喉癌术后喉狭窄患者喉重建术后的嗓音分析

目的:分析喉癌术后喉狭窄患者行颈前旋转肌皮瓣喉重建术后的嗓音康复情况.方法:应用Dr.Speech嗓音分析系统对19例喉癌术后喉狭窄患者喉重建术后的嗓音参数,包括基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)及声门噪声能量(NNE)值进行分析,并与喉重建术前以及成人喉乳头状瘤15例、声带息肉20例、正常人20例进行对比.结果:喉癌术后喉狭窄患者喉重建后的F0较术前有显著上升(P＜0.05),而Jitter、Shimmer及NNE值较术前均明显下降(P＜0.05);F0较喉乳头状瘤组有显著下降(P＜0.05);与声带息肉组相比,F0、Jitter均显著下降(P＜0.05);与正常组比较,Jitter、Shimmer及NNE值均明显上升(P＜0.05).结论:喉癌术后喉狭窄患者行颈前旋转肌皮瓣喉重建术后的嗓音较术前有明显改善,能获得较好的嗓音功能.     

喉部分切除转门肌皮瓣喉重建术的嗓音学观察

目的:观察声门癌扩大部分喉切除转门肌皮瓣修复缺损喉腔术后患者的嗓音恢复情况.方法:应用计算机Dr. Speech嗓音测试康复系统嗓音分析法评价患者手术前后的嗓音变化.结果:术后1个月,患者嗓音各项参数值(Jitter、Shimmer及NNE)与术前相比略差,但除NNE (P<0.05)外均无统计学意义(P>0.05);术后半年,患者嗓音各项参数值综合评价好于术前.结论:转门肌皮瓣修复扩大部分喉切除术后喉腔缺损,可获得较好的嗓音质量.     

声门型喉癌患者喉部分切除术后发声功能评估

目的:研究声门型喉癌患者喉部分切除发音功能重建术式与术后嗓音质量的关系。方法:采用Dr.Speech4.0嗓音分析软件,对48例声门型喉癌喉部分切除采用室带下拉、双蒂接力肌、颈阔肌皮瓣修复术患者术前1天、术后6个月、术后1年行发声功能测试,对基频、频率微扰、振幅微扰、标准化噪声能量、最大发声时间进行分析。结果:各组患者术后嗓音质量逐渐好转,术后6个月～1年嗓音逐渐进入稳定期。结论:发声功能恢复与手术方式及重建方法密切相关,创伤大小、修复体功能特性、新声门形态以及发音时新声门能否良好闭合等因素直接影响着术后嗓音质量。手术修复应尽量减少术后声门上结构代偿振动参与发音导致的嗓音质量下降。     

全喉切除术后喉再造3例

喉再造术是利用颈前转门肌皮瓣技术 ,恢复因喉部恶性肿瘤行全喉切除术后患者喉的发音功能、吞咽功能、呼吸功能 ,通过锻炼恢复经鼻呼吸 ,恢复嗅觉 ,加强味觉等的一种术式。 2 0 0 1年 11月至 2 0 0 1年 12月我院耳鼻咽喉科实施此项手术 ,通过 3例喉再造手术治疗 ,患者成功恢复了喉的呼吸、吞咽保护和发音三大功能。现报告如下。1　临床资料1 1　病例报告例 1,男 ,5 6岁。因声带癌于 1998年 5月在外院行全喉切除术 ,术后放疗 3次 ,量不详 ,未做化疗 ,曾行“发音扣手术”失败 ,现偶有食道音。术前一般情况良好 ,心肺腹检查未见明显异常 ,辅助…     

改良垂直部分喉切除术治疗声门型喉癌的疗效观察

目的 探讨改良垂直部分喉切除术治疗声门型喉癌临床疗效.方法 选取商丘市第一人民医院2011年1月至2014年8月收治声门型喉癌患者共70例,采用随机区组法分为常规组35例和改良组35例.常规组患者采用常规垂直部分喉切除术,改良组患者采用改良垂直部分喉切除术,比较两组患者发音功能和吞咽功能恢复情况、术后拔管率及随访24个月患者生存率等.结果 改良组患者发音功能和吞咽功能恢复有效率高于常规组,差异有统计学意义(P<0.05);改良组患者术后拔管率高于常规组,差异有统计学意义(P<0.05);两组患者出院后随访24个月,两组患者生存率比较差异无统计学意义(P>0.05).结论 相较于常规垂直部分喉切除术,改良垂直部分喉切除术治疗声门型喉癌可有效促进发音功能、吞咽及呼吸功能恢复,改善生活质量,且不降低远期生存率.     

