• 期刊

身體質量指數與Friedman舌位置分級的相關性

BACKGROUND: It is thought that body mass index (BMI) influences Friedman tongue position (FTP). More specificity, patients with higher BMIs may have higher degree of FTPs. We check the suggestion in factory worker groups.METHODS: In 2008, 497 healthy workers were screened for oral cancer in a certain county of North Taiwan. One man with congenital cleft palate was excluded. Four hundreds and ninety-six examinee were enrolled, including 409 males and 87 females.They were 40.3 ± 9.6 years old (average ± standard deviation). Obtained the examinee's BMI, we divided them into four groups by degrees of FTP (I, II, III and IV). For subgroup analysis, we categorized them into FTP I & II / FTP III& IV and analyzed the relation of gender, age and BMI. Data was analyzed by ANOVA, chi-square and logistic regression tests (α = .05).RESULTS: In the male group, we found those with different degrees of FTP have significant difference on those BMI values. On the contrary, the increased degrees of FTP (especially I to III) are associated with increased BMI (ANOVA test, p ＜ .001). In the female group, there is no such significant relation statistically. In subgroup analysis, patients aged over 40 years have odds ratio of 2.51 to have FTP III&IV. When adjusted by age and BMI, the odds ratio increased up to 2.74. Patients with BMI≧27 kg/m^2 have odds ratio of 2.11 to have FTP III & IV. When adjusted by age and gender, the odds ratio increased up to 2.63.CONCLUSIONS: Because the women cases were far less than the men, the data of women is controversial. As far as healthy men are concerned, we confirmed patients with higher BMIs have higher degree of FTPs. The increased stages of FTP (especially I to III) are also associated with increased BMIs. Higher BMI and older age are associated with increased agrees of FTP.

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慢性鼻及鼻竇炎患者之鼻咽－帆咽界面

背景：運用電腦斷層之2維多層面數位重建可以對恰巧位於鼻咽－帆咽界面進行定性與定量的研究，可進一步採討慢性鼻及鼻竇炎患者之該界面狀況，以彌補傳統的反射鏡檢或內視鏡檢封該軸狀切面研究之不足。方法：共有207名（男127，女80）成年患者納入本研究，年齡48.5±15.8歲（平均值±標準差），均因慢性鼻及鼻竇炎曾於本院接受鼻竇電腦斷層檢查，兩側Lund-Mackay計分總分為8.2±6.2分。把儲存的主體像素輸出到後置影像處理系統，開啟2維多層面數位重建功能，找到該界面切面，測量該界面之面積與中軸前後徑。所有統計分析之α值為.05。結果：男性患者之該界面面積（48.1±16.2 mm^2）與女性患者（49.2±15.0 mm^2）相較並無差異（雙尾t檢定，p=.6355），與兩側Lund-Mackay計分總分間呈現有意義之負相關（r=-.211）與負向迴歸（b=-5.316）。男性患者之該界面中軸前後徑（18.6±4.6mm）與女性患者（19.5±4.0mm）相較亦無差異（雙尾t檢定，p=.1303），亦與兩側Lund-Mackay計分總分間呈現有意義之負相關（r=-.192）與負向迴歸（b=-.138）。然而，女性患者之該界面之中軸前後徑或面積，與其兩側Lund-Mackay計分總分間並無有意義之相關與迴歸。結論：本文首次確認在一般呼吸狀態下，仰臥姿勢時，慢性鼻及鼻竇炎之成年男性患者，其鼻咽－帆咽界面之中軸前後徑與面積均會隨兩側Lund-Mackay計分總分增加而減少，然而，缺乏正常對照組是本文研究上的限制。

