新型冠状病毒肺炎疫情下非疫情中心区域耳鼻咽喉头颈外科急诊防护的思考与建议

2019新型冠状病毒（SARS CoV 2）引起的肺炎具有较高的传染性，人群普遍易感，能通过飞沫及接触传播；气溶胶和粪-口等传播途径尚待明确。耳鼻咽喉头颈外科的急诊诊疗存在医患室内近距离接触，检查过程中患者喷嚏、咳嗽和恶心等反应均极易产生携带病毒的飞沫及气溶胶，且医患直接接触机会多，导致医患暴露风险明显增加。非疫情中心区域，大部分耳鼻咽喉头颈外科急诊患者多为无疫区接触及暴露的人群，如何在保障医疗安全和效果的同时，防范于未然、做好防护、避免医患院内感染显得尤为重要。     

新型冠状病毒肺炎疫情期间耳鼻咽喉头颈外科手术室管理策略

摘要：目的根据疫情期间耳鼻咽喉头颈外科医护人员面临的交叉感染风险和职业暴露危险，制订手术室管理策略，达到保障手术患者和医务人员安全的目的。方法2020年1月25日—2020年3月8日空军军医大学西京医院耳鼻咽喉头颈外科完成手术29例。手术室从人员、物资、手术、环境、安全防护等方面入手，制定严格的管理策略，规范手术实施，并对医护人员防护效果及患者围手术期状况进行评估。结果通过对患者术前临床观察以及直至术后14 d的跟踪随访，在29例手术中，无疑似、确诊和漏诊病例，无医护人员交叉感染，所有患者手术顺利，无围手术期并发症。结论制定严格有效的手术室管理策略，保证了疫情期间手术的正常及时开展，保护医护人员、手术患者安全有效，防止院内交叉感染的发生。     

新型冠状病毒肺炎疫情期间喉癌和下咽癌诊治的思考与建议

目前我国由2019新型冠状病毒（SARS-CoV-2）引起的肺炎疫情仍在持续，抗疫形势仍很严峻。新型冠状病毒肺炎（COVID-19）潜伏期较长、传染能力强、人群普遍易感，给医护人员、患者和人民群众都造成了严重威胁。耳鼻咽喉头颈外科中的喉癌和下咽癌患者在疫情下仍需进行限期处理，因此在做好COVID-19排查和防控工作后，合理选择治疗方式，根据不同的风险等级，做好医务人员自身的防护措施，协调手术各方，合理有序地开展手术治疗及患者术后的规范化管理，对疫情下救治喉癌和下咽癌患者具有重要意义。     

新型冠状病毒肺炎疫情下气管切开术适应证的总结与防护建议

2019年底，由新型冠状病毒（SARS CoV 2）引起的新型冠状病毒肺炎属于乙类传染病甲类管理，从武汉开始席卷全国，目前疫情还在持续。病毒主要通过呼吸道飞沫及接触传播，密闭环境下存在气溶胶传播可能，人群普遍易感；传染源主要是新型冠状病毒肺炎感染者，但无症状感染者也可能成为传染源；其潜伏期1~14 d，且部分患者可无明显症状。气管切开术，尤其是局麻下进行者，可产生大量飞沫和气溶胶，疫情期间存在巨大的院内感染的风险。本文依据国家卫健委新型冠状病毒肺炎相关的诊疗方案和措施，结合中南大学湘雅医院耳鼻咽喉头颈外科在隔离病房行气管切开术的经验，探讨新型冠状病毒肺炎疫情期间气管切开术的基本原则，总结不同类型患者的手术适应证，并提出在隔离区进行气管切开术时的操作及防护建议。     

新型冠状病毒肺炎疫情下耳鼻咽喉头颈外科住院手术流程及防护建议

2019新型冠状病毒肺炎(新冠肺炎)疫情发展迅速,防控形势持续严峻,耳鼻咽喉头颈外科作为医护人员防护难度高、感染风险大的高危科室之一,其住院手术诊疗流程也受肺炎疫情影响整体难以按常规开展。本文根据耳鼻咽喉头颈外科医生工作特点和复旦大学附属眼耳鼻喉科医院在本次新冠肺炎疫情防控工作中的实际情况,初步提出耳鼻咽喉头颈外科住院手术流程及防护相关建议,以供参考和讨论。     

