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CT of Inverted Papilloma in the Nasal Cavity and Nasal Sinuses

目的：著重探討鼻腔及鼻竇內翻性乳突狀瘤CT表現特征及診斷價值。材料和方法：收集經手術和病理確診的鼻腔及鼻竇內翻性乳突狀瘤65例CT資料，進行回顧性研究。結果：65例IP的CT表現特征，以鼻中道為中心的一側鼻竇和/或鼻腔內不規則軟組織腫塊。其中，僅鼻腔受累者18例，一側鼻腔及鼻竇均受累者47例。鼻腔及鼻竇有膨大并骨質破壞者43例。軟組織腫塊強化者23例。術后IP復發者13例（20%）；惡變者9例（14.3%）。結論：CT檢查對IP的病變部位、范圍、程度等能準確確定，可為手術治療提供重要依據。

鼻腔嗅神經母細胞瘤誤診一例

Etiology and Treatment of Re-Blockage after Dacryocystorhinostomy

【摘要】 目的 探討淚囊鼻腔吻合術后復發的原因和手術方法。 方法 對1999年1月-2009年10月因淚道阻塞行淚囊鼻腔吻合術后3個月以上復發的47例患者，行再吻合術，術中仔細分離切除瘢痕及肉芽，盡量做雙瓣吻合。 結果 本組50只眼，術后隨訪3個月～2年，成功49只眼，1例再阻塞，治愈率98%。 結論 首次手術失敗的主要原因是骨孔過小，吻合口粘連，淚囊太小或萎縮，解剖層次不清和手術操作粗暴導致術中出血等。再次吻合手術治療效果滿意。【Abstract】 Objective To explore the reasons of recurrence and the operative method for re-blockage after dacryocystorhinostomy. Methods Forty-seven patients with dacryocystorhinostomy who were recurred after 3 months were included from January 1999 to October 2009. All patients underwent re-anastomosis. The operation required careful separation and resection of scar and granulation, and performed anastomosis with double valve as far as possible. Results All patients were followed up for three months to two years. Operations were successful in 49 eyes of total 50 eyes, and re-obstruction in one case with a cure rate of 98%. Conclusion The major reasons for the failure of the first operation include too small bone hole, anastomotic adhesions, too small or atrophy of lacrimal sac, unclear anatomy and surgical gross bleeding. The best treatment is surgical re-anastomosis.

鼻內鏡下鼻腔擴容術綜合治療鼻源性頭痛60例

目的探討鼻內鏡下鼻腔擴容術綜合治療鼻源性頭痛患者的療效。 方法選取 2011 年 3 月—2012 年 3 月就診的 60 例鼻源性頭痛患者，其中單純性頭痛不伴鼻塞、流涕等鼻部癥狀者 25 例，頭痛伴有鼻塞者 25 例，頭痛伴鼻塞、有流膿涕者 10 例；頭痛部位多位于前額部、鼻根部、太陽穴處及眶部，多為鈍痛或頭部昏沉感。所有患者均經鼻內鏡檢查及鼻竇冠位 CT 掃描檢查診斷為鼻腔結構異常和（或）鼻腔、鼻竇炎性病變。根據不同病變，選擇性采取相應的鼻腔擴容術，并進行術后綜合治療。術后定期隨訪 3～12 個月，參照中華醫學會耳鼻咽喉科學分會、中華耳鼻咽喉科雜志編委會 1997 年制定的慢性鼻竇炎鼻息肉臨床分型分期內鏡鼻竇手術療效評定標準評定治療效果。 結果60 例患者于術后隨訪 3～12 個月。治愈 40 例（66.7 %），好轉 18 例（30.0%），無效 2 例（3.3%），總有效率為 96.7%。60 例患者均未見鼻中隔穿孔、血腫、外鼻塌陷或畸形，未發生眶眼并發癥、顱腦并發癥等嚴重并發癥。 結論采用鼻內鏡下鼻腔擴容術對于鼻源性頭痛患者療效顯著，在手術成功的基礎上結合綜合治療及加強術后隨訪是提高有效率的關鍵。

經口腔吸入及鼻腔給藥人體藥物代謝動力學研究實施體會

經口腔吸入及鼻腔給藥的藥物制劑日趨增多，通常具有血藥濃度低，容易發生沾染，藥物吸收入血迅速等特點，根據口、鼻腔給藥的特點及影響因素，確保給藥劑量的標準化，防止藥物沾染是實現此類方式給藥的重要問題。結合工作實踐，現就經口、鼻腔給藥制劑人體藥物代謝動力學研究過程中的注意事項予以討論交流，以供參考。

Diagnosis and Treatment of Extranodal Rosai-Dorfman Disease in Nasal Cavity and Nasopharynx

