"Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"[jour]; +23 new citations:
1
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):913-920. doi: 10.3760/cma.j.cn115330-20200225-00126.
[Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery]
[Article in Chinese]
J J Xu 1, L Z Zhang 2, Q H Zhang 2, H W Guo 1, Z Tan 1, J F Wang 1, L H Jiang 1, C M Zheng 1, M H Ge 1, X B Lan 3
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PMID: 33036505
DOI: 10.3760/cma.j.cn115330-20200225-00126
Abstract
in English, Chinese
Objective: To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery. Methods: A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis. Results: The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant (t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups (P>0.05). Conclusion: GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.
Keywords: Axillary approach; Surgical procedures, minimally invasive; Thyroid neoplasms; Thyroidectomy.
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2
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):934-943. doi: 10.3760/cma.j.cn115330-20200727-00626.
[Research of SIRT1 on promoting the proliferation, migration and lipid metabolism of nasopharyngeal carcinoma]
[Article in Chinese]
H M Yin 1, X He 2, Y Shan 1, H X Zhai 3, K W Zhang 1, T Xia 1, S Y Zhang 1, W H Chen 1, Y W You 1
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PMID: 33036508
DOI: 10.3760/cma.j.cn115330-20200727-00626
Abstract
in English, Chinese
Objective: To analyze the differential expression of silent information regulator transcript-1 (SIRT1) in tissues and cells of nasopharyngeal carcinoma (NPC), to explore the effects of SIRT1 on the proliferation and migration of NPC cells, as well as the effects on and mechanisms of lipid metabolism in NPC cells. Methods: Experimental subjects: In this study, tissue specimens were obtained from patients who visited the Department of Otolaryngology and performed nasopharyngeal tissue biopsy in the Affiliated Hospital of Nantong University from 2019 to 2020. Among them, 6 cases were male, 6 cases were female, age range: 27-72 years old, including 7 cases of NPC diagnosed by pathology and 5 cases of normal nasopharyngeal mucosa. Experimental methods and outcome measures: Western Blot and quantitative real time polymerase chain reaction (qRT-PCR) were used to detect the protein and mRNA levels of SIRT1. CNE2 cell line was selected for subsequent experiments. Cell viability and migratory ability were evaluated by CCK8, wound healing and Transwell assays respectively. Animal xenograft tumor model was used to explore the role of SIRT1 inhibitor Ex527 on tumor growth in nude mice. Oil red and Bodipy were used to stain intracellular lipids. For the mechanical investigation, the interactions between SIRT1 and hypoxia inducible factor-1α (HIF-1α) were analyzed by immunoprecipitation (IP) and chromatin immunoprecipitation (ChIP). Finally, statistical analysis was performed by SPSS 26.0 software, P<0.05 was considered statistically significant. Results: The levels of SIRT1 protein (1.005±0.168) and mRNA (5.829±2.395) in NPC tissues were higher than those in normal nasopharyngeal mucosa (0.181±0.042,1.995±1.605). Differences were statistically significant (t values were 6.438 and 2.759, both P<0.05). The mRNA and protein levels of CNE1, CNE2, 5-8F and 6-10B cell lines were also higher than those in normal nasopharynx epithelial cell line NP69. Besides, overexpression of SIRT1 correlated with the proliferation and migration of NPC cells. The tumorigenesis ability of nude mice in the Ex527 group was lower than that in the control group. The low SIRT1 expression reduced the protein level of the key enzymes of liposynthesis in NPC cells, improved the expression of lipolysis enzymes, while HIF-1α overexpression promoted lipid synthesis enzymes in NPC cells. SIRT1 inhibited HIF-1α transcription by enhancing deacetylation levels. The binding ability of HIF-1α to SIRT1 promoter regions decreased when NPC cells were hypoxic. Conclusions: SIRT1 promotes the proliferation, migration and lipid metabolism of nasopharyngeal carcinoma cells, which might be expected to provide new theoretical basis for prognosis judgment and gene therapy.
Keywords: Hypoxia inducible factor-1α; Lipid metabolism; Nasopharyngeal carcinoma; Silent information regulator transcript-1.
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3
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):921-925. doi: 10.3760/cma.j.cn115330-20200519-00422.
