简易定位法结合软通道置管冲洗引流,效果满意,现将诊治体会报道如下.