[Cervical esophagostomy improves the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma].

OBJECTIVE: To evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects. METHODS: 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. RESULTS: 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). CONCLUSION: Cervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.

[Treatment for benign thyroid nodules with hoarseness as primary symptom].

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.

[Clinical reseach of early laryngocarcinoma treatment by carbon dioxide laser microsurgery].

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) . The rate of local recurrence rate of anterior commissure involvement was 7.14% and that was 7.14% when this site was not compromised by the tumor, which has no statistically significant differences (chi2 = 0.000, P > 0.01). CONCLUSION: According to our reaserch, endoscopic CO2 laser sur gery is an effective treatment for early laryngocarcinoma.

Modified endoscope-assisted partial-superficial parotidectomy through a retroauricular incision.

OBJECTIVES: The aim of this study was to evaluate the feasibility of an endoscope-assisted partial parotidectomy through a modified retroauricular incision. PATIENTS AND METHODS: Thirty patients with benign parotid superficial lobe tumors with a diameter of 2.4 ± 0.5 cm, located in the anterior portion of the inferior auricular lobule, underwent an endoscope-assisted partial-superficial parotidectomy. A retrograde approach through a small skin incision was used. An additional 30 patients who underwent conventional surgeries were used as controls. The operation time, operative bleeding volume and subjective satisfaction with the incision scar were compared between the groups. RESULTS: All operations were successfully performed. The endoscopic surgery duration (74.8 ± 15.7 min), bleeding volume (12.7 ± 3.9 ml) and incision length (4.8 ± 0.4 cm) differed between the groups (p = 0.001). The mean patient satisfaction score was 8.6 ± 1.2 in the endoscope-assisted surgery group and 5.4 ± 1.3 in the control group (p = 0.001). There were no tumor recurrences during the 9-36 months of follow-up. CONCLUSION: Endoscope-assisted partial-superficial parotidectomy via a modified retroauricular incision is a feasible method for the treatment of benign parotid superficial lobe tumors located in the anterior portion of the inferior auricular lobule. The main advantage of this procedure was that the small operative scars improved the cosmetic results.

Endoscope-assisted second branchial cleft cyst resection via an incision along skin line on lateral neck.

The aim of the study is to report the feasibility of endoscope-assisted second branchial cleft cyst resection via a small incision along the skin line on the lateral neck. In total, 41 patients from the Department of Otolaryngology, Foshan Hospital of Yat-sen University were randomly assigned to conventional (20 patients) or endoscope-assisted (21 patients) second branchial cleft cyst resection. The patient clinical characteristics, operation time, operative bleeding volume, postoperative complications, and subjective satisfaction with the incision scar (measured using a visual analog scale) were compared between the groups. All 41 s branchial cleft cyst resections were successfully performed, and the wounds healed uneventfully. The bleeding volume (6.3 ± 2.5 ml) and incision length (2.7 ± 0.3 cm) differed between the groups (P < 0.00). The mean patient satisfaction score was 8.0 ± 0.8 in the endoscope-assisted surgery group and 6.4 ± 0.9 in the control group (P < 0.00). All of the patients in the endoscope-assisted surgery group were satisfied with their cosmetic results. No marginal nerve palsy occurred. No complications such as bleeding, salivary fistula, or paresis of the marginal mandibular branch occurred. All of the patients were disease free through a follow-up period of 6-24 months (median: 14 months). Endoscope-assisted second branchial cleft cyst resection via a small incision along the dermatoglyph on the lateral neck is a feasible technique. This procedure may serve as an alternative approach, allowing a minimally invasive incision and better cosmetic results.

[Cervical chronic radiation ulceration reconstruction with flap after radiotherapy for nasopharyngeal carcinoma].

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.

[Study on the height and weight in children with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To investigate the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) on children's growth. METHOD: Fifty-three children diagnosed as OSAHS were included in the treatment group and underwent tonsillectomy or adenoidectomy, and 51 normal children were employed as the control group. Main data monitored by PSG and growth hormone (GH) in children of the treatment group were recorded before and after surgery, in addition, growth hormone, height and weight of children in the treatment group and control group were respectively recorded and compared. RESULT: Height and weight of children with OSAHS before treatment were lower than that of the normal children and the difference was significant (P<0.05). Compared with the data before surgery, oxygen saturation of blood in children of treatment group recorded by PSG increased (P<0.05), while value of other data decreased (P<0.05). Growth hormone in children of the treatment group was lower than that of the control group and the difference between two group was significant (P<0.05), while the content of growth hormone in children of the treatment group elevated after 3 months postoperatively and at this time no difference was found between the two groups. CONCLUSION: Children with OSAHS present the symptom of upper airway obstruction, which badly affects sleep quality and results in decreased secretion of growth hormone and finally the height and weight of children is got involved. Timely surgery is necessary to alleviate the symptom.

[Comparative study of endoscopic and open thyroidectomy].

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.

[An experimental study of mucociliary clearance of trachea reconstructed with free jejunum].

