To investigate time of delayed reinnervated laryngeal muscle, 15 dogs were divided into two groups. The right recurrent laryngeal nerves of 10 dogs in experimental group were cut, and repaired at 4, 6, 8, 10 and 12 months intervals by transposition of the phrenic nerve to the recurrent laryngeal nerve after cutting and suturing the adductor branch to the main branch of ansa cervicalis. The right recurrent laryngeal nerves of 5 dogs in control group were cut, but did not repair. Laryngoscope, electromyography, contractile tension of laryngeal muscle and histologic studies were performed at six months postoperatively. The results showed that fair recovery of adduction and abduction was noted within ten months interval, and the effect of adduction was better than that of abduction. The effect decreased gradually with the denervated time increased. The conclusion demonstrated that delayed reinnervation of laryngeal muscle should be performed within ten months.
Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages, disadvantage, and indication of each material. Methods The cl inical data were retrospectively analyzed, from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006. There were 229 males and 108 females aged from 2 to 54 years (median, 23.5 years). According to Cotton’s grading criteria for laryngotracheal stenosis, there were 94 cases of grade II, 218 cases of grade III, and 25 cases of grade IV, and all accompanied by laryngotracheal framework defect of 1-5 cm. The costal cartilage autograft was performed in 157 cases, thyroid cartilage graft in 27 cases, nasal septal cartilage graft in 8 cases, sternohyoid myocutaneous rotary door flap graft in 104 cases, hyoid bone flap of sternocleidomastoideus graft in 7 cases, musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases, hydroxyapatite artificial tracheal ring graft in 10 cases, and pedicle myocutaneous flap with “C” shape nickel-titanic alloy net graft in 3 cases. Silastic T-tube was used after reconstruction for 6-12 months. Results Infection occurred in 5 cases and the incisions healed by second intention, the others achieved healing of incision by first intention. Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases; they were all cured after symptomatic treatment. After operation, 4 cases failed to be followed up and 12 cases did not recover, including 6 cases of costal cartilage autograft, 1 case of hyoid bone flap of sternocleidomastoideus graft, and 5 cases of sternohyoid myocutaneous rotary door flap graft. A total of 321 patients were followed up for 1-10 years (mean, 3.5 years). The patients had no laryngotracheal restenosis with good swallowing function and respiratory function. Conclusion Different materials of laryngotracheal framework reconstruction have advantages and disadvantage respectively. The appropriate material should be selected according to the special details of pathological change, and the satisfactory curative effect may be obtained.
目的 探讨反义ATM多核苷酸（AS-Lipo）作用于裸鼠移植瘤对喉鳞状细胞癌(Hep-2)放射治疗敏感性的影响。 方法 用克隆生存率来检测喉鳞状细胞癌放射治疗后的生存能力；用流式细胞仪来分析喉癌细胞的凋亡情况；用Tunel染色法检测各组瘤体中细胞凋亡情况。 结果 在同等剂量的放射治疗下，AS-Lipo组的生存分数最低。接受4 Gy放射治疗后，行流式细胞仪检测，结果发现AS-Lipo组的凋亡率为（30.7 ± 1.31）%，远高于转染Sen-Lipo、Mis-Lipo、Lipo组。ATM AS-Lipo+放疗组的细胞凋亡数显著高于单独放射治疗组；ATM AS-Lipo+放射治疗组裸鼠瘤体内的凋亡指数为（17.12 ± 4.2）%，与其他组比较差异有统计学意义。 结论 反义ATM多核苷酸增强了裸鼠喉鳞状细胞癌对放射治疗的敏感性。
Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve （RLN） by meticulous capsular dissection and exposure of RLN in thyroid lobectomy. Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed. Results All of the 452 cases underwent thyroid lebectomy successfully without death， and the operative time was 45-110min （average 60 min）， the blood loss was 5-100mL （average 20mL）. The pathological results showed that there were thyroid adenoma in 193 cases， nodular goiter in 175 cases， Hashimoto thyroiditis in 38 cases， thyroid cancer in 46 cases. After operation， 4 cases suffered RLN injury， 1 of the 4 cases recovered after removal of drainage tube， and other 3 cases recovered during 0.5 to 3.0 months. In addition， 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week， 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding， including branch of anterior venous bleeding in 1 case， thyroid side arterial tube bleeding in 1 case， and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation， and no recurrence happened during the followed up period. Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible， which plays an important role in avoiding serious RLN injury.
