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凯纷与曲马多在患儿扁桃体和腺样体术中的镇痛效果

【摘要】 目的 总结凯纷与曲马多在患儿扁桃体和腺样体手术的镇痛效果及不良反应。 方法 2009年4月-2009年10月，将60例行扁桃体和腺样体摘除术患儿，随机分为A组（凯芬组）、B组（曲马多组）及C组（对照组）。A组于麻醉插管后手术开始前10 min静注凯纷1mg/kg，B组静注曲马多1 mg/kg，C组静注等量生理盐水。观察其拔管时间、苏醒期反应、恢复期疼痛评分、低血氧症的发生、恶心呕吐及术野区出血情况。 结果 3组患儿的拔管时间、术后低氧血症的发生率均无统计学意义。监测治疗室（PACU）中A、B组患儿的苏醒期躁动发生率及疼痛评分明显低于C组（Plt;0.05），且A组无恶心呕吐发生，B、C组恶心呕吐的发生率分别为11.1%和5%。 结论 凯纷及曲马多用于小儿扁桃体和腺样体手术均可获得良好的镇痛及镇静效果，并减少了拔管期的躁动发生且不增加拔管时间及术后低血氧症。但凯纷组患儿没有恶心呕吐发生，更适用于小儿的扁桃体；腺样体；手术。

REPAIR AND FUNCTIONAL RECONSTRUCTION OF OROPHARYNGEAL DEFECTS AFTER RESECTION OF ADVANCED-STAGE TONSILLAR CANCER

【Abstract】 Objective To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap. Methods Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2N1M0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm × 2 cm to 12 cm × 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases. Results The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8). Conclusion For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.

保留扁桃体的茎突截短术

目的　总结茎突综合征患者经口入路保留扁桃体的茎突截短术的方法及疗效。 方法　 回顾分析2003年3月－2011年10月收治的13例茎突综合征患者的临床资料。患者中单侧发病者 11例，双侧者2例；以咽痛前来就诊者11例，耳痛、耳鸣、咽部异物感2例，咽痛伴面部疼痛2例。所有患者均行经口入路保留扁桃体的茎突截短术。 结果　术后随访6个月以上，其中症状消失者11例，症状减轻者1例，无改善者1例。 结论　经口入路保留扁桃体的茎突截短术手术创伤小，出血少，术后患者反应轻，康复快；术中保留扁桃体，既保全了患者的免疫防御功能，又避免了切除扁桃体后由于咽部瘢痕挛缩引起咽部的不适。

扁桃体滤泡树突状细胞肉瘤一例

【摘要】　目的　总结滤泡树突状细胞肉瘤的临床表现，诊断，病理分析及治疗。　方法　2008年9-10月，对1例右扁桃体滤泡树突状细胞肉瘤患者，经CT、X线片查示确诊后，全麻下行双侧扁桃体切除术。　结果　术后病现学检查CD21（+），CD23（+），诊断为右扁桃体滤泡树突状细胞肉瘤，术后予CHOP方案化疗并行局部放疗。　结论　滤泡树突状肉瘤是一种罕见的肿瘤，确诊主要依靠免疫组织化学结果，手术是首选治疗，术后辅助放化疗效果目前不明确。

自发性低颅压综合征致小脑扁桃体下疝及硬膜下血肿护理一例

双歧杆菌乳杆菌三联活菌片对小儿化脓性扁桃体炎抗生素相关性腹泻的预防效果观察

目的探讨双歧杆菌乳杆菌三联活菌片预防小儿化脓性扁桃体炎抗生素相关性腹泻（ADD）的临床疗效。 方法选取2013年1月－2014年7月儿科住院诊断为化脓性扁桃体炎患儿300例，按入院先后顺序，采用随机数字表法分为对照组和干预组各150例，对照组常规给予抗生素和对症治疗；干预组在对照组常规治疗的基础上，给予双歧杆菌乳杆菌三联活菌片口服预防治疗，比较两组患儿住院期间ADD发生率。 结果干预组13例患儿发生ADD，发生率为8.67%；对照组29例患儿发生ADD，发生率为19.33%。干预组ADD发生率低于对照组，差异有统计学意义（χ2=7.087，P=0.008）。 结论双歧杆菌乳杆菌三联活菌片辅助治疗小儿化脓性扁桃体炎可预防抗生素治疗后引起的不良作用，提高患儿机体的免疫力，降低ADD的发生率。

