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Objective@#To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia.@*Methods@#A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data.@*Results@#The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM.@*Conclusions@#New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.
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Objective@#To introduce the method of transoral coblation-assisted endoscopic minimally invasive surgery for superficial tongue base tumour.@*Methods@#A total of 15 patients treated with transoral coblation-assisted endoscopic minimally invasive surgery from Mar. 2006 to Aug. 2016 were retrospectively reviewed. There were 9 patients with malignant tumors, 6 patients with benign neoplasms. Adjuvant postoperative radiation therapy was applied in three cases of squamous cell carcinoma, neck was performed in four cases of cancer. One case of non-Hodgkin lymphoma received postoperative chemotherapy.@*Results@#One case with ectopic thyroid gland was treated by subtotal resection and one case with squamous cell carcinoma changed into open surgery because of major lingual artery bleeding. The En bloc resection under edoscope was achieved in 92.86%(13/14)of patients. Fifteen cases of neoplasms were followed-up for 8-50 months(median 20 months), one patient with Cowden syndrome was lost to follow-up because of appendical carcinoid combined pulmonary metastasis, one patient with non-Hodgkin lymphoma died of recurrence in other head neck areas 2 years after chemotherapy.@*Conclusion@#Transoral coblation-assisted endoscopic surgery can successfully treat for the patients with superficial tongue base tumours.
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Objective@#To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation(RFC).@*Methods@#Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled. Among these patients, 15 suffered from pyriform sinus carcinoma, 4 suffered from postcricoid carcinoma, and 3 suffered from posterior hypopharyngeal wall carcinoma. According to the AJCC 2002 guideline, the tumor stages were T1N0M0 for 3 patients, T2N0M0 for 9 patients, T1N1M0 for 1 patient, T1N2M0 for 1 patient, T2N1M0 for 4 patients, and T2N2M0 for 4 patients respectively. All patients with N+ underwent concurrent neck dissection; 2 patients underwent concurrent prophylactic tracheotomy; 17 underwent post-operative radiotherapy for 50-66 Gy. The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.@*Results@#All patients except 2 underwent the TOS successfully, while the two patients were treated with open approach surgery due to unsure safe margin. Most patients returned to oral feeding within one week. Among the 18 patients with complete follow up data, 3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence, multiple primary esophageal carcinoma, and distant metastasis 4 years after surgery (5.6%). According to the Kaplan-Meier method, the 5-years local control rate and survival rate were 57.8% and 67.5% respectively. All patients had no disorders in speech, swallowing and respiration during the follow up.@*Conclusions@#The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage, which is useful in lowering the operation difficulty. The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.
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<p><b>OBJECTIVE</b>To explore the methods and results of surgical management for refractory dysphagia and aspiration.</p><p><b>METHODS</b>The clinical data of 24 refractory dysphagia and aspiration patients who accepted surgical management were retrospectively analysed.</p><p><b>RESULTS</b>Twenty-four refractory dysphagia and aspiration patients accepted 26 operations between 2001 and 2014. Of the 26 operations, 17 were cricopharyngeal myectomy (CPM), 6 were scarectomy, 3 were laryngeal-tracheal separation. No severe complications occurred. Assessments of dysphagia were completed in 18 operations before and after operation. Aspiration scores of videofluoroscopic swallowing study (VFSS) were 4.50 [4.00;7.00] vs 2.00 [1.00; 3.25], P = 0.000; swallow dysfunction scroes of VFSS were 5.00 [4.00; 12.00] vs 1.00 [1.50; 10.00], P = 0.001; aspiration scores of fibroptic endoscopic evaluation of swallowing (FEES) were 4.00 [5.00; 7.00] vs 2.00 [1.75; 3.00], P = 0.000. But the surgical results for post radiotherapy dysphagia were not successful (n = 5): aspiration scores of VFSS were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109;swallow dysfunction scroes of VFSS were 12.00 [10.50; 12.00] vs 12.00 [7.50; 12.00], P = 0.180;aspiration scores of FEES were 7.00 [6.50; 8.00] vs 6.00 [2.00; 7.50], P = 0.109.</p><p><b>CONCLUSION</b>Surgical management was effective for refractory dysphagia and aspiration, but the surgical indication selection should be strict.</p>
Subject(s)
