Analyzing the efficiency of increasing blood pressure before the end of the operation to reduce post coblation assisted tonsillectomy hemorrhage / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the efficiency of reducing post-tonsillectomy hemorrhage by increasing blood pressure before the end of the coblation operation.METHODS Clinical data of 1069 patients with coblation assisted tonsillectomy under general anesthesia between January 2008 and January 2016 were retrospectively reviewed.The treatment group were 546 patients checked the operation cavity after increasing blood pressure before the end of tonsillectomy,while the control group were 523 patients checked the operation cavity with routine procedure without increasing the blood pressure.Post-tonsillectomy hemorrhage incidence and postoperative bleeding volume were compared between the two groups.RESULTS Checking the operation cavity after increasing blood pressure before the end of tonsillectomy can reduce the incidence of postoperative primary hemorrhage (P＜0.05),but cannot reduce the incidence of postoperative secondary hemorrhage (P＞0.05).CONCLUSION Increasing blood pressure before the end of tonsillectomy can effectively reduce the incidence of postoperative primary hemorrhage.

Comparison of bleeding volume during endoscopic sinus surgery in patients with hypertension under total intravenous anesthesia and combined intravenous with inhaled anesthesia / 临床麻醉学杂志

Objective To compare the bleeding volume during endoscopic sinus surgery in pa-tients with hypertension under total intravenous anesthesia or combination of intravenous with inhaled anesthesia.Methods Forty adult patients with hypertension (ASA Ⅰ or Ⅱ),male 25 and female 1 5,aged 35-54 years,agreed to be on electively endoscopic sinus surgery,were divided randomly into two groups(group A and group B,n =20 each).All patients were injected intravenously with fenta-nyl,propofol and cisatracurium during the induction of general anesthesia.During the maintenance stage of the general anesthesia,patients in group A were injected intravenously with propofol,and patients in group B were inhaled with sevoflurane until 5 minutes before the end of the operation.BIS was 40-60 during the operation in the two groups.After induction of anesthesia and tracheal intubation,ni-troglycerin and esmolol were given to adjust blood pressure and hypervolemic hemodilution was performed.. Bleeding volume and operation duration were recorded at the end of the operation.The arterial blood gas, blood lactate and coagulation function were monitored 30 minutes before the operation (T0 ),30 minutes (T1 )and 90 minutes after the operation beginning (T2 )and 30 minutes after the end of the operation (T3 ). Results Bleeding volume in group A was significantly less than that in group B (P <0.05).Fifteen minutes before the operation,the MAP of all the patients in two groups was controlled slowly to 60 mm Hg.Com-pare to those at T0 ,there was no significant difference in the arterial blood pressure,blood lactate and coag-ulation function at T1 ,T2 and T3 .Conclusion During the endoscopic sinus surgery with intravenous anes-thesia for patients with hypertension,the bleeding volume was less than that with inhalation anesthesia.

A Comparative Study Between Laryngeal Microsurgery and Traditional Operation in the Treatment of Reinke’ s Edema of Vocal Cords / 中国微创外科杂志

