1临床资料 患者,女,58岁,因"咽痛3 h"就诊于苏北人民医院耳鼻咽喉科门诊.患者3 h前出现咽部疼痛,伴下颌疼痛,无意识不清,无头晕,无恶心呕吐,体温正常,无其他不适.患者既往高血压病史十年余,未进行正规治疗及定期监测血压,否认冠心病、糖尿病等慢性疾病史,否认手术史、外伤史,否认吸烟酗酒等其他不良嗜好.门诊查体:咽部色红,扁桃体Ⅰ度、不伴充血肿胀,间接喉镜下会厌正常.电子喉镜示双侧声带肥厚,黏膜慢性充血,双侧前中1/3处边缘结节样小隆起.颈内动脉超声检查发现左侧颈总动脉内见絮状回声,范围较大,大部分充填血管管腔,内血流部分充盈,提示左侧颈总动脉内急性栓子,范围较大(图1),考虑可能为导致咽痛的主要原因,遂转诊于血管外科.头颈CT血管造影(CTA)检查示左侧颈动脉夹层,予以抗凝溶栓等对症治疗,随即患者咽痛症状消失.3个月后随访,未见异常.

目的 探讨锁骨上皮瓣在头颈肿瘤缺损修复中的应用.方法 回顾性分析2017年1月～2020年12月于扬州大学附属苏北人民医院收治的应用锁骨上皮瓣修复头颈缺损的9例患者临床资料,通过研究其头颈肿瘤缺损的原因、术前放疗史、手术方式、皮瓣尺寸及术后愈合情况等因素,探讨锁骨上皮瓣的制备技巧、应用指征及术后并发症的处理.结果 9例患者均为男性,年龄51～79岁.3例一期修复包括1例下咽癌,1例舌根恶性肿瘤,1例鼻咽癌继发颈部淋巴结转移癌;6例二期修复包括1例下咽癌术后继发颈部淋巴结转移癌,1例喉癌术后继发气管造瘘口癌,1例喉及食管癌术后吻合口瘘,3例下咽癌术后咽瘘.2例咽瘘患者采用锁骨上皮瓣联合胸大肌皮瓣修复缺损,7例患者单独采用锁骨上皮瓣修复.术中所取锁骨上皮瓣宽度为4～8 cm,长度为6～15 cm.8例术后随访皮瓣存活,1例术后皮瓣坏死,清创换药后愈合.1例下咽癌术后患者皮瓣存活,但食管入口肿瘤复发予以放射性粒子植入,局部未控,术后第11个月死亡.结论 锁骨上皮瓣是喉咽及颈部皮肤术后缺损较为理想的修复组织瓣,技术比较成熟,术中应注意皮瓣血管的保护,治疗效果比较可靠.

Objective:To observe the characteristics of different negativity negativity （MMN） in patients with unilateral sudden deafness, and compare them with normal MMN, in order to provide theoretical reference for discussing the pathogenesis of unilateral sudden deafness and their relationship with the auditory centers, and to provide theoretical basis for the treatment of sudden deafness in the future. Methods:Twenty-six cases of unilateral total sudden deafness were recruited as experimental group, 25 cases of normal healthy people as control group, the MMN inspections was performed respectively, the two groups using classical mode of oddball, standard and deviation stimulate with 1000 Hz and 2000 Hz short pure tone test MMN respectively, to observe the MMN latency and amplitude characteristics, and compare the latent period and amplitude difference between the two groups. Results:Among the 51 subjects, only 1 patient with unilateral total sudden deafness did not elicit MMN waveform, while the rest were all induced. The average incubation period of MMN in the experimental group was （162.03±38.64） ms, the average amplitude was （2.83±1.14）μV, and the mean age was （48.64±10.27） y. While the average incubation period of MMN in the control group was （197.52±27.43） ms, the average amplitude was （2.58±1.07）μV, and the mean age was （45.00±8.20） y. The MMN latency was significantly different between the two groups （P<0.01）. There was no statistical difference in amplitude between the two groups （P>0.05）. There was no statistical difference in age between the two groups （P>0.05）. Conclusion:The latency period of MMN of unilateral total sudden deafness is shorter than that of the control group. It suggests that the auditory center function of patients with acute sudden deafness has changed, and we speculate that the auditory center of patients with acute sudden deafness may have corresponding emergency changes, so as to make its function have adaptive changes, which will provide further reference for the discussion of the pathophysiological mechanism and treatment of sudden deafness in the future.We speculated that acute unilateral auditory deprivation caused by unilateral total deafness sudden deafness has an impact on cerebral cortical auditory function, which provides further reference for the discussion of pathophysiological mechanism and treatment plan of sudden deafness in the future.