[The effect of operative approach selection on the protection of parathyroid function in thyroid cancer]
[Article in Chinese]
M C Li 1, Q S Zhang 1, D Li 1, G Chen 1, Z Chen 1, J Lyu 1
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PMID: 33036506
DOI: 10.3760/cma.j.cn115330-20200519-00422
Abstract
in English, Chinese
Objective: To investigate the effect of endoscopic thyroidectomy and open thyroidectomy on parathyroid function in patients with thyroid cancer. Methods: The clinical data of 73 patients with thyroid cancer who met the inclusion criteria in Zhengzhou Central Hospital Affiliated to Zhengzhou University from July 2018 to September 2019 were retrospectively analyzed, including 17 males and 56 females, aged 19-55 years. The patients underwent routine thyroidectomy (group A, n=31), oral endoscopic thyroidectomy by vestibular approach (group B, n=19) or transthoracic thyroidectomy (group C, n=23), and all patients received central neck dissection. The levels of parathyroid hormone (PTH) and serum calcium after operation were compared among three groups. SPSS 21.0 software and GraphPad Prism v6.01 were used for statistical analysis. Results: After operation, the mean levels of PTH and serum calcium in three groups were significantly decreased (all P<0.05). On the first day after operation, the mean level of PTH in group C was lower than that in group A [(12.3±9.0) vs. (22.2±13.2) pg/ml, t=3.04, P=0.004] or group B [(12.3±9.0) vs. (20.0±14.1) pg/ml, t=2.09, P=0.043], and also the level of serum calcium in group C was lower than that in group A [(1.89±0.11) vs. (2.02±0.16) mmol/L, t=3.24, P=0.002] or group B [(1.89±0.11) vs. (2.01±0.15) mmol/L, t=2.72, P=0.010], with no significant difference in the mean levels of PTH or serum calcium between group A and group B (t=0.54, 0.29, respectively, both P>0.05). The incidences of permanent hypoparathyroidism/persistent hypocalcemia were 3.2% (1/31) in group A, 5.3% (1/19) in group B and 21.7% (5/23) in group C, and the incidence of group C was significantly higher than that (4%, 2/50) of both group A and group B (χ(2)=5.251, P=0.022). Conclusion: The postoperative parathyroid function and serum calcium level have different degrees of change and they are significantly associated with thyroidectomy approaches, the protection of parathyroid by oral endoscopic thyroidectomy and routine thyroidectomy can achieve the same effect, and is better than that of transthoracic thyroidectomy.
Keywords: Endoscope; Hypocalcemia; Parathyroid; Thyroid carcinoma.
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4
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):893-898. doi: 10.3760/cma.j.cn115330-20200526-00447.
[Protection of nerve function during transoral endoscopic thyroidectomy by vestibular approach]
[Article in Chinese]
Z Wu 1, J G Fang 2, X Chen 2, L Z Hou 2, Q Zhong 2, H Z Ma 2, Y Zhang 2, X X Shen 2
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PMID: 33036502
DOI: 10.3760/cma.j.cn115330-20200526-00447
Abstract
in English, Chinese
Objective: To explore the method of functional protection in transoral endoscopic thyroidectomy by vestibular approach. Methods: Retrospective analysis was performed on the case data of 66 patients who underwent transoral endoscopic thyroidectomy by vestibular approach in the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital from February 2018 to February 2020. There were 11 males and 55 females aged 22-64 years, including 19 patients with benign diseases and 47 patients with malignant diseases. Important neurological functions were protected by a combination of anatomical exposure and intraoperative nerve monitoring. The clinical data and the effect of neurofunctional protection were summarized. SPSS 25.0 software was used for statistical analysis. Results: All operations were successfully completed with none transferred to open surgery. Three weeks after surgery, the numbness and tingling symptoms in the lower jaw and lower lip were basically relieved. There was no permanent mental nerve palsy, no permanent recurrent laryngeal nerve palsy but 2 cases with temporary recurrent laryngeal nerve palsy, no external branch injury of superior laryngeal nerve. There were 3 cases of temporary parathyroid gland dysfunction, 1 case of neck infection, 2 cases of subcutaneous effusion, 1 case of neck skin injury, and 2 cases of postoperative eye conjunctivitis. Conclusion: In transoral endoscopic thyroidectomy by vestibular approach, anatomical exposure can decrease mental nerve injury, and anatomical exposure combined with intraoperative nerve monitoring can protect the functions of the external branches of the superior laryngeal nerve and the recurrent laryngeal nerve.
