目的 探讨T3期喉癌采用支撑喉镜下CO2激光切除术和部分喉切除术两种手术治疗方式的临床治疗效果。 方法 将2003年8月－2010年7月收治的31例患者按所接受手术方式分为A、B两组（非随机分组），A组16例中男15例，女1例，年龄38～72岁，中位年龄51岁；B组15例，均为男性，年龄46～68岁，中位年龄58岁。病变均累及前联合，A组10例和B组11例累及对侧声带约1/3。A组选择支撑喉镜下CO2激光切除术，B组选择气管切开＋部分喉切除术。两组患者首次术后均未接受放射（放疗）或化学治疗（化疗）。术后第1、3、6、12、24个月门诊纤维喉镜复查。随访时间14～78个月。 结果 A组5例复发或颈部淋巴结转移，复发率31.3%；5例患者均行再次手术、颈清扫及放、化疗。B组4例复发，复发率26.7%；4例均行全喉切除双侧选择性颈清扫术，其中3例术后辅以放、化疗。两组复发率比较差异无统计学意义（P＞0.05）。 结论 采用支撑喉镜下CO2激光切除治疗T3期喉癌，有望得到类似部分喉切除的临床治疗效果。
ObjectiveTo evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. MethodsBetween November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years (range, 35-65 years). All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours (range, 1-48 hours). Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot and ankle score system at last follow-up. The range of motion (ROM) of the ankle and complications were also been recorded. ResultsDelayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average (range, 12-24 months). Radiographic examination demonstrated the mean time of bone healing was 12 weeks (range, 10-14 weeks). No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6±6.5, and the VAS score was 1.3±1.5. The ROM of the ankle was (70.0±8.0)° of flexion and (84.0±5.1)° of extension. ConclusionDual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence, so it is a safe and effective method.
Objective To explore the appl ication of submental island flaps in repairing pharyngeal fistula after total laryngectomy. Methods From July 2002 to February 2006, 9 cases of concomitant pharyngeal fistula (including 7 cases of laryngeal carcinoma and 2 cases of hypopharyngeal neoplasms) were repaired with submental island flaps after total laryngectomy. All patients were male and their ages were 52-71 years (mean 61.8 years). Pharyngeal fistula occurred 5-62 days (mean 14.7 days) after total laryngectomy. The diameter of medial pharyngeal fistula ranged from 1.9 cm to 4.1 cm. All patients failed to respond to conservative therapy for 25-46 days. The size of submental island flap was 2.5 cm × 2.4 cm to 4.6 cm × 4.0 cm. After the pharyngeal fistula were repaired with submental flap, the donor site were sutured directly. Results All of the nine submental flaps were survived and no local necrosis or wound infection occurred. Incision at donor site healed by first intention and no obvious scar formed. Fistula occurred 10 days after operation and was cured after symptomatic treatment in one patient who received radiotherapy before operation; other patients achieved the satisfactory results of one-stage repair. The gastric tube was pulled out 14 to 22 days after operation, all of the patients have no sense of swallow obstruction. Nine patients were followed up for 10-38 months (mean 27 months). The ppearance of neck was satisfactory. Conclusion Because of its short distance, abundant blood supply, convenient operation and minimal donor-site morbidity, the submental island flap is a good alternative mthod in repairing pharyngeal fistula.
Objective To explore the effectiveness of detailed physiotherapy in perioperative rehabilitation of patients undergoing thyroid cancer surgery with lymph node dissection. Methods A total of 97 patients with thyroid malignancy who underwent surgical treatment in West China Hospital of Sichuan University between February and June 2021 were selected and randomly divided into the trial group (n=50) and the control group (n=47). The patients in the trial group received detailed physiotherapy, and the patients in the control group received routine perioperative rehabilitation. The degree of pain within the operation area and the degree of neck and shoulder discomfort associated with surgery within 4 weeks, and the scores of Neck Dissection Impairment Index 4 weeks after surgery were compared between the two groups. The pain score, which was non-normally distributed, was described by median (lower quartile, upper quartile) and compared by generalized estimation equation; the discomfort score and score of Neck Dissection Impairment Index, which were normally distributed, were described by mean ± standard deviation, and the former was compared by multivariate analysis of variance, and the latter was compared by Student’s t-test. Results In the 1st, 2nd, 3rd, and 4th week after surgery, the pain scores within the operation area were 2.2 (1.7, 3.3), 1.5 (1.0, 2.2), 1.5 (0.0, 2.3), and 0.0 (0.0, 1.2), respectively in the trial group, and 3.4 (2.7, 5.2), 2.6 (1.5, 3.5), 2.4 (1.1, 3.4), and 1.5 (1.1, 2.0), respectively in the control group; the surgery-related neck and shoulder discomfort scores were 8.72±4.14, 5.28±2.98, 5.89±2.78, and 3.57±1.83, respectively in the trial group, and 10.56±5.30, 7.54±4.51, 7.37±3.49, and 5.05±2.59, respectively in the control group. Within 4 weeks after operation, the surgical-area pain scores and surgery-related neck and shoulder discomfort scores in the trial group were lower than those in the control group, and the differences were statistically significant (Wald χ2=28.826, P<0.001; F=7.695, P=0.007). In the post-operative week 4, the Neck Dissection Impairment Index in the trial group was higher than that in the control group, and the difference was statistically significant (75.23±20.40 vs. 63.83±19.52; t=2.809, P=0.006). Conclusion For patients undergoing thyroid cancer surgery with lymph node dissection, detailed physiotherapy intervention is more effective than routine perioperative rehabilitation.
Objective To investigate the diagnostic value of esophageal high-resolution manometry combined with salivary pepsin levels in laryngopharyngeal reflux disease (LPRD). Methods The patients with the chief complaint of “throat discomfort” for treatment at the Department of Otolaryngology, Head and Neck Surgery, the First People’s Hospital of Longquanyi District, Chengdu / West China Longquan Hospital Sichuan University between January and October 2022 was selected. According to the reflux findings score and refluxsymptomindex at admission, the enrolled patients were divided into LPRD group and non-LPRD group. The basic patient information, esophageal high resolution manometry, and salivary pepsin concentration of included patients were collected. Results A total of 112 patients were included. Among them, there were 68 cases (60.7%) in the LPRD group and 44 cases (39.3%) in the non-LPRD group. The LPRD group was significantly younger (P=0.007) , but the salivary pepsin concentration (P<0.001), upper esophageal sphincter (UES) resting pressure (P<0.001) and distal contractile integral (P=0.007) were all higher than the non-LPRD group. The results of multivariate logistic regression analysis showed that salivary pepsin concentration [odds ratio (OR)=1.077, 95%CI (1.035, 1.120), P<0.001] and UES resting pressure [OR=1.035, 95%CI (1.019, 1.052), P<0.001] were independent factors for the diagnosis of LPRD. The area under the working curve (0.971), specificity (0.99), and sensitivity (0.77) in the combined index were higher than those of saliva pepsin concentration and UES resting pressure. Conclusion Esophageal high resolution manometry and salivary pepsin are significant for the diagnosis of LPRD, and their combined application can improve the diagnostic value and also serve as an alternative method for the diagnosis of LPRD.