目的 检测突发性聋(Sudden deafness,SD)患者外周血血常规、血脂、血液流变学的水平,并与健康正常人相比,同时探讨这些指标与其疗效的关系.方法 回顾性分析2018年1月至2019年6月148例突发性聋(简称突聋)患者的临床资料,与同期的160例健康对照者相比较,分析不同听阈曲线类型(低频下降型、平坦下降型、高频下降型及全聋型)的突聋患者血常规相关指标(白细胞、 中性粒细胞、 淋巴细胞、 平均血小板体积(mean platelet volume,MPV)、 血小板/淋巴细胞比值(platelet lymphocyte ratio,PLR)及中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte,NLR),血脂相关指标(总胆固醇、甘油三酯),血液流变学(血浆粘度、全血粘度高切、全血粘度中切、全血粘度低切)的水平及其与突发性聋疗效的相关性.结果 ①突聋组血常规、血脂、血液流变学与对照组的比较:突聋组白细胞、中性粒细胞、淋巴细胞、MPV、NLR、PLR、总胆固醇、甘油三酯、全血粘度中切与对照组相比差异有统计学意义(P<0.05),其中突聋组患者白细胞、中性粒细胞、MPV、NLR、PLR、总胆固醇、全血粘度中切均较对照组升高,淋巴细胞、甘油三酯较对照组降低.突聋组血浆粘度、全血粘度高切、全血粘度低切较对照组升高,差异无统计学意义(P>0.05).②不同类型听阈曲线突聋患者血常规、血脂、血液流变学的比较:低频下降型、平坦下降型、高频下降型及全聋型患者的白细胞、中性粒细胞、MPV、NLR、PLR与对照组相比明显升高;其淋巴细胞与对照组相比明显降低;低频下降型总胆固醇、全血粘度高切、中切、低切较对照组升高;平坦下降型总胆固醇、全血粘度高切、中切较对照组升高;全聋型总胆固醇、全血粘度高切较对照组升高,以上差异均有统计学意义(P<0.05).高频下降型总胆固醇、全血粘度高切、中切、低切较对照组升高,各类型突聋患者与对照组的甘油三酯、血浆粘度差异,均无明显统计学意义(P>0.05).③不同类型听阈曲线突聋患者不同疗效的血常规、血脂、血液流变学的比较:突聋组治疗无效组白细胞、中性粒细胞、NLR、血浆粘度、全血粘度高切、低切较治疗有效组升高;低频下降型治疗无效组的白细胞、中性粒细胞、NLR、全血粘度低切较治疗有效组升高;高频下降型治疗无效组的白细胞、中性粒细胞、全血粘度高切、中切、低切较治疗有效组升高;平坦下降型治疗无效组的白细胞、中性粒细胞、淋巴细胞、血浆粘度较治疗有效组升高;全聋型治疗无效组的白细胞、中性粒细胞、NLR、PLR较治疗有效组升高,以上差异均有统计学意义(P<0.05).④突聋组患者血常规指标中白细胞 、中性粒细胞、NLR与预后呈负相关性,血液流变学指标中的血浆粘度、全血粘度低切与预后呈负相关性.结论 突聋患者可能存在炎症感染、脂代谢异常以及血流变学异常,同时发现突聋患者的白细胞、中性粒细胞、NLR、血浆粘度、全血粘度低切对其预后能起到一定的预测作用.临床工作中,我们应该关注突聋患者的血常规、血液流变学指标,可给予抗感染、降低血粘度等治疗,可能有助于其预后.