OBJECTIVE: To investigate tracheal mucociliary transport change after reconstructed with free jejunum. METHODS: Twelve canine models of extensive circumferential tracheal defects reconstructed with revascularized jejuno combined with Ni-Ti alloy mesh tube were established. Every canine model was marked in cervical skin projecting the lower resected margin of trachea lumen and was injected 50% barium sulfate mucilage as a tracer into the trachea lumen under bronchoscopy. Record the time from tracer injected into trachea lumen to its arriving glottis (mucociliary transit time, MTT) and the length from tracer injected into trachea lumen to glottis (mucociliary transport length, MTL). Mucociliary transit rate (MTR), as MTL/ MTT, was calculated. The same procedure was performed at preoperative and postoperative 7th day, 1 month, 3 months and 6 months. RESULTS: There were statistical significance between preoperative MTR and 1 month postoperative MTR (P < 0.05). There were no differences between preoperative MTR and postoperative MTR at the 7th day, 1 month, 3 months and 6 months. There were also no differences between postoperative MTR at the 7th day and 1 month, 3 months and 6 months. CONCLUSION: In new tracheal tract reconstructed with free jejunum, MTR becomes normal at 3 months postoperatively.

[18F-FDG PET in the diagnosis of head and neck tumor].

OBJECTIVE: To analyze the value of 18F-FDG PET in the diagnosis of patients suspected of having head and neck malignant tumor. METHOD: Seventy-five cases patients suspected of having head and neck cancer or recurrence were analyzed retrospectively. 18F-FDG PET was performed in all cases. The results of some cases were compared with CT and MRI. RESULT: 18F-FDG PET yielded a sensitivity 91.30% and specificity 76.92% and accuracy 86.11% in the diagnosis of nasopharyngeal carcinoma; sensitivity 100.00% and specificity 83.33% and accuracy 94.44% in esophageal carcinoma; sensitivity and specificity and accuracy 100% in thyroid carcinoma, laryngeal carcinoma and hypopharyngeal carcinoma. CONCLUSION: Preliminary clinical application of 18F-FDG PET has demonstrated its significant advantages in evaluating head and neck malignant diseases.

[Experimental reconstruction of the canine trachea with shape-memory titanium-nickel alloy stent coupled with free jejunal graft].

OBJECTIVE: To explore the reconstruction method of extensive circumferential tracheal defects longer than 6.0 cm and evaluate the influence on pulmonary function from jejunal secretion. METHODS: Jejunal secretion model without extraneous nerve were established. 10 mongrel dogs were randomly divided into two groups. In group A, the nude stent made by shape-memory titanium-nickel alloy (SMA stent) was placed in the interior of the intestinal lumen. In group B, the SMA stent with silicone membrane was placed in the interior of the intestinal lumen. The secretion and histological chance of these jejunal were observed regularly. The cervical tracheal segment (6.5 cm) was replaced by the intestinal graft. In group C (6 mongrel dogs), the nude stent made by SMA stent was placed in the interior of the intestinal lumen. In group D (6 mongrel dogs and 6 Beagle dogs), the SMA stent with silicone membrane was placed in the interior of the intestinal lumen, the nude "C-shaped" SMA stent was placed out of the intestinal lumen, and the silicone stent was removed the fourth week after operation. In group C and group D, endoscopic and histological examinations were performed between the first week and eighth month. RESULTS: The secretory peak of Jejunal secretion model without extraneous nerve ranged from the first day to seventh day after operation. The jejunal secretion reduced gradually from 7th days after operation. The jejunal secretion remained steady after postoperative two months. In group C, endoscopic examination showed heavy proliferation of granulation in the tracheo-intestinal anastomosis. 4 dogs died between seventh day to second month. In group D, one dog died from ileus third month after operation. The other all survived operation. Gentle pneumonia happened to some dogs during 1-2 months after operation by X-ray examination. No one died of pneumonia result from hypersecretion. CONCLUSIONS: Reconstruction of the canine trachea with SMA stent with silicone membrane placed in the interior of the intestinal lumen together with the nude "C-shaped" SMA stent placed out of the intestinal lumen achieve satisfactory effect, the reconstructed trachea remain unblocked and this method of tracheal reconstruction may be relatively perfect and be expected for clinical application in future. The jejunal secretion didn't have severe influence on pulmonary function of experimental canine and couldn't cause experimental canine death.

[Modified type I thyroplasty for treating unilateral vocal cord paralysis].

OBJECTIVE: To explore a new surgical approach for treating unilateral vocal cord paralysis. METHODS: Five cases of unilateral vocal cord paralysis due to various causes were treated with modified type I thyroplasty. Laryngostroboscopy and electroglottography were performed before and after the operations. RESULTS: The vocal cords were shifted very close to the median line in all the 5 cases postoperatively as shown by laryngostroboscopy and electroglottography. Complete closure of the glottis was achieved. The patients had almost normal results of electroglottography, and the vocal sound nearly recovered normal or was significantly improved. CONCLUSION: Modified type I thyroplasty is effective, safe and easy in treating unilateral vocal cord paralysis.