Objective To investigate the clinical efficacy of the self-retaining laryngeal microsurgical operation in the treatment of Reinke ’ s edema of vocal cords . Methods There were 24 cases of Reinke ’ s edema who were treated with self-retaining laryngoscope mucosal stripping surgery of vocal cords from January 2004 to December 2009 ( traditional group ) , while another group of 32 cases of Reinke ’ s edema were treated with self-retaining laryngoscopic microsurgery lateral submucosal incision micro-flap operation of vocal cords from January 2010 to December 2015 ( laryngeal microsurgery group ) .The two groups were executed with electronic laryngoscopy and subjective voice evaluation GRBAS ( The Speech and Language Institute of Japanese in 1979, G: Grade, R:Roughness, B:Breathness, A:Asthenia, S:Strain) in pre-operation and post-operation (1 week, 3 weeks, 8 weeks).The wound healing time of vocal cords , hoarseness improved time and voice improvement were retrospectively compared between the two groups . Results The patients in laryngeal microsurgery group had earlier voice hoarse improvement and more rapid mucosal epithelial of vocal cords recovery time in post-operation as compared with the patients in the traditional group [voice improving time, (7.3 ±1.9) d vs. (11.3 ±2.7) d, t=-6.481, P=0.000;mucosal epithelial of vocal cords recovery time , (12.2 ±3.1) d vs.(20.1 ±3.4) d, t=-9.062, P=0.000].The results of pre-operative voice evaluation with GRBAS showed no significant differences between the two groups, but the results of post-operative evaluation of each session (1 week, 3 weeks, 8 weeks) showed that the main data were statistically different.The GRBAS score of laryngeal microsurgery group was lower than that of traditional group in post -operation, especially after 8 weeks (8 weeks after post-operation, G:1.0 ±0.8 vs.1.6 ±0.2, t=-3.584, P=0.000; R:1.0 ±0.9 vs. 1.5 ±0.4, t=-2.536, P=0.014;B:1.0 ±0.6 vs.1.4 ±0.5, t=-2.647, P=0.011).In laryngeal microsurgery group, 24 cases were cured , 5 cases were effective and 3 cases were invalid , contrasting in the traditional group with 11 cases of cured , 7 cases of effective and 6 cases of invalid respectively, with a significant difference (Z=-2.239, P=0.025).No significant difference in effective rate between the two groups [90.6%(29/32) vs.75.0%(18/24),χ2 =1.459, P=0.227]. Conclusion The clinical efficacy of self-retaining laryngoscope microsurgery in the treatment of Reinke ’ s edema of vocal cords is faster and better comparing traditional operation , with a more significant pronunciation quality improvement .

Analysis of clinical diagnosis and treatment of 112 cases of parapharyngeal space tumors / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the diagnosis, treatment and surgical approaches of parapharyngeal space tumors.@*METHOD@#This retrospective study consisted of 112 patients with parapharyngeal space tumors underwent surgeries. The data included clinical symptoms and signs, pathological types, imaging examinations, surgical approaches and postoperative complications.@*RESULT@#Computerized tomography (CT), magnetic resonance imaging (MRD and digital subtraction angiography (DSA) made clear the tumor size, localization and its relation to adjacent structures. The postoperative histopathology varied and showed benign in 98 cases consisting of salivary gland tumors (52 cases), neurogenic tumors(33 cases) and other types (13 cases). During the 3 years follow-up period, local recurrence appeared in 3 patients with salivary pleomorphic adenoma and 1 patient with neurofibromatosis. These recurrent tumor cases were cured with second surgery. In 14 patients with malignant tumors reported, 8 cases survived for 5 years, 2 cases (1 adenoid cystic carcinoma and 1 carcinoma in pleornorphic adenoma) recurred in the two and a half years cured with second surgery affiliated radiation therapy through 3 years follow-up time and the rest were followed up 1 to 3 years without recurrence. Peripheral facial paralysis was observed in 25 patients, and 3 patients experienced hypoglossal nerve palsy. Only 1 patient encountered vagus nerve injury, and 2 patients appeared Horner's syndrome, and 4 patients endured Frey syndrome. Gills leakage was discovered in 3 cases and cavity infection was noted in 1 patient.@*CONCLUSION@#CT, MRI and DSA were important in the diagnosis and differential diagnosis of parapharyngeal space tumors. The key to successful treatment is knowing the anatomy of the parapharyngeal space, preoperative assessment and appropriate surgical approach.

The application of decompression in the treatment of gnathous cystic lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the application of decompression in the treatment of ganthous cystic lesions.@*METHOD@#Decompression surgery were performed on 32 patients with gnathous cystic lesions, the cavities of cysts were open and the cysts pressure was relieved. The cavities of cysts were flushed after the operation and the prognosis were assessed in the regular follow-up.@*RESULT@#All cysts cavities were shrinks afer decompression operation. Through the X-line and/or CT scans, we could observe that the new bones formed around cysts cavities, tilt shift teeth were gradually corrected and the permanent tooth germs of pediatric patients almost returned to the right places and erupted; There were the only remaining small bone indentations in the 18 cases, which do not need the Phase II surgery. Eight cases of cysts cavities shrinks more than 50%, which needed cystectomy. Six cases of cysts cavities shrinks less than 50%, which were still in the follow-up treatment.@*CONCLUSION@#The decompression surgery is a simple, economical and effective method for the treatment of gnathous cystic lesions.