ObjectiveTo investigate the clinical manifestations, diagnosis, treatment and prognosis of Rosai-Dorfman disease (RDD) in nasal cavity and nasopharynx. MethodsWe retrospectively analyzed the clinical data of 4 patients with extranodal RDD admitted to the Department of Otolaryngology, Head and Neck Surgery of our hospital between November 2009 and August 2013. ResultsAll patients received complete surgical removal of the lesions. Histopathological examination showed that large histocytes had an abundant foamy cytoplasm containing ingested lymphocytes as a result of emperipolesis, and were strongly positive for S-100 and CD68 on immunohistochemical analysis, but negative for CD1a. All patients were followed up for 28 to 45 months (averaging 35 months), and no recurrence was observed during the follow-up period. ConclusionRDD is a rare disease, and the exact etiology and pathogenesis of RDD are not fully understood. There is no unified treatment plan recommended, and complete surgical removal of the lesions is an effective method. Minimally invasive surgery may be a good choice for treatment of this disease.

清醒志愿者被經口鼻腔吸痰的心理體驗

目的 深入了解清醒志愿者被吸痰期間的心理體驗，為臨床護理人員采取針對性的護理措施提供依據。 方法 2016 年 3 月 12 日，采用自我體驗加質性研究方法，研究者及7名學生作為志愿者親自體驗被吸痰的過程，吸痰后對 8 名志愿者進行深入訪談，采用 Colaizzi 分析法進行資料分析。 結果 經口鼻腔吸痰的心理體驗包括：被吸痰前的期望體驗和對被吸痰的恐懼，被吸痰時極度不舒適，被吸痰后體會到該如何體貼愛護患者。 結論 針對清醒患者的吸痰，護士應該更多地給予安慰和鼓勵，重視患者和家屬的心理支持，采用多種措施減少負性體驗；采用體驗式教學可增加護生的愛傷意識。

Application of Nasal Endoscope after Dacryocystorhinostomy

目的:探討鼻內窺鏡在淚囊鼻腔吻合術后的應用。方法:343例436眼實施淚囊鼻腔吻合術,術后結合鼻內窺鏡檢查。結果:術后隨訪1～12月,手術治愈好轉率為96.33%。結論:鼻內窺鏡對淚囊鼻腔吻合術后吻合口行檢查及修復,能很好的提高淚囊鼻腔吻合術成功率。

Nasal Endoscopic in the Treatment of Nasal Inverted Papilloma

目的：探討鼻內鏡手術治療鼻內翻性乳頭狀瘤(NIP)的療效。方法：回顧性分析用鼻內鏡手術治療的36例經病理確診的NIP患者的臨床資料，隨訪1～6年。結果:”一次性治愈31例(86.1%)；5例復發(13.9%)，3例在門診內窺鏡下分次摘除并結合YAG激光治愈，2例再次于鼻內鏡結合Caidwell-Luc手術治療，無惡變病例，結論：根據病變范圍選擇適當的手術方式，經鼻內鏡手術切除鼻腔鼻竇內翻性乳頭狀瘤效果良好。

Comparison of Endoscopic Dacryocystorhinostomy with Mitomycin C versus without Mitomycin C for Nasolacrimal Obstruction: A Meta-Analysis

Objective　To systematically review the effectiveness of endoscopic dacryocystorhinostomy (En-DCR) with versus without Mitomycin C (MMC) for nasolacrimal obstruction. Methods　Databases such as PubMed, EMbase, CENTRAL (Issue 12, 2012), VIP, WanFang Data, CBM and CNKI were electronically searched to collect the randomized controlled trials (RCTs) which investigated the comparison between En-DCR with and without MMC for nasolacrimal obstruction. The searched data was updated to December 31st, 2012. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of the included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2.0 software and the quality of evidences was graded using GRADEpro 3.6 software. Results　A total of 9 RCTs were included in the meta-analysis. The results of meta-analysis showed that, the recovery rate in the MMC group was significantly elevated (RR=1.13, 95%CI 1.04 to 1.22, P=0.003), the area of ostium in the MMC group was bigger at 1, 6 and 12 months than in the control group, postoperatively (MD=6.68 mm2, 95% 5.43 to 7.94, Plt;0.000 01; MD=11.61 mm2, 95%CI 4.67 to 18.55, P=0.001; MD=15.65 mm2, 95%CI 2.95 to 28.34, P=0.02), respectively, but the area of ostium in the MMC group at the third month was bigger than that in the control group (MD=8.20 mm2, 95%CI –6.67 to 23.08, P=0.28). The operative time was significantly prolonged in the MMC group (MD=10.1 min, 95%CI 8.00 to 12.20, Plt;0.000 01). Conclusion　En-DCR combined with MMC could improve the recovery rate and prevent the over shrinkage of ostium area effectively due to nasolacrimal obstruction.