Keywords: Endoscopy; Neuroprotection; Oral vestibular; Surgical procedures, minimally invasive; Thyroid neoplasms.
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5
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):899-904. doi: 10.3760/cma.j.cn115330-20200604-00472.
[Clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach: a report of 98 cases]
[Article in Chinese]
Y Z Luo 1, Y L Fu 1, G Y Wu 1, J B Fu 1, S Q Lin 1, Z F Song 1, J Y Chen 1, W Yan 1, P H Kuang 1, E D Lin 1, X Q Hong 1, F S Lin 1
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PMID: 33036503
DOI: 10.3760/cma.j.cn115330-20200604-00472
Abstract
in English, Chinese
Objective: To summarize the clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach (TOETSLVA). Methods: We retrospectively reviewed the medical record of patients who underwent TOETSLVA in our department from November 2011 to May 2020, including 3 males and 95 females, aged from 18 to 57 years old. Initial 81 cases were categorized in "Period A (November 2011-November 2015)" and subsequent 17 cases in "Period B (August 2019-May 2020)" . Data about demographics, operation time and complications were collected. SPSS 22.0 software was used for statistical analysis. Results: In Period A, the average age of patients was (34.2±9.4) years old; the mean tumor diameter was (2.33±0.80) cm; postoperative pathology showed benign nodules in 76 cases and malignant carcinoma in 5 cases; there were 65 cases of unilateral subtotal thyroid lobectomy, 6 cases of isthmus lobectomy, and 5 cases of bilateral subtotal thyroid lobectomy, with the mean operation time of (132.70±47.22) min; in 5 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (185.4±31.40) min; postoperative neck infections occurred in 6 cases; temporary vocal cord paralysis occurred in 1 case, which it recovered within two months; and CO(2) gas embolism occurred in 2 cases. In Period B, the average age of patients was (35.1±8.5) years old; mean tumor diameter was (1.32±0.67) cm; postoperative pathology indicated malignant nodules in 15 cases and benign nodules in 2 cases; in 2 cases of unilateral thyroid lobectomy, the mean operation time was (153.5±34.64) min; in 15 cases of unilateral thyroid lobectomy with central lymph node dissection, the mean operation time was (123.73±14.26) min; and none of patients developed postoperative neck infections or CO(2) gas embolism. All patients had different degree of cutaneous numbness in the submandibular region after surgery, which recovered within 1-2 weeks. There were no complications such as postoperative secondary hemorrhage, permanent vocal cord paralysis, hypoparathyroidism in both the periods. The median follow-up time was 86 months (57-105 months) in Peroid A and 5 months (3-12 months) in Peroid B. During the follow-up periods, there were no obvious abnormalities in swallowing, chewing, oral sensory function and neck activity, and also no tumor recurrence or metastasis. Conclusions: TOETSLVA is a safe and feasible surgery method, with a good cosmetic result. This approach will not lead to a postoperative cutaneous numbness of the submandibular region for a long time.
Keywords: Sublingual and vestibular approach; Surgical procedures, minimally invasive; Thyroid neoplasms; Thyroidectomy.
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6
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):957-961. doi: 10.3760/cma.j.cn115330-20200427-00338.
[Tap-hammer elicited vestibular-evoked myogenic potentials system: its design and preliminary application]
[Article in Chinese]
Y Z Zhang 1, P Xiong 2, H D Zhao 1, Z C Chen 1, X Y Wei 1, Q Liu 1, F Y Chen 1, Y Cheng 1, J Hu 1, S N Li 3, J Yang 3, Q Zhang 4
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PMID: 33036511
DOI: 10.3760/cma.j.cn115330-20200427-00338
Abstract
in English, Chinese
Objective: The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system. Methods: A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs (P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio(P>0.05). Conclusion: The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.
Keywords: Bone conduction; Vestibular evoked myogenic potentials.
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7
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):944-951. doi: 10.3760/cma.j.cn115330-20200423-00322.
