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颈前及咽喉横断性锐器伤的修复

报道了247例颈及咽喉腔切割伤的处理经验,分析不同损伤部位及其预后。强调减少术后并发症的关键在于急症手术时应细致修复咽喉腔的解剖结构。对常见合并症、死亡原因等进行了讨论。

Identification and protection of non-recurrent laryngeal nerve in thyroidectomy

Objective To explore anatomical features and variation of non-recurrent laryngeal nerve and to summarize identification method, operation skill, and damage treatment experience of it. Method The clinical data of 15 patients with non-recurrent laryngeal nerve in 4 054 patients who underwent thyroidectomy from our division by the same medical group from January 2006 to January 2016 were retrospectively analyzed. Results A total of 6 626 recurrent laryngeal nerve (left side 3 248, right side 3 378) were exposed in 4 054 cases. Fifteen patients with non-recurrent laryngeal nerve were detected with an incidence of 0.23% (15/6 626), all located on the right side. There were 3 males and 12 females. There were 3 cases of type Ⅰ, 10 cases of type Ⅱa, 2 cases of type Ⅱb. And 2 patients with non-recurrent laryngeal nerve were injured. Conclusions Incidence of non-recurrent laryngeal nerve is lower, most of which occur on right side of neck, there is a high injury rate for its special anatomical location. It’s key to prevent nerve injury for careful interpreting preoperative auxiliary examination results and improving awareness of non-recurrent laryngeal nerve, fining dissection, conventional exposuring recurrent laryngeal nerve, and accurate using nerve monitor during operation.

Treatment of Larynxderived Cough with Modified Zhisousan

目的：观察古方止嗽散加味治疗喉源性咳嗽的疗效。方法：采用加味止嗽散治疗喉源性咳嗽116例，并设西药对照组113例。结果：治疗组有效率87.3%，对照组有效率68.2%，两组比较有显著差异(Plt;0.01)。治疗组不良反应例数为零；对照组不良反应例数约占10.2%。结论：加味止嗽散具有疏风宣肺、清热解毒、利咽祛痰、益气养阴、扶正祛邪、抗病毒、抗菌、抗炎和增强免疫功能等功效，为治疗喉源性咳嗽的有效方药。

喉肿瘤切除会厌重建喉前壁22例

Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter

Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.

Clinical Application of Recurrent Laryngeal Nerve Protection and Monitoring During Thyroidectomy

Objective To investigate the clinical significance of visual identification and intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy. Methods Totally 1 664 patients underwent thyroidectomy with RLN protection from January 2009 to December 2009 were included in this study, in which 1 447 cases were protected by visual identification only, and 217 complex thyroidectomy cases were protected by visual identification and intraoperative monitoring. Results By the “multisites, three steps” RLN exposure method, 1 417 cases （85.16%） were successfully recognized and the recognition time was (3.57±1.26) min. The recognition time in the rest 30 complex cases (2.07%) without intraoperative neuromonitoring was (17.02±5.48) min. By this method, the temporary RLN injury occurred in 23 cases (1.54%) and 15 cases (65.22%) recovered within 2 weeks. In patients undewent intraoperative neuromonitoring, the recognition rate was 100% (217/217) and recognition time was (2.18±0.67) min. The temporary RLN injury occurred in 4 cases (1.84%) and 3 cases (75.00%) recovered within 2 weeks. All temporary RLN injuries recovered within 1 month and no persistent RLN injury occurred. Conclusions Conventional visual identification can reduce the RLN injury, but not meet the needs of the RLN protection during complex thyroidectomy. The combination of visual identification and intraoperative neuromonitoring can further improve the recognition rate and shorten the recovery time of vocal cord dyskinesia.