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住院病患聲帶麻痺病之病因探討：十年之分析報告

背景：聲帶麻痺為許多疾病的臨床表徵之一，其病因牽涉極廣且比例分布各異。本研究主要針對北部某醫學中心的聲帶麻痺住院患者進行病因分析。方法：從2000年6月到2011年12月，針對聲帶麻痺之住院患者的病歷紀錄做回溯性整理，以得其病因資料。結果：本研究共得555名患者的聲帶麻痺病因，其中316名男性、239名女性，單側麻痺490例、雙側麻痺65例。分析單側聲帶麻痺的病因，手術佔43.0%、腫瘤佔32.2%、不明原因佔10.4%、創傷佔5.7%、中樞性佔2.9%、放射線治療佔2.9% 、發炎佔1.6%及心血管相關疾病佔1.2%；另分析雙側聲帶麻痺的病因，手術佔44.7、不明原因佔13.8%、創傷佔12.3%、腫瘤佔9.2%、中樞性佔9.2%、放射線治療6.2%、發炎佔3.1%及心血管相關疾病佔1.5%。在手術導致的單側及雙側聲帶麻痺中，甲狀腺手術皆為最常見的病因，分別為119例及26例。腫瘤導致之聲帶麻痺則以肺癌最常見，共64例。在316名男性聲帶麻痺的患者中，因腫瘤引起的共112例，為最常見的病因；但在239名女性患者中，最常見病因則為手術，共131例。結論：手術是罹患聲帶麻痺的住院病人中最主要的致病因素，其中以甲狀腺手術引起的最常發生。診斷不明原因的聲帶麻痺之前，必須先排除腫瘤的可能性。除癌症外，良性的腫瘤如甲狀腺腫瘤亦可造成聲帶麻痺。對於放射線治療後的頭頸癌患者，須考慮放射線引起聲帶麻痺之可能性。

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上呼吸道感染後嗅覺喪失

背景：根據國外文獻報告上呼吸道感染是嗅覺喪失常見原因之一，但國內尚未有類似報告。本研究嚐試採討我們處理上呼吸道感染後發生嗅覺喪失的經驗。方法：從2006年1月至2012年4月收集主訴在上呼吸道感染後發現嗅覺功能喪失之病患。這些病患接受酚基乙基乙醇氣味查覺閾值試驗檢查嗅覺功能，並同時接受必要的檢查來排除其他原因導致嗅覺功能喪失之可能性。被診斷因上呼吸道感染後發生嗅覺喪失的病患接受低劑量類固醇治療（10mg prednisolone bid）並再利用酚基乙基乙醇閾值試驗來觀察他們的嗅覺功能是否有進步。結果：在本研究期間共有100名病患被診斷為上呼吸道感染後嗅覺喪失，接受至少兩周口服類固醇治療並回診接受酚基乙基乙醇氣味查覺閾值試驗追蹤嗅覺功能變化的病患有74名。其中嗅覺全失（閾值為-1）病患有47名，追蹤期間發現嗅覺功能有進步有22名（46.8%），從開始接受治療至發現嗅覺功能有進步時間平均52.4天。嗅覺部分喪失（閾值大於-1）病患有27名，追蹤期間發現嗅覺功能有進步有20名（74.1%），從開始接受治療至發現嗅覺功能有進步時間平均26.6天。嗅覺功能進步比率在嗅覺部分喪失病患顯著高於嗅覺全失病患（p=0.042），而且從開始接受治療至發現嗅覺功能有進步的時間在嗅覺部分喪失病患也明顯較快（p=0.032）。治療後嗅覺功能有進步病患共有42名，排除2名發病至治療間隔超過6個月的病患後，平均發病至治療間隔為62.3天；治療後嗅覺功能無進步病患共有32名，排除5名發病至治療間隔超過6個月的病患後，平均發病至治療間隔為89.19天；結果顯示嗅覺功能有進步病患之發病至治療間隔時間明顯較短（p=0.02）。結論：本研究顯示上呼吸道感染後導致嗅覺喪失的病患仍有不少數尚有嗅覺功能，也有較高機會嗅覺功能會進步。

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淋巴結密度可否作為頰膜癌預後之危險因子？

背景：在淋巴結轉移封口腔鱗狀細胞癌患者預後的影響（OSCC）已經被廣泛認可。在我們的研究中，以淋巴節密度作為一個獨立的預後因子針對那些接受過頸淋巴廓清術且呈現