[Long non-coding RNA colon cancer associated transcript-2 from nasopharyngeal carcinoma-derived exosomes promotes angiogenesis]
[Article in Chinese]
S K Zhou 1, F Gao 2, Z S Zhong 2, H Yao 3
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PMID: 33036509
DOI: 10.3760/cma.j.cn115330-20200423-00322
Abstract
in English, Chinese
Objective: To evaluate the role of exosomal long non-coding RNA (lncRNA) colon cancer associated transcript-2(CCAT2) in angiogenesis in nasopharyngeal carcinoma(NPC). Methods: Human umbilical vein endothelial cells (HUVECs) were divided into CNE2 supernatant coculture group and NP69 supernatant coculture group. The proliferation ability of HUVEC in each group was examined by CCK8. The lncRNA CCAT2 level in HUVEC was detected using real-time fluorescent quantitative PCR (qRT-PCR). HUVECs were divided into coculture group of serum in patients with NPC and coculture group of serum in healthy donors. The proliferation ability of HUVEC in each group was examined by CCK8. The lncRNA CCAT2 level in each group was detected using qRT-PCR. Exosomes from CNE2,NP69 supernatant were obtained by ultracentrifugation. HUVECs were divided into coculture group of CNE2's supernatant exosomes and coculture group of NP69's supernatant exosomes. Biological experiments like CCK8 were conducted to compare the angiogenesis ability of HUVEC in each group. shRNA transfection was used in HUVEC to suppress the expression of lncRNA CCAT2. Biological experiments like CCK8were conducted to compare the HUVEC's function with different expression of lncRNA CCAT2. CNE2 was transfected with shRNA, the total supernatant exosomal RNA was extracted, and the difference of exosomal lncRNA CCAT2 in CNE2 supernatant with low expression and normal expression of lncRNA CCAT2 was detected by qRT-PCR. The above mentioned two groups of exosomes were cocultured with HUVEC respectively. The difference of lncRNA CCAT2 expression in each group's HUVEC was detected by qRT-PCR and the function of HUVEC was examined with migration assay. GraphPad Prism 8 software was used for graphing and statistical analysis. Results: Compared with those in the NP69 supernatant coculture group, HUVECs in the CNE2 supernatant coculture group showed a higher proliferation ability and higher expression of lncRNA CCAT2(1 vs. 1.40±0.01, t=42.23, P=0.000). Compared with those in serum of healthy donors, HUVECs in serum of patients with NPC showed a higher proliferation ability and the expression of lncRNA CCAT2 increased (1 vs. 1.25±0.03, t=14.43,P=0.001). Compared with those in the coculture group of NP69 cells' supernatant exosomes, HUVEC in the coculture group of CNE2 cells' supernatant exosomes showed a higher proliferation ability and there were more cells that had passed the well during the migration experiment (53.12±2.13 vs. 154.74±4.17, t=37.73, P=0.000) and more knots formed in the tube-formation experiment(10.72±1.02 vs. 53.65±3.21, t=22.63, P=0.000). Compared with those in the sh-NC group, HUVEC in the sh-CCAT2 group showed a lower proliferation ability, and there were less cells that had passed the cell during the migration experiment(401.34±22.15 vs.138.25±6.85, t=23.19, P=0.000) and less MVC in the experiment of subcutaneous stroma embolization in nude mice(41.00±0.32 vs. 27.15±0.23, t=61.53, P=0.000). Compared with the supernatant exosomes in the sh-NC exosome group, the expression of lncRNA CCAT2 was lower in the supernatant exosomes of sh-CCAT2 group (1 vs. 0.65±0.02, t=30.31, P=0.000). Compared with those of the exosomes of sh-NC exosome group, the expression of lncRNA CCAT2 was lower in the HUVEC cocultured with exosomes of the sh-CCAT2 exosome group (1 vs. 0.73±0.01, t=46.77, P=0.000) and the exosomes of sh-CCAT2 exosome group showed a lower migration ability (389.73±26.34 vs. 190.54±8.36, t=12.47, P=0.001) after cocultured with HUVEC. Conclusion: Nasopharyngeal carcinoma-derived exosomal lncRNA CCAT2 could promote angiogenesis.
Keywords: Angiogenesis; Exosomes; Nasopharyngeal neoplasms; lncRNA CCAT2.
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8
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):952-956. doi: 10.3760/cma.j.cn115330-20200228-00141.