水平垂直部分喉切除术疗效分析

探讨29例T3期声门上型和跨声门型喉癌,行水平垂直部分喉切除术治疗声门上型和跨声门型喉癌的疗效.结果:3年生存率为72.4%,5年生存率为48.3%,术后3个月拔管率为96%.在正确掌握手术适应证和喉重建技巧,水平垂直半喉切除术3～5年生存率不低于全喉切除术,并且保留了吞咽和发音功能.     

喉部分切除术后喉功能重建60例临床分析

目的：探讨喉部分切除术后喉功能重建方法的选择与应用。方法：对60例T2、T3及T4喉癌患者行喉部分切除术的术式及修复方法进行了回顾性分析。结果：60例中58例获得随访,主要应用颈前皮瓣、喉腔及梨状窝黏膜、胸舌骨肌膜瓣、甲状软骨膜及会厌软骨等修复喉结构,总体术后拔管率为81.7%,均获得了较好的吞咽及发音功能。喉声门区癌和喉声门上区癌3年和5年生存率分别为87.5%、70%和65%、50%。结论：在彻底切除病变的基础上,尽可能保留正常喉组织,保全喉功能,有利于患者恢复良好的吞咽和发音功能,提高了患者的生存质量。     

喉部分切除术治疗喉癌的探讨(附11例报道)

本文报告喉部分切除术治疗喉癌11侧,其中声门上癌4例,声门癌6例,梨状窝癌1例。病理类型鳞癌10例,腺癌1例。UICC 的TNM 分类法T_1N_0M_0 4例,T_2N_0M_0 5例,T_3N_0M_0 1例,T_3N_1M_0 1例。施行术式包括喉裂开术,侧前半喉切除术、水平上半喉切除术、喉次全切除加发音重建、梨状窝癌切除加同侧颈淋巴结清扫术等。术后无严重并发症,喉功能保存良好,全部恢复吞咽功能,喉发音100%。随访5个月至5年,3年生存率54.5%(6例)。     

喉部分切除声门重建术：附11例报告

报告喉部分切除声门重建术11例,均为喉声门区T_1～T_2鳞状上皮癌,其中1例伴有一侧喉咽部侵犯,还加作颈功能廓清术。所有病例采用本术治疗,喉功能(呼吸、吞咽、发音)恢复满意,随访1/2～4年无一例复发。     

V形喉硅胶膜在声门型喉癌中的应用研究

目的分析T形与V形喉硅胶膜在早期声门型喉癌喉裂开术后的应用价值。方法收集2012年7月至2015年3月我院收治的早期声门型喉癌(T1~T2期)行喉裂开病变切除术共60例,34例术后放置T形硅胶膜,26例放置V形喉硅胶膜。对比两组患者术后的疼痛程度、呼吸功能、发音功能、吞咽功能及黏膜的恢复等情况。结果两组患者术后疼痛程度(NRS)评分比较,差异有统计学意义(P<0.05)。两组在胃管拔除时间上T形膜组时间长于V形膜组(P<0.05)。T形膜组发音质量(VHI)与V形组相比差异有统计学意义(21.13±6.10 Vs18.36±7.28,P<0.05),嗓音总嘶哑度评估中,两组大部分为轻中度异常,差异有统计学意义(82.35%Vs96.15%,P<0.05)。结论本研究显示喉硅胶膜置入能有效避免声门型喉癌喉裂开术后瘢痕形成而引起喉狭窄,V形硅胶膜则是从声门正常的结构考虑能更有效恢复患者的嗓音学状态,术后痛苦小、恢复快、并发症少,术后喉功能保全良好,提高了患者的生存质量。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.