the Complications and Surgical Skills of LowEnergy CO2 Laser Tonsillectomy

目的:探讨低能量CO2激光切除扁桃体切除术中手术技巧与并发症的关系,以改进手术技巧,减少手术并发症。方法:对我科51例低能量CO2激光扁桃体切除术的患者进行回顾性研究分析。观察、记录扁桃体切除所需手术时间、术中出血量、术后疼痛时间及程度、术后创面反应程度、术后再出血、术后术区瘢痕共6项指标。结果:低能量CO2激光扁桃体切除术主要的并发症是术后较轻的伤口疼痛、术中少量出血,无术后再出血及术后术区瘢痕。结论:低能量CO2激光扁桃体切除术,出血量少,术后疼痛小,反应轻,手术方法易掌握,提高手术技巧可进一步减少低能量CO2激光扁桃体切除术并发症,更好体现低能量CO2激光扁桃体切除术是扁桃体切除术中一种安全、有效、微创的术式。

Microsurgical Treatment for ArnoldChiari Malformation with Syringomyelia

目的：总结54例Chiari畸形合并脊髓空洞症的显微外科手术治疗经验。方法：本组对1998年9月至2005年9月共收治的54例Chiari畸形合并脊髓空洞症患者采用后路手术入路，对颅底凹陷症采用后路减压，显微镜下行小脑扁桃体软膜下部分切除，正中孔开放手术治疗。结果：54例患者术中观察发现延髓和上颈髓明显受压和不同程度同小脑扁桃体粘连，正中孔引流不畅；随访1月～7年，术后42例症状显著改善，12例明显改善；影像学复查提示脊髓空洞明显缩小。结论：显微外科手术治疗Chiari畸形合并脊髓空洞症疗效确切可靠。

扁桃体术后出血的原因分析及护理

目的分析扁桃体切除术后出血的原因，总结护理经验。 方法对2008年1月－2013年5月8例接受扁桃体摘除术并在术后发生伤口出血的患者资料进行回顾性分析，总结其扁桃体术后出血的原因及护理措施。 结果共1 183例患者接受扁桃体摘除术，8例发生术后出血，出血的发生率为0.68%。其中原发性出血5例，继发性出血3例，均经止血处理后康复出院。 结论发生扁桃体摘除术后出血，及时、准确的止血是治疗与护理的关键。良好的护理措施是减少并发症发生，促进患者早日康复的保证。

Effects of age and gender on posterior cranial fossa linear volume and cerebellar tonsil position in normal populations

ObjectiveTo investigate the effects of gender and age on the posterior cranial fossa linear volume and cerebellar tonsil position in normal populations.MethodsA total of 180 normal adults who underwent cervical MRI examination at the physical examination center were selected, including 90 males and 90 females; the age ranged from 20 to 79 years, with an average of 50.4 years. The posterior cranial fossa linear volume and cerebellar tonsil position were measured by two spine surgeons on the mid-sagittal plane of the cervical MRI T2-weighted image. The posterior cranial fossa linear volume included the length of clivus (AB), anteroposterior diameter of foramen magnum (BC), length of supraocciput (CD), anteroposterior diameter of posterior fossa (DA), posterior fossa height (BE), and clivus angle (∠α). The index of the cerebellar tonsil position was the distance from the lower edge of the cerebellar tonsil to the baseline (MN). The differences of each indicators between males and females were compared, and the correlations between age and each indicators were analyzed.ResultsThe posterior fossa cranial linear volume AB, BC, CD, BE, and ∠α in males were significantly larger than those in females (P<0.05); DA in males was larger than that in females, but showing no significant difference (t=1.978, P=0.050). The cerebellar tonsil position (MN) in females was higher than that in males, but showing no significant difference (t=0.526, P=0.600). Correlation analysis showed that age was negatively correlated with AB, BC, CD, DA, BE, ∠α, and MN (r=−0.375, P=0.001; r=−0.417, P=0.001; r=−0.046, P=0.001; r=−0.244, P=0.001; r=−0.326, P=0.001; r=−0.320, P=0.001; r=−0.334, P=0.001).ConclusionThe posterior cranial fossa linear volume of normal adults is significantly larger in males than in females; the posterior cranial fossa linear volume and the cerebellar tonsil position may have a decreasing process of age-related degeneration.