[Preliminary application of robot-assisted electrode insertion in cochlear implantation]
[Article in Chinese]
H Jia 1, J X Pan 1, Y Li 1, Z H Zhang 1, H Y Tan 1, Z Y Wang 1, H Wu 1
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PMID: 33036510
DOI: 10.3760/cma.j.cn115330-20200228-00141
Abstract
in English, Chinese
Objective: To evaluate the safety and outcomes of robot-assisted electrode insertion in cochlear implantation. Methods: We first reported the case of robot-assisted electrode insertion of cochlear implantation in October 2019. A new slim electrode array of Nurotron cochlear implant (CS-10A TM) and RobOtol(®) robot system were used in this case. The robotic assistance procedures, surgical outcomes were analyzed. Results: Robot-assisted electrode insertion was successfully performed in this adult patient. The preparation of robot system cost six minutes, the electrode array was slowly and fully inserted into tympanic scala with robot assistance. No damage in the surgical field occurred by the robotic instrument. Intraoperative electrode impedances and neural response measurements were normal. No postoperative complications occurred. Up to three months of follow up after implantation, the cochlear implant functioned well and rehabilitated hearing was satisfactory. Conclusion: Otological robot system shows its advantage in the elimination of human involuntary tremors and the augmentation of accuracy during micromanipulation, it could safely assist cochlear implantation to realize minimally invasive and full tympanic scala insertion of the electrode array, and to ensure the good preservation of the intracochlear fine structure.
Keywords: Cochlear implantation; Hearing rehabilitation; Robotics; Tympanic scala.
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9
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):926-933. doi: 10.3760/cma.j.cn115330-20200804-00646.
[Analysis of correlation between magnetic resonance imaging features and prognosis of invasive pituitary adenoma]
[Article in Chinese]
H Liu 1, Q Zhang 2, W Hang 2, G Liu 2
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PMID: 33036507
DOI: 10.3760/cma.j.cn115330-20200804-00646
Abstract
in English, Chinese
Objective: To explore the application of conventional nuclear magnetic resonance imaging, diffusion-weighted imaging and dynamic contrast-enhanced imaging in invasive pituitary adenoma, and to study the correlation between its imaging features and prognosis. Methods: The imaging manifestations (including T1WI, T2WI, ADC and dynamic contrast-enhanced MR), clinical features and pathological data of 47 cases of invasive pituitary adenomas (IPA) in Tianjin Huanhu Hospital from June 2017 to June 2018 were retrospectively analyzed, and compared with 16 cases of non-invasive pituitary adenoma (NIPA). The differences in tumor/white matter signal intensity ratio on T1WI and T2WI images, MR signs, ADC values and time signal-curve type, peak enhancement time and average enhancement rate between the two groups were observed. Postoperative MR enhanced scan and related hormone results were reviewed to evaluate the prognosis of all patients. Logistic stepwise regression analysis was used to analyze the relationship between IPA imaging characteristics and prognosis. Results: The location, shape, size, Knosp classification and ADC value of tumors were significantly different between IPA and NIPA groups (χ(2) values were 41.344, 21.818, 28.596 respectively, t values were 5.869, 11.720 respectively, all P<0.05). The majority of T1WI, T2WI and enhanced heterogeneous signals occurred in IPA group (P<0.05). IPA showed two-stage enhancement characteristics of rapid enhancement and fast subsidence phase. There were significant differences in peak enhancement time between intrasellar tumors and invasive cavernous sinus tumors. There were no significant differences in signal intensity of T1 and diffusion limitation and two-stage enhancement characteristics between the two groups (all P>0.05). There was a significant correlation between the ratio of tumor body/white matter signal on T2WI, ADC value and the constitution of invasive pituitary tumors (all P<0.05). In IPA, 9 cases(19%) were totally resected, 25 cases(53%) subtotally resected and 13 cases(28%) partially resected. Postoperative symptoms were improved in 29 cases(62%), alleviated in 6 cases(13%), unhealed in 3 cases(6%), assisted drug therapy in 7 cases and radiotherapy in 15 cases. All cases were followed up for 7 to 16 months, with a median time of 12.5 months. Eight cases recurred, with a recurrence rate of 17%. There were significant differences in the total/subtotal resection rate, the improvement rate of symptoms and the need for adjuvant treatment among IPA with different texture (all P<0.05).Knosp grade, tumor size and the ratio of tumor body to white matter on T2WI were associated with IPA recurrence (all P<0.05). Conclusion: It is helpful to diagnose IPA by analyzing the distribution, shape, size, ADC value and signal difference of tumors in sella turcica region through MR and DWI signs. Combined with dynamic contrast enhancement features, the invasion of IPA and its surrounding tissues can be early judged, and the texture of the tumors can be assessed by imaging signs, so as to better evaluate the therapeutic effect and prognosis of IPA.
