Clinical analysis of 27 cases with descending necrotizing mediastinitis / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM).@*Methods@#A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People’s Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis.@*Results@#ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ2=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ2=4.074, P=0.044) and necrotizing fasciitis (χ2=4.457, P=0.035) in died cases were significantly higher than those in cured cases.@*Conclusion@#DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.

Treatment of glottic cancer involving the anterior commissure by transoral CO2 laser surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To study the clinical outcome of transoral CO2 laser surgery for glottic cancer involving the anterior commissure.@*Methods@#Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO2 laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years.@*Results@#All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO2 laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) (Log Rank χ2=0.788, P=0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) (Log Rank χ2=9.504, P=0.002).@*Conclusion@#With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO2 laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

Cervical esophagostomy improves the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects.</p><p><b>METHODS</b>A retrospective study was performed on 53 nasopharyngeal carcinoma (NPC) patients with dysphagia, who received cervical esophagostomy. The nutritional status of these patients was measured at five given time before and after operation. The occurrence of pneumonia and reflux esophagitis before and after operation was recorded, and the quality of life based on SF-36 quality of life (QOL) scale was studied.</p><p><b>RESULTS</b>After operation, the nutritional status of these patients improved substantially, including the weight, levels of hemoglobin, total protein, albumin and transferring (P<0.05). The pneumonia-infection decreased from 60.38% (32/53) before operation to 15.22% (7/46) after operation (χ(2)=21.04, P<0.01). The incidences of reflux esophagitis decreased from 26.42% (14/53)without operation to 6.52% (3/46) after operation (χ(2)=5.00, P<0.01). Meanwhile, the status of physical health, mental health as well as physical function and social function of these patients were improved significantly at 1 month, 6 months, 1 year and 2 years after operation (P<0.05).</p><p><b>CONCLUSION</b>Cervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.</p>

Histopathologic changes after tracheal reconstruction with a scraped partial mucosa jejunal autograft / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the histopathological changes of the new trachea reconstruction with a scraped partial mucosa jejunal autograft hy microscope and transmission electron microscope.@*METHOD@#Eight canine models of extensive circumferential tracheal defects with revascularized jejuna combined with NiTi alloy mesh tube were established. Operations were performed on these dogs under general anesthesia by intravenous ketamine. A 6.5 cm length of segment of the jejunum was resected. The graft was prepared by scraping the partial mucosa with operating knife blade and dry gauze. During the resecting course, micro-vascular anastomoses were done between the mesenteric artery and the right common carotid artery,and the mesenteric vein with the right common carotid vein. The silicone intraluminal stent was placed in the lumen of the jejunal segment and was removed the fourth week after operation. A Ni-Ti alloy prothesis was placed over the jejunal segment, with the mesenteric vascular supply egressing through the longitudinal defect of the mesh tube. Then the free jejunum was used to reconstruct the tracheal defects. Biopsy were performed and recorded at the 1 at, 2nd, 3rd and 4th postoperative months. All specimens were observed by microscope and transmission electron microscope examinations.@*RESULT@#Eight dogs postoperative all survived expected time. One month after operation, the tracheointestinal snastomosis showed smooth and was covered by continuous internal lining. The mucosa of the jejunum was slightly atrophied. Two months after operation, examination of the jejunal mucosa of the autografts demonstrated obviously thinned. The lumen of the reconstructed trachea was covered by squamous epithelium entirely at 3 months postoperatively. The partial squamous epithelium has transformed ciliated columnar epithelium at 4 months postoperatively.@*CONCLUSION@#A free scraped partial jejunum reconstructed trachea can accelerated the atrophying process of mucous epithelization and promoted mucosal metaplasia of the jejunum. The reconstructed tracheal lumen has completely transformed squamous epithelium at 3 months postoperatively and partial squamous epithelium has transformed ciliated columnar epithelium at 4 months postoperatively.

Clinical reseach of early laryngocarcinoma treatment by carbon dioxide laser microsurgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carci noma.@*METHOD@#A retrospective study of 112 patients with laryngocarcinoma treated. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. After the patients were given the general anesthesia and oral intubation, the tumors in the study group were resected along the margin of the tumor under larynscope, and the safety margin was reserved as 3-5 mm. All the patients were followed-up for 12-62 months.@*RESULT@#Eight relapses were detected in 112 cases of glottic laryngeal carcinoma after CO2 laser surgery. The local recurernce rate was 7.14% (8/112),of the rate for T1a, T1b and T2 were 0.89%, 0.89% and 5.04% respectively, with significant differences among groups (chi2 = 5.306, P 0.01).@*CONCLUSION@#According to our reaserch, endoscopic CO2 laser sur gery is an effective treatment for early laryngocarcinoma.

Treatment for benign thyroid nodules with hoarseness as primary symptom / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of operation on Benign thyroid nodules with hoarseness as primary symptom.@*METHOD@#Twelve patients were underwent the operation of subtotal thyroidectomy and exposing of recurrent laryngeal nerve. We evaluating the effect by fibrolaryngoscope and voice acoustic analysis before and after operation.@*RESULT@#All the 12 patients underwent surgery successfully. The hoarseness improved obviously and vocal cords were reactivate. Jitter, shimmer and dysphonia severity index showed significant difference pre and one month after surgery.@*CONCLUSION@#Benign thyroid nodules could also cause vocal cord paralysis and hoarseness, the effect can be satisfying by subtotal thyroidectomy and exposing of recurrent laryngeal nerve if it can be early diagnosed.

Cervical chronic radiation ulceration reconstruction with flap after radiotherapy for nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the application of flaps or musculocutaneous flaps in repairing cervical postradiation ulcer (cpu) at nasopharyngeal carcinoma.@*METHOD@#Deltopectoral flaps and pectoralis major flaps were applied to repair cervical radiation ulceration with different size and depth in 19 cases.@*RESULT@#Twelve cases repaired with deltopectoral flaps and 7 cases repaired with pectoralis major flaps, impaired wound healing happened at distal end of one deltopectoral flap, and the wound was healing hy second intention after debridement and dressing change. All the other deltopectoral flaps and pectoralis major flaps stayed alive. Flaps stayed alive without the recurrence of ulcer after the long-term follow-up for one to ten years.@*CONCLUSION@#The effectiveness of cervical radiation ulceration reconstruction by deltopectoral flaps and pectoralis major flaps was proved. The reconstruction could prevent the recurrence of ulcer. Refer to the poor prognosis of chronic radiation ulceration with expectant treatment, precautions do count.

Comparative study of endoscopic and open thyroidectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the therapeutic effect between endoscopic thyroidectomy and open thyroidectomy.@*METHOD@#One hundred and nine patients were randomly divided into two groups. The first group with 52 patients were carried out endoscopic thyroidectomy; and the second group with 57 patients was carried out open thyroidectomy. Clinical features including operation time, operative blood loss, hospitalization and complications were compared between the two groups.@*RESULT@#The average operative time was (105.1 +/- 30.2) min in endoscopic group and (145.3 +/- 27.4) min in open group (P<0.01); the mean operative blood loss was (7.5 +/- 4.2) ml in endoscopic group and (48.6 +/- 18.6) ml in open group (P<0.01); the average hospitalization after operation was (4.1 +/- 1.4) days and (8.0 +/- 1.9) days (P<0.01), the complication rate was 5.8% in endoscopic group and 8.8% in open group (P<0.01).@*CONCLUSION@#Compared to the traditional open surgery, endoscopic thyroidectomy is safe and effective,with advantages in terms of the aesthetic property,the amount of bleeding and the postoperative complications.