Humans , Deglutition Disorders , General Surgery , Endoscopy , Fluoroscopy , Larynx , Larynx, Artificial , Retrospective Studies , TracheaABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical value of localization of upper airway obstructive site with the method of combination of nasopharyngeal airway and polysomnography (PSG).</p><p><b>METHODS</b>Forty-seven patients diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) by PSG were enrolled. Each patient was examined by Somte PSG for the first night, underwent repeated PSG examination with the nasopharyngeal airway in place for the second night and received airway continuous pressure measurements (ApneaGraph) examination for the third night. The standard of treatment success was defined as apnea-hypopnea index (AHI) less than 20/h and a reduction of 50% or more. The patients were divided into success group and failure group. The PSG indices and ApneaGraph data of the two groups were compared. Correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were calculated. SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>Forty-two patients completal three-night examination. With the nasopharyngeal airway in place, AHI, the lowest oxyhemoglobin saturation (LSaO2), average oxyhemoglobin saturation, percent of sleep time with oxyhemoglobin saturation <0.90 (SaO2 < 0.90T%) were improved obviously (P < 0.001). Twenty-nine patients (69.0%) achieved treatment success. There were statistical differences (t = 2.670, P = 0.011; Z = -3.252, P = 0.001 and t = -4.556, P < 0.001) of LSaO2 by PSG, lower AHI and constituent ratio of lower obstruction by ApneaGraph compared success group with failure group. The correlations between AHI with nasopharyngeal airway in place by PSG and lower AHI and constituent ratio of lower obstruction by ApneaGraph were 0.616 (P < 0.001) and 0.526 (P < 0.001).</p><p><b>CONCLUSION</b>The method of combination of nasopharyngeal airway with PSG is a reliable method of localization of upper airway obstructive site and can be used as a simple means to find out if there's any retroglossal obstruction.</p>
Subject(s)
Humans , Airway Obstruction , Diagnosis , Nasopharynx , Polysomnography , Research , Sleep , Sleep Apnea, Obstructive , Diagnosis , Treatment OutcomeABSTRACT
OBJECTIVE@#To analyses the clinical characteristics of 28 chronic rhino-sinusitis patients only characterized olfactory disorders.@*METHOD@#Twenty-eight patients who have only olfactory disorder were diagnosed chronic rhino-sinusitis, among which 16 patients accepted intranasal budesonide for 15 days. All patients accepted CT scan, T&T test and olfactory event-related potentials test before and after treatment.@*RESULT@#(1) No difference was found between 21 patients ( 12 months) (P > 0.05), significant difference was found between maxillary sinus,ethmoid sinus and frontal sinus, sphenoid sinus in CT scan (P < 0.01). (2) Olfactory function improves after treatment (P < 0.01). Significant difference is found between 12 patients ( < or =12 months) and 4 patients (P < 0.01).@*CONCLUSION@#(1) Chronic rhino-sinusitis patients who have only olfactory disorder were found; (2) Intranasal budesonide treatment could improve olfactory functions of chronic rhino-sinusitis' patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Budesonide , Therapeutic Uses , Chronic Disease , Olfaction Disorders , Diagnosis , Drug Therapy , Olfactory Mucosa , Sinusitis , Diagnosis , Drug TherapyABSTRACT
OBJECTIVE@#To investigate the dynamic changes in the upper airway that cause the obstructive sleep apnea-hypopnea syndrome by measuring the variations of upper airway pressures in the palatal segment of oropharynx and in segment of laryngopharynx.@*METHOD@#The two pressure sensors of the manometer: Apnea Graphs were positioned below uvula and upper esophagus. By comparing the difference between the two sites with the reference of outer atmospheric pressure and using two temperature sensors to determine the air flow through the nose and mouth, we got apnea and hypopnea index (AHI) of 21 patients of obstructive sleep apnea-hypopnea syndrome at the supine position and siding position and obtained the information about the site of upper airway collapse and obstruction.@*RESULT@#1. The AHI was (47.83 +/- 18.05) per hour for supine position, while (35.11 +/- 18.88) per hour for lateral position in the studying group. The difference between these two groups is statistically significant (P < 0.05). 2. The apnea events were mainly caused by the collapse and obstruction of palatal segment of oropharynx which constitute 84.48% of the obstruction. The collapse at the segment of laryngopharynx was responsible for 12.58% of the obstruction.@*CONCLUSION@#The upper airway pressure measurements could provide direct informations about the obstructive sleep apnea-hypopnea syndrome. These informations help choosing appropriate operation for apneic patients.