Keywords: Features; Invasive; Magnetic resonance imaging; Pituitary adenoma; Prognosis.
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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):905-912. doi: 10.3760/cma.j.cn115330-20200520-00430.
[A comparative study on the efficacy of transoral vestibular approach, via bilateral areola approach endoscopic and open thyroidectomy on stage T1b papillary thyroid carcinoma]
[Article in Chinese]
Z D Liu 1, Y J Li 1, X Yu 1, C Xiang 1, P Wang 1, Y Wang 1
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PMID: 33036504
DOI: 10.3760/cma.j.cn115330-20200520-00430
Abstract
in English, Chinese
Objective: To compare the surgical efficacy and cosmetic satisfaction of the transoral endoscopic thyroidectomy by vestibular approach (TOETVA), endoscopic thyroidectomy via bilateral areola approach (BAA), and open thyroidectomy (OT) in the treatment of papillary thyroid carcinoma (PTC) in stage T1b. Methods: A total of 178 patients with PTC in stages pT1bN0M0 and pT1bN1aM0 treated from January 2017 to December 2018 were divided into TOETVA group (n=59), BAA group (n=43), and OT group (n=76). The baseline characteristics, relevant indexes of surgical efficacy and follow-up data were compared between the three groups, and also the surgical efficacy indexes were compared between unilateral lobectomy + central lymph node dissection (unilateral lobectomy subgroup) and bilateral lobectomy + central lymph nodes dissection (total resection subgroup). SPSS 19.0 statistical software was used for data analysis. Results: The mean ages of patients in TOETVA group and BAA group were significantly younger than those in OT group, and the proportion of women in TOETVA group and BAA group was significantly higher than that in OT group, all P<0.05. None of patients in TOETVA and BAA groups were converted to open surgery. Among TOETVA, BAA and OT groups, there were significant differences in the mean operation time [unilateral lobectomy subgroup: (198.0±45.2) min, (162.0±36.9) min and (79.4±28.6) min, P<0.05; total resection subgroup: (230.0±36.0) min, (219.8±68.1) min and (102.8±40.0) min, P<0.05], in total drainage volume [unilateral lobectomy subgroup: (195.0±55.6) ml, (178.1±50.4) ml and (127.0±30.1) ml, P<0.05; total resection subgroup: (221.1±46.7) ml, (245.3±71.2) ml and (137.7±41.6) ml, P<0.05], and the incidence of subcutaneous ecchymosis in TOETVA group or BAA group was higher than that in the OT group [5.1% (3/59), 11.6% (5/43) vs. 0, χ(2)=3.952 and 9.225 respectively, both P<0.05]. The mean level of C-reactive protein in TOETVA group was higher than that in OT group [(16.8±10.7) vs. (9.5±6.9), P<0.05]. Following-up in the third month after surgery between three groups in cosmetic satisfaction scores [(2.7±0.5) vs. (2.6±0.7) vs. (1.7±0.8)], scar self-consciousness scores (0[0,1] vs. 1[0,2] vs. 2[1,2]), and quality of life scores [(9.1±1.1) vs. (8.9±1.1) vs. (7.5±0.8)], cosmetic satisfaction and quality of life in TOETVA and BAA group were better than that in OT group, in terms of scar self-consciousness: TOETVA<BAA<OT (all P<0.05). But there were no significant differences in the levels of Tg or TgAb between three groups for total resection subgroup (all P>0.05). The median follow-up time of the three groups was 25 months (TOETVA group), 28 months (BAA group), and 32 months (OT group) respectively, without disease progression. Conclusion: TOETVA and BAA are optional surgical methods for PTC in stages pT1bN0M0 and pT1bN1aM0, with good safety and patient's cosmetic satisfaction.