规律含漱对喉癌术后口腔pH值及口咽细菌的影响

目的探讨采用复方氯己定漱口液规律含漱对喉癌术后口腔pH值及口咽细菌的影响。 方法选择2011年5月－2012年10月收治的71例患者，按住院日期单双号分为观察组35例（单号），对照组36例（双号），对照组给予常规口腔护理2次/d，观察组在此基础上配合复方氯己定漱口液规律含漱，即术后每天07：00、11：00、12：00、16：00、20：00、22：00各含漱10 min。 结果术后第8天，观察组口腔pH值为（6.84±0.52）明显较对照组（5.37±0.62）趋于正常范围，组间比较差异有统计学意义（t=10.809，P=0.000）；观察组口咽细菌阳性2例，阳性检出率仅为5.71%，明显低于对照组阳性检出率27.78%，差异有统计学意义（χ2=6.151，P=0.013）；观察组并发症总发率为11.43%，对照组并发症总发生率为41.67%，两组口腔并发症发生率差异有统计学意义（χ2=8.279，P=0.004）。 结论采用复方氯己定含漱液进行规律漱口，能纠正口腔pH值，减轻口腔发生菌群繁殖，预防口腔并发症的发生，促进患者术后康复。

Effects of BQ123 on Carcinoma Angiogenesis of Implanted Laryngeal Carcinoma

摘要:目的: 探讨选择性内皮素A受体拮抗剂BQ123对人喉癌Hep2细胞裸鼠种植瘤的生长及血管形成的影响。 方法 :将实验动物裸鼠随机分为3组:BQ123［n =8,2mg/(kg·day)］、氟尿嘧啶组［n =8,2mg/(kg·day)］、生理盐水组(n =8),比较各组裸鼠成瘤体积、微血管密度(MVD)。 结果 :BQ123组肿瘤体积为(162±053)cm3,明显小于生理盐水组及氟尿嘧啶组,差异具有统计学意义;BQ123组的肿瘤组织中MVD高倍镜下为232,明显低于生理盐水组(586)及氟尿嘧啶组(395),差异具有统计学意义。 结论 :BQ123对人喉癌Hep2细胞在裸鼠体内有明显抑瘤作用,肿瘤的体积、肿瘤组织MVD显著低于对照组,表明BQ123可通过抑制肿瘤血管生成而显著抑制肿瘤生长。Abstract: Objective: To study the effects of endothelin A receptor blockade BQ123 on the implanted human laryngeal carcinoma angiogenesis of nude mouse. Methods : From March 2008 to July 2009, 24 Balb/c nude mice were randomly divided into three groups: BQ123 group ［〖WTBX〗n =8, BQ123 at 2mg/(kg·day)］, 5Fu group ［〖WTBX〗n =8, fluorouracil at 2mg/(kg·day)］ and the control group (〖WTBX〗n =8, normal saline). The carcinoma volume and microvascular density of each group were compared. Results : The tumor size of BQ123 group, which was (162±053)cm3 in average, was significant smaller than the tumor sizes of the other two group s. The average microvascular density score of the tumors in BQ123 group was 232 per hyper power len (HP), which was also significantly less than the average scores of control groups (586 and 395 respectively). Conclusion : Nude mouse experiments show that the carcinoma volume and microvascular density of BQ123 group are significantly lower than those of the control groups. BQ123 inhibits the growth of carcinoma by its inhibition of carcinoma angiogenesis.

Dissecting and clinical application of the external branch of the superior laryngeal nerve with endoscopic thyroidectomy via gasless unilateral subclavian approach

ObjectiveTo investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring. MethodsThe clinical data of 30 patients who underwent the gasless nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed. ResultsAll operations were successfully completed under endoscopy approach without transfer to open surgery. A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases, the revealed rate was 96.7%. The time for dissecting the external branch of the superior laryngeal nerve was 2–6 min [(3.6±2.3) min]. There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients. ConclusionFor the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring, excellent anatomical protection of the external branch of the superior laryngeal nerve can be obtained.

妇科腹腔镜手术通气策略的研究进展

腹腔镜在妇科手术中已被广泛应用，于妇科腹腔镜手术的麻醉研究也相应增多，而二氧化碳气腹引起的相关不良反应（高碳酸血症、低氧血症、呼吸机相关性肺损伤、术后认知功能障碍等）并未引起麻醉医生的高度重视。该文通过综述近年来妇科腹腔镜手术中不同通气策略（不同吸入氧浓度、适当增加分钟通气量、针对肥胖患者的几种通气模式以及喉罩通气策略）对患者的影响，旨在为妇科腹腔镜手术乃至其他科室的腹腔镜手术麻醉管理提供参考依据。