目的 评估图像增强内镜（image enhancement endoscopy，IEE）系统对鼻腔鼻窦恶性肿瘤的诊断价值。 方法 对2019年1月至2021年12月于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科就诊的鼻腔肿物患者使用普通白光内镜（white light endoscopy，WLE）和IEE检查鼻腔并采集图片后靶向活检。盲法分析鼻腔病变患者的内镜图像，将病理诊断分别与普通WLE和IEE诊断进行比较。计算普通WLE和IEE对鼻腔鼻窦恶性肿瘤的诊断敏感度、特异度、阳性预测值（positive predictive value，PPV）和阴性预测值（negative predictive value，NPV）， P <0.05为差异有统计学意义。采用诊断试验的一致性评价（kappa指数，κ）评价普通WLE和IEE诊断与组织病理学的一致性，最后将肿瘤的血管纹与窄带成像的Ni内镜分型进行对比。 结果 本研究最终纳入193例鼻腔肿物患者，病理学证实鼻腔恶性肿瘤41例（21.24%，41/193例），普通WLE正确诊断18例（43.90%，18/41），IEE正确诊断28例（68.29%，28/41）。41例恶性肿瘤中有28例（68.29%，28/41）呈斑片样或大小不一的点状、扭曲的血管纹，与Ni内镜分型Ⅴ型一致。14例（34.15%，14/41）鳞状上皮来源恶性肿瘤均表现为Ni内镜分型Ⅴ型的血管纹。27例非鳞状上皮来源恶性肿瘤中14例（34.15%，14/41）表现为Ni内镜分型Ⅴ型；7例（17.07%，7/41）肿瘤表现为假阴性；6例（14.63%，6/41）因表面覆盖难以清除的坏死组织而无法辨认血管纹。IEE和WLE对恶性肿瘤诊断的敏感度、特异度、PPV和NPV分别为80.00% vs 51.42%、98.68% vs 96.69%、93.33% vs 78.26%、95.51% vs 89.57%；与病理诊断的一致性为95.16% vs 88.17%，κ值为0.832 vs 0.554。 结论 IEE可以提高鼻腔鼻窦恶性肿瘤的内镜诊断率。Ni内镜分型Ⅴ型适用于对鼻腔鼻窦鳞状上皮来源恶性肿瘤的诊断。
正常的颈内动脉由颈总动脉发出后,在咽的外侧垂直上行至颅底,再经颈动脉管入颅。颈内动脉位于颈动脉三角内平甲状软骨上缘,起自颈总动脉,与颈外动脉伴行,开始在颈外动脉的后外侧上行,继而转向其后内侧,沿咽侧壁和椎前筋膜前侧上到颅底,再经颈动脉管进入颅中窝。颈内动脉走行位置及走行路线偏离正常路径者被视为颈内动脉异位。口咽部颈内动脉异位较少见,常无明显临床症状,临床诊断较为困难,临床上如果误诊为囊肿,血管瘤等而采取外科手术,危及患者生命,所以准确诊断口咽部颈内动脉异位非常重要,口咽部颈内动脉异位依靠影像学检查确诊。颈段的颈内动脉异位与耳鼻咽喉头颈外科息息相关,因此,该科室的临床医生在诊治过程中需要排除颈内动脉异位,避免造成不可逆转的后果。现回顾性分析误诊为咽侧壁肿物的口咽部颈内动脉异位1例,使得临床医师对于口咽部颈内动脉血管的变异有更深刻的了解,避免发生危险的并发症。The normal internal carotid artery, after emanating from the common carotid artery, travels vertically up the lateral part of the pharynx to the skull base, and then enters the skull through the carotid canal. The internal carotid artery is located at the upper margin of the plain thyroid cartilage in the carotid triangle, starting from the common carotid artery and accompanying the external carotid artery, ascending posterolateral to the external carotid artery, then turning posterolateral to the skull base along the parietal pharynx and anterior to the prevertebral fascia, and then entering the middle cranial fossa through the carotid canal. The position and route of the internal carotid artery deviated from the normal path was considered as ectopic internal carotid artery. Oropharyngeal internal carotid artery ectopia often has no obvious clinical symptoms, clinical diagnosis is difficult, clinical misdiagnosis is often based on imaging diagnosis. Ectopia of internal carotid artery in the neck is closely related to otorhinolaryngology and head and neck surgery. Therefore, clinicians in this department need to exclude ectopia of internal carotid artery during diagnosis and treatment to avoid irreversible consequences. We retrospectively analyzed 1 case of oropharyngeal internal carotid artery ectopic misdiagnosed as lateral pharyngeal wall mass, which enabled clinicians to have a deeper understanding of the variation of oropharyngeal internal carotid artery vessels and avoid dangerous complications.
目的:探讨手术治疗联合耳模加压辅助治疗耳廓假性囊肿的效果。方法:回顾性分析2020年3月~2024年11月我科共收集56例耳廓假性囊肿患者临床资料,全部病例均行囊肿前壁软骨切除,后壁软骨粗糙化,以及用自制塑料耳模加压片,压迫囊肿区前、后皮肤,贯穿耳廓软骨缝扎囊肿区前、后皮肤的方法治疗耳廓假性囊肿,术后随访观察耳廓的恢复情况。结论:采用耳廓假性囊肿前壁软骨切除,后壁软骨粗糙化,以及用自制塑料耳模加压片,压迫囊肿区前、耳后皮肤,贯穿耳廓软骨缝扎囊肿区前、后皮肤的方法治疗耳廓假性囊肿,术后局部创面加压患者无明显的疼痛,肿胀。极大减少复发,术后外观恢复好,治疗效果好,疗程短,患者满意,疗效确切。Objective: To explore the effect of surgical treatment combined with ear mold pressure-assisted treatment of auricular pseudocyst. Methods: A retrospective analysis of the clinical data of 56 patients with auricular pseudocyst collected in our department from March 2020 to November 2024 was performed. All cases underwent anterior wall cartilage resection, posterior wall cartilage roughening, and self-made plastic ear mold pressure sheet to compress the anterior and posterior skin of the cyst area, and penetrate the auricular cartilage to sew the anterior and posterior skin of the cyst area to treat auricular pseudocyst. The recovery of the auricle was observed after follow-up. Conclusion: The treatment of auricular pseudocyst by resection of the anterior wall cartilage, roughening of the posterior wall cartilage, and using a homemade plastic ear mold pressure sheet to compress the skin in front of and behind the cyst area, and suturing the skin in front of and behind the cyst area through the auricular cartilage, can greatly reduce the recurrence, with good treatment effect, short treatment course and definite efficacy.
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