Keywords: Breast areola approach; Natural orifice endoscopic surgery; Patient satisfaction; Safety; Surgical procedures, minimally invasive; Thyroid neoplasms.
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11
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):985-989. doi: 10.3760/cma.j.cn115330-20191126-00725.
[Progress in ototoxicity of aminoglycoside antibiotics]
[Article in Chinese]
H Z Han 1, Y D Dong 1, W Wei 1, X L Ma 1
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PMID: 33036519
DOI: 10.3760/cma.j.cn115330-20191126-00725
Abstract
耳蜗毛细胞是一种特殊的感觉上皮细胞，它接收机械声波并将其转化为神经信号传到神经中枢产生听觉。很多药物在临床使用过程中被发现有损伤内耳毛细胞的不良反应，其中氨基糖苷类抗生素（aminoglycosides，AG）的耳毒性研究一直是药物性聋领域的重要课题。本文就近年国内外最新文献简要讨论了AG导致听力损失机制的研究进展，另外介绍了抗AG耳毒性潜在疗法的研究进展，为目前针对耳毒性药物导致导致听力障碍的临床治疗提供参考。.
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12
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):990-993. doi: 10.3760/cma.j.cn115330-20200224-00124.
[Perioperative management of endoscope-assisted functional rhinoplasty]
[Article in Chinese]
F Wang 1, Y Shen 1, C Y Zhou 1
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PMID: 33036520
DOI: 10.3760/cma.j.cn115330-20200224-00124
Abstract
科学合理的围手术期管理是功能性鼻整形手术的重要组成部分，能够有效地保证手术的顺利进行，避免术后并发症的发生，提高手术成功率以及患者的满意度。本文详细介绍了鼻内镜下功能性鼻整形手术的围手术期管理，包括术前检查、评估、手术方案的制订、术中器械的准备和围手术期人文关怀以及术后随访。.
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13
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):998-1001. doi: 10.3760/cma.j.cn115330-20200122-00047.
[Diagnosis and treatment of qualitative olfactory dysfunction]
[Article in Chinese]
J F Liu 1, J H Zhao 1, Y B Wang 1, Y Zhao 1, Z Y Chen 1, J Han 1
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PMID: 33036522
DOI: 10.3760/cma.j.cn115330-20200122-00047
Abstract
嗅觉障碍包括嗅觉定量障碍（嗅觉下降、嗅觉丧失）和嗅觉定性障碍（嗅觉倒错、幻嗅）。相对于嗅觉定量障碍，嗅觉定性障碍对患者日常生活的影响更大。目前人们对嗅觉定性障碍的病因和发病机制认识仍然有限，治疗仍具有挑战性。对于中枢性嗅觉定性障碍以药物治疗为主，对于严重的持续性外周性嗅觉定性障碍可以考虑手术治疗。本文就该疾病的诊断和治疗进展做一总结，以期为临床实践提供参考。.
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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):967-969. doi: 10.3760/cma.j.cn115330-20191203-00741.
[Lipoma of tympanum and mastoid: a case report]
[Article in Chinese]
Z R Zhu 1, K H Xi 1, X H Liu 1, X B Zhang 1
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PMID: 33036514
DOI: 10.3760/cma.j.cn115330-20191203-00741
Abstract
报道一例被误诊为胆脂瘤的累及鼓室和乳突的中耳脂肪瘤病例。患者为中老年男性，因间断头晕伴听力下降就诊，经耳科、听力及影像学检查初步诊断为中耳胆脂瘤而行手术治疗，术中发现乳突和鼓室內充满黄色颗粒状新生物，术后病理回报脂肪瘤。中耳脂肪瘤少见，同时累及鼓室和乳突者相对更少见，临床上应注意加以鉴别。.
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15
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):889-892. doi: 10.3760/cma.j.cn115330-20200501-00365.
[Evaluation of endoscopic thyroid surgery with extra-cervical approaches]
[Article in Chinese]
J G Fang 1
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PMID: 33036501
DOI: 10.3760/cma.j.cn115330-20200501-00365
Abstract
本述评对目前基本成熟的各种颈外入路腔镜下甲状腺手术进行了综合评价，包括操作的便利性和容易程度、创伤的大小、手术的适应证和禁忌证、美容效果、并发症以及费用效益比值等。.