The effect of cream of bedsore on the treatment of severe bedsore / 国际外科学杂志

Objective To study the effect of cream of bedsore on the treatment of severe bedsore.Method One hundred and twenty patients were randomly divided into treatment group and control groups Ⅰ and Ⅱ,respecially 40 patients,given systemic treatment.Results The decubitus wound healing of treatment group was significantly better than the other two groups,the total effective rate being 85%,P ＜ 0.01.In the treatment group,pathogenic bacteria culture positive rate on decubitus wound was significantly lower than the two control groups,inhibition rate being 78%,P ＜ 0.05.Staphylococcus aureus,Pseudomonas aeruginosa,Escherichia coli and so on were inhibited.Conclusions In the treatment group,bedsore healing ointment was significantly better than Western medicine used in the control groups.It can improve the microcirculation of the blood perfusion,promote the establishment of collateral circulation,increase the affected area nutrition,improve the local tissue ischemia,hypoxia-induced metabolic disorders,and remove the necrotic tissue,and promote tissue repair and regeneration,the granulation growing,and the effect of epithelial healing.

Diagnosis and treatment experiences on 35 cases of closed abdominal injury / 国际外科学杂志

Objective To detect the clinical significance of diagnosis and treatment on closed abdominal injury patients. Methods We retrospectively analysed the clinical data of 35 patients,who were diagnosed to closed abdominal injury and treated in our hospital from 2003 to 2008. Results Thirty-four cases were cured greatly in the 35 patients. The cure rate was 97.1%. One case, who was diagnosed as liver rupture and intracranial haematoma, was dead because of multiple organ dysfunction syndrome. The mortality was 2. 9%. Conclusions It is the key to succesful treatment of closed abdominal injury to make proper diagno-sis, give timely surgical treatment and choose the right way for operation; We must correctly handle the prob-lems of bleeding, organization infection and repairment.

Early post-operative effect of enteral nutrition fluids support for colon cancer / 国际外科学杂志

Objective To explore more reasonable way of early post-operative effect of enteral nutrition fluids support for colon cancer.Methods A total of 86 case of colon cancer were selected and assigned to enteral nutrition group(EN n=45)and parenteral nutrition group(PN n=41)randomly.Parameters inclu ding the body wetght,IsA,IgM,lymphocyte,human serum prealbumin and albumen were monitored on three days before operation,the fifth,and eighth days after operation.Results The IgA,IgM,lympho cyte,human serum prealbumin and albumen levels of patients in EN group were much higher than that in PN group on the fifth and eighth days after operation(P＜0.05).Also IgA,lgM levels of EN group patients were almost higher than that in PN group on eighth day after operation(P＜0.01).Concusions It showed that to perform enteral nutrient supports for patients of colon cancer during early post-operative could increase their gut immunity after operation and reduce the complications and raise human serum prealbumin and albu men of them for their body recovery.

The therapy of inguinal hernia based upon individuality / 国际外科学杂志

The therapy based upon individuality is becoming a trend Oil general surgery field which has been highlighted by lots of specialists,scholars and clinic doctors,and so as the therapy of inguinal hernia.Along with the rushing appearoace of new idea and technique,the problem up to the minite which is confusing clinic doctors is how to select proper method of inguinal hernia therapy.This article is focused on the therapy of inguinal hernia based upon individuality.

Isolated sphenoid sinus disease presented the primary symptom as headache or ocular disturbance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To improve the understanding of the symptoms and signs of isolated sphenoid sinus disease and decrease the occurrence of misdiagnoses.@*METHOD@#The clinical manifestation and the advantage of endoscopic sinus surgery were analyzed in 22 cases of isolated sphenoid sinus disease.@*RESULT@#Twelve cases had endoscopic sphenoidotomy, 7 cases had external ethmoidal sphenoidotomy, 3 cases had antibiotic, steroid and neurotrophic therapy. All of the patients were free of headache,improvement in vision and ocular motility after treatment. After 3 to 6 months' follow up, 1 case recurred and symptom relieved after endoscopic sinus surgery. 1 case adenoid cystoid carcinoma underwent post operative radiotherapy without recurrence after 3 years follow up.@*CONCLUSION@#Isolated sphenoid sinus disease presented the primary symptom as headache and/or ocular disturbance is prone to be misdiagnosed, application of CT, MRI and endoscopy improve its diagnosis and treatment standard. Endoscopic sinus surgery is the primary therapy for isolated sphenoid sinus disease.