目的评价喉罩或单腔气管内插管在胸腔镜下胸交感神经链切断术的应用效果。 方法选择80例行胸腔镜下胸交感神经链切断术的手汗症患者，采用计算机随机法将患者分为A、B两组，每组各40例。其中A组男20例、女20例，平均年龄24岁；B组男21例、女19例，平均年龄23岁。A组使用喉罩通气，B组使用单腔气管内导管，均应用小潮气量较快频率正压通气及间歇人工气胸。观察两组麻醉期间各时点心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）、动脉血氧饱和度（SpO2）、心电图（ECG）的变化。同时记录喉罩/单腔导管置入时间、CO2充气时间、手术时间、术中术后不良反应和并发症。 结果两组患者手术顺利，无并发症。A组喉罩/插管置入时间和喉罩/单腔管呛咳、术后咽喉疼痛发生率低于B组，差异有统计学意义（P<0.05）。B组MAP、HR水平在T2（喉罩/单腔管置入后）和T7（苏醒后拨喉罩/单腔管时）明显高于T1（麻醉诱导完成），差异有统计学意义（P<0.05）；A组MAP、HR水平在T2和T7时亦明显低于B组，差异有统计学意义（P<0.05）。所有患者术中ECG、SpO2和PetCO2无明显变化。 结论喉罩或单腔气管内插管结合间歇的人工气胸都能满足胸交感神经切断术的操作需要，喉罩具有更稳定的血流动力学状态和更高的安全性。
ObjectiveTo investigate the clinical efficacy of carbon dioxide (CO2) laser ablation in the treatment of laryngeal papilloma and analyze the relevant factors for recurrence. MethodsWe retrospectively analyzed the clinical data of 102 patients with laryngeal papilloma treated between February 2003 and October 2010 in our department. They were divided into the juvenile group (n=70) and adult group (n=32). Patients in both groups underwent microsurgery with CO2 laser ablation to remove the lesions under general anesthesia. During the process, we observed patients'site of lesions, recurrence time, the incidence of postoperative vocal adhesions, and the occurrence of malignancy. ResultsAll patients were followed up for 1 to 8 years. Eleven cases of vocal cord adhesion occurred, and patients with the adhesion all had former joint lesions, which accounted for 27.5% of all the anterior commissure adhesion patients. Four cases of malignancy all occurred in adults with an adult malignancy rate of 12.5%. Recurrence occurred in 41 cases and 76 cases of times, including 5 times in 2 cases, 4 times in 4 cases, 3 times in 3 cases, twice in 9 cases, and once in 23 cases. The difference in times of recurrence was significant between the juvenile and the adult group (P<0.05). Significant difference was found between single lesion and multiple lesion recurrence in both groups (P<0.05). There was no significant difference between the two groups in terms of single lesion recurrence (P>0.05), while the difference in multiple lesion occurrence was significant (P<0.05). The first recurrence time was within 12 months after surgery in both groups, and recurrence mainly occurred within 6 months after surgery. Single lesion and multiple lesion recurrence mainly manifested as anterior commissure lesions (2/3, 66.7%) and subglottic lesions (5/6, 83.3%) respectively. ConclusionMicro-laryngoscopy CO2 laser laryngeal papilloma resection is safe, effective, and minimally invasive in the treatment of laryngeal papilloma, and is the preferred surgical method in clinic, but it still needs further improvement.
The pectoralis major myocutaneous flap was used to repair laryngopharyngeal and esophageal defect following radical excision of pharyngeal and inferior laryngeal carcinomas in 3 cases. The results were susscessful. The patients were follwedup for 6 months to 3 years. The deglutition functions were all reestablished, the general nutritional conditions were improved, and no recurrence or distant metastasis was observed. The advantages of this operative procedure were discussed.
Acute pharyngitis belongs to the category of "acute throat impediment" in traditional Chinese medicine (TCM), which has a high incidence and is easy to recur. In clinical practice of TCM, Chinese patent medicines with the effects of clearing heat and detoxifying, reducing swelling and relieving pain are widely used in the treatment of acute pharyngitis. These medicines have the advantages of definite efficacy, low side effects, and low risk of developing drug resistance. However, at present, there are no standardized clinical diagnostic and therapeutic evaluation norms for acute pharyngitis in TCM, which has hindered the application of TCM in the prevention and treatment of acute pharyngitis and the development of new TCM preparations. Therefore, the China Association of Chinese Medicine initiated this expert consensus, which was led the formulation by Xiyuan Hospital, China Academy of Chinese Medical Sciences. This expert consensus integrates the current best evidence and extensive clinical expert experience from the front line, covering seven aspects: applicable scope, diagnosis in both Chinese and Western medicine, syndrome classification and evaluation scales, basis for efficacy evaluation, and time for efficacy evaluation. It has formed 8 types of TCM syndromes for acute pharyngitis, as well as the diagnostic criteria, syndrome classification and evaluation scales, evaluation basis for efficacy, and scoring standards for syndromes and diseases. This expert consensus can be used to standardize the diagnosis of the TCM syndromes of acute pharyngitis, as well as the core indicators and evaluation methods for syndrome and disease efficacy, with the aim of providing references for clinical practice and scientific research on acute pharyngitis.