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16
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):975-979. doi: 10.3760/cma.j.cn115330-20200507-00384.
[Indications and contraindications for transoral endoscopic thyroidectomy by vestibular approach]
[Article in Chinese]
L Yi 1, Z Y Liu 1, X W Peng 1, Z Li 1, B Zhou 1, C L Lyu 1, D J Song 1, Y Y Tang 1, P Wu 1, H Li 1, W Peng 1, M Li 2
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PMID: 33036517
DOI: 10.3760/cma.j.cn115330-20200507-00384
Abstract
经口腔前庭入路腔镜甲状腺手术（transoral endoscopic thyroidectomy vestibular approach，TOETVA）近年成为研究热点。由于技术、器械、观念等因素，各中心报道的TOETVA适应证及禁忌证有所异同。故本文从客观因素如腺体大小、恶性肿瘤清扫彻底性、颈部因素、特殊类型甲状腺炎、口腔颌面因素和其他因素，以及主观因素即患者意愿，对TOETVA的适应证、相对适应证、相对禁忌证、绝对禁忌证进行综述，旨在帮助甲状腺外科医师更全面判断患者是否适合行TOETVA，并作出最优选择。.
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17
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):980-984. doi: 10.3760/cma.j.cn115330-20200217-00097.
[A contemporary review of deep learning in otorhinolaryngology-head and neck surgery]
[Article in Chinese]
Q W Wu 1, Q T Yang 1
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PMID: 33036518
DOI: 10.3760/cma.j.cn115330-20200217-00097
Abstract
近年来，大数据、人工智能和云计算等技术的快速发展给医疗健康领域带来巨大机遇和挑战。以深度学习（deep learning，DL）为代表的人工智能研究方法在耳鼻咽喉头颈外科疾病诊疗、预后分析及病因研究等方面发挥日益重要的作用。DL不仅与专家诊断水平相当，而且节约时间和经济成本，但也存在获取高质量大数据和临床推广运用等多方面难题。本文对其相关研究进行回顾分析，探讨其临床运用价值及面临的挑战。.
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18
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):972-974. doi: 10.3760/cma.j.cn115330-20200414-00296.
[Acquired subglottic cysts in infants with ultra-low birth weight: a case report]
[Article in Chinese]
X Y Zhao 1, Y S Teng 2, Z N Li 2, H G Pan 2
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PMID: 33036516
DOI: 10.3760/cma.j.cn115330-20200414-00296
Abstract
报道深圳市儿童医院诊治1例4月龄早产婴儿继发性声门下囊肿的诊疗过程。患儿早产、气管插管病史明确，表现为气促、喉喘鸣、呼吸困难加重，电子喉镜及CT检查提示声门下囊肿。全麻诱导时出现插管困难遂紧急行气管切开术，内镜下完整切除多发肿物。术后病理证实为声门下囊肿。术后1个月、5个月复查，患儿均无呼吸困难症状，无声嘶，电子喉镜检查示未见囊肿复发及声门下狭窄。.
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19
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):1002. doi: 10.3760/cma.j.cn115330-20200214-00086.
[Application of narrow band imaging laryngoscope in the postoperative follow-up of laryngeal cancer]
[Article in Chinese]
X G Ni 1
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PMID: 33036523
DOI: 10.3760/cma.j.cn115330-20200214-00086
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20
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi
. 2020 Oct 7;55(10):993-997. doi: 10.3760/cma.j.cn115330-20200813-00671.
[Research progress on the role of type Ⅱ inflammation in chronic rhinosinusitis with polyps]
[Article in Chinese]
J Chen 1, Y Y Mao 1, Z Chen 1, M Liao 1, S Li 1, J Y Liu 1, Y C Yang 1
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PMID: 33036521
DOI: 10.3760/cma.j.cn115330-20200813-00671
Abstract
慢性鼻窦炎发病机制不清，在其炎症病理机制中，Ⅱ型炎症具有重要作用，目前已有针对其不同炎症因子的生物制剂并逐渐应用于临床。但作为生物标志物，Ⅱ型炎症相关细胞及细胞因子，特别是血液相关细胞或因子，在慢性鼻窦炎特别是鼻息肉中的作用还不十分清楚，本文对其研究进展进行综述。.
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