新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染已被纳入《中华人民共和国传染病防护法》规定的乙类传染病,并采取甲类传染病预防控制措施。耳鼻咽喉头颈外科急症食管异物、呼吸道异物、鼻出血、喉阻塞合并呼吸困难及头颈部外伤发病率相对较高,部分可迅速危及生命的急症需紧急手术。本文根据新型冠状病毒肺炎诊疗方案(试行第五版),在疫情蔓延地区结合华中科技大学同济医学院附属协和医院耳鼻咽喉科急诊手术处理的经验,现总结制订了新型冠状病毒防控期间耳鼻咽喉头颈外科急症手术诊疗建议,以期在新型冠状病毒防控期间提高耳鼻咽喉头颈外科急症的救治成功率及减少或避免围手术期医护人员新型冠状病毒感染可能。     

耳鼻咽喉头颈外科应对新型冠状病毒疫情院内感染的防控策略及方法

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染疫情形势严峻,初步调查显示,在抗击疫情一线,武汉市各大医院耳鼻咽喉头颈外科几乎都有医护感染发生。为了应对2019-nCoV疫情对医护人员院内感染防控的巨大挑战,本文结合武汉市某医院耳鼻咽喉头颈外科在这方面的实践经验及教训,分享在疫情中,耳鼻咽喉头颈外科防控院内感染的策略和方法,期望有助于保护医护人员,维持疫情中日常医疗工作的运行,快速遏制疫情的蔓延。     

对耳鼻咽喉头颈外科医务人员新型冠状病毒感染防护的建议

目前2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染的疫情进入了一个严峻而复杂的局面。截至2020年2月1日,全国已有超过11000例新型冠状病毒感染确诊病例,给社会和经济带来极大影响,也严重影响着耳鼻咽喉头颈外科的日常医疗运行。本文针对耳鼻咽喉头颈外科的门诊及病房手术各个环节所需的医务防护措施进行讨论和建议,以期减少在2019-nCoV暴发和流行期间耳鼻咽喉头颈外科医护人员的感染。     

新型冠状病毒肺炎疫情下气道改道患者的气道防护措施

目的讨论新型冠状病毒肺炎疫情期间，对气道改道患者（气管切开术后或全喉切除气管造瘘）的气道防护措施。方法随访2018年1月—2019年12月在湘雅二医院耳鼻咽喉头颈外科行气管切开术未拔管及全喉切除气管造瘘患者122例，并在2020年1月22日—2020年2月18日疫情期通过建立微信群和电话随访方式对患者进行针对性的气道防护及宣教，收集患者日常活动信息及身体状况信息。结果截止至2020年2月18日，122例随访患者均未出现确诊病例。结论在呼吸道传染病疫情期间对气道改道患者进行针对性的气道防护指导，可以有效的降低此类患者的被感染率。     

耳鼻咽喉头颈外科医疗纠纷现状分析及防御对策研究

目的 通过分析耳鼻咽喉头颈外科诊疗特点以及医疗纠纷现状,提出针对耳鼻咽喉头颈外科医疗纠纷的防御对策及干预措施.方法 对医务人员和患者医疗纠纷的认识等情况以及既往医疗纠纷病例进行调查分析,提出减少或避免耳鼻咽喉头颈外科医疗纠纷的防御对策,并运用于临床.以2016年全年医疗纠纷数量及患者对医疗满意度等指标为对照组,2017...     

COVID-19 and ENT Pediatric otolaryngology during the COVID-19 pandemic. Guidelines of the French Association of Pediatric Otorhinolaryngology (AFOP) and French Society of Otorhinolaryngology (SFORL)

ObjectiveJoint guidelines of the French Pediatric Otolaryngology Society (AFOP) and of the French Society of otorhinolaryngology–head and neck surgery (SFORL) on the management of paediatric otolaryngology patients in the context of the COVID-19 pandemic.MethodsA nation-wide workgroup drew guidelines based on clinical experience, national and local recommendations and scientific literature. Proposals may have to be updated on a day-to-day basis.ResultsIn children, incidence of symptomatic COVID-19 (1–5%) is low and of good prognosis. The indications for nasal flexible endoscopy should be drastically limited. If undertaken, full Personal Protective Equipment (PPE) including FFP2 masks are required, as well as use of a sheath. Saline nose wash done by caregivers other than parents at home should require PPE. Unless foreign body tracheobronchial aspiration is clinically obvious, CT-scan should be performed to confirm indication of endoscopy. Surgical indications should be limited to emergencies and to cases that cannot be delayed beyond 2 months (especially endonasal, endopharyngeal laryngo-tracheobronchial procedures). Postponement should ideally be a group decision and recorded as such in the medical file. Surgical techniques should be adapted to limit the risk of viral dissemination in the air, avoiding the use of drills, microdebriders, monopolar cautery or lasers. Continuous suction should be placed near the operating field. In case of confirmed Covid-19 cases, or suspected cases (or in some centres systematically), PPE with FFP2 mask should be worn by all staff members present in the operating room.     

新型冠状病毒肺炎疫情下防喷溅面罩在发热隔离病房气管切开患者中的应用

目的在新型冠状病毒肺炎（COVID 19）疫情期间，观察防喷溅面罩在发热隔离病房气管切开患者（使用吸氧面罩）中的应用效果。方法选取2019年12月—2020年3月在发热隔离病房使用吸氧面罩的气切患者13例，使用自制的防喷溅面罩防止患者从气切处通过飞沫、气溶胶喷溅污染周围环境及医务人员等，观察使用前后患者对环境的污染度、呼吸频率、血氧饱和度及痰液黏稠度的变化。结果气切患者使用防喷溅面罩后，对环境的污染度明显少于使用前，差异具有统计学意义（P＜0.05)，患者呼吸频率均保持在16~20次/min，血氧饱和度均维持在95%~100%，气道湿化效果满意。结论防喷溅面罩可减少气道分泌物对环境的污染，在COVID 19疫情期可以对患者本身和相关医护人员进行防护。此方法不仅在COVID 19疫情期间可以使用，也可作为其他通过呼吸道传播的感染性疾病（如甲流等）及日常工作的防护手段。     

Review of practical recommendations for otolaryngologists and head and neck surgeons during the COVID-19 pandemic

IntroductionOtolaryngologists are at very high risk of COVID-19 infection while performing examination or surgery. Strict guidelines for these specialists have not already been provided, while currently available recommendations could presumably change in course of COVID-19 pandemic as the new data increases.ObjectivesThis study aimed to synthesize evidence concerning otolaryngology during COVID‐19 pandemic. It presents a review of currently existing guidelines and recommendations concerning otolaryngological procedures and surgeries during COVID-19 pandemic, and provides a collective summary of all crucial information for otolaryngologists. It summarizes data concerning COVID-19 transmission, diagnosis, and clinical presentation highlighting the information significant for otolaryngologists.MethodsThe Medline and Web of Science databases were searched without time limit using terms ‘‘COVID-19”, “SARS-CoV-2” in conjunction with “head and neck surgery”, “otorhinolaryngological manifestations”.ResultsPatients in stable condition should be consulted using telemedicine options. Only emergency consultations and procedures should be performed during COVID-19 pandemic. Mucosa-involving otolaryngologic procedures are considered high risk procedures and should be performed using enhanced PPE (N95 respirator and full face shield or powered air-purifying respirator, disposable gloves, surgical cap, gown, shoe covers). Urgent surgeries for which there is not enough time for SARS-CoV-2 screening are also considered high risk procedures. These operations should be performed in a negative pressure operating room with high-efficiency particulate air filtration. Less urgent cases should be tested for COVID-19 twice, 48 h preoperatively in 24 h interval.ConclusionsThis review serves as a collection of current recommendations for otolaryngologists for how to deal with their patients during COVID-19 pandemic.     

Safe tracheotomy for patients with COVID-19

Patients affected by severe acute respiratory syndrome coronavirus 2 disease (COVID-19) with respiratory distress may need invasive mechanical ventilation for a long period of time. Head and neck surgeons are becoming increasingly involved in the care of COVID-19 patients because of the rapidly increasing number of tracheotomies required. This procedure, when performed without protection, may lead to the infection of the medical and nursing staff caring for the patient.The aim of this report is to share our protocol for performing a safe surgical tracheotomy in COVID-19 patients. Infection of the nursing/medical staff involved in the first 30 tracheotomies performed in patients affected by COVID-19 in the Intensive Care Unit of a tertiary referral center were evaluated. Mistakes that occurred during surgery were analyzed and discussed. None of the nursing/medical staff presented signs or symptoms of COVID-19 within 15 days after the procedure.Conclusion: The authors have prepared a protocol for performing a safe surgical tracheotomy in patients affected by COVID-19. Surgeons who might be involved in performing the tracheotomies should become familiar with these guidelines.     

首发于头颈部的Rosai-Dorfman病临床分析

目的探讨首发于头颈部的Rosai Dorfman病（Rosai Dorfman disease,RDD）临床表现、治疗方法及预后。方法回顾性分析1986~2017年收治的首发于头颈部的RDD患者10例,分析其一般情况、临床表现、病理特征、治疗经过及预后。结果10例首发于头颈部的RDD患者中男6例,女4例,确诊RDD时中位数年龄为36.5岁（22~77岁）。病变累及最多的部位为鼻部（8例）、喉部（6例）,其中8例为≥2个部位受累。RDD临床表现与病变累及的部位及范围有关。治疗多采用激素+手术切除。中位数随访时间89个月（3~384个月）,1例失访,1例治愈,其余8例带病生存。结论确诊RDD的患者需进行耳鼻咽喉科详尽的检查。患者的临床表现及影像学检查缺乏特异性。病理及免疫组织化学检查可确诊。采用激素+手术治疗的方式患者全身情况及头颈部病变可基本稳定,但仍需长期随诊。一般预后良好.     

Otolaryngology during COVID-19: Preventive care and precautionary measures

Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery. Therefore, infection prevention and control measures for this specialty are essential. Literatures on the epidemiology, clinical characteristics and infection control measures of COVID-19 were reviewed, practical knowledge from first-line otolaryngologists in China, the United States, and Brazil were reviewed and collated. It was recommended that otolaryngology professionals should improve screening in suspected patients with relevant nasal and pharyngeal symptoms and signs, suspend non-emergency consultations and examinations in clinics, and rearrange the working procedures in operating rooms. The guidelines of personal protective equipment for swab sampling, endoscopy and surgery were listed. Indications for tracheotomy during the pandemic should be carefully considered to avoid unnecessary airway opening and aerosol-generation; precautions during surgery to reduce the risk of exposure and infection were illustrated. This review aimed to provide recommendations for otolaryngologists to enhance personal protection against COVID-19 and reduce the risk of nosocomial infection.     

NBI flexible laryngoscopy targeted tissue sampling in head and neck cancer patients with difficult airways

Direct suspension laryngoscopic biopsy of neoplasms in larynx, oropharynx, and hypopharynx was an arduous procedure in patients with a history of head and neck cancer and difficult airways. This preliminary study was aimed to report the efficacy and safety of a narrow band imaging-guided biopsy of this category by flexible laryngoscopy. This is a retrospective chart review study conducted in setting of tertiary referral centre. Nineteen consecutive head and neck cancer patients with difficulty in general anesthesia and rigid endoscopic approach due to trismus, craniofacial deformities, and/or limited neck extension after cancer therapy were referred for endoscopic biopsy of their suspicious lesions in larynx, hypopharynx, or parts of oropharynx. Following topical anesthesia, a flexible laryngoscope was introduced through the nose into the pharynx. Under narrow band imaging magnified view, the specified tumor foci were biopsied in an office-based setting. All of the lesions were reached and biopsied to obtain sufficient tissue samples. The procedure took <20 min in every case. Twelve of the 19 pathologic examinations disclosed the malignancies at the first biopsy, and another underwent a second biopsy to prove cancer recurrence. The other six patients with benign lesions received further follow-up for at least 6 months and showed no recurrence. There were no complications associated with the technique. This study introduced that flexible laryngoscopy with narrow band imaging has the advantages of nimbleness, precision, and minimal morbidity. This combined technique may be a safe and promising method for tissue sampling of suspicious recurrence in head and neck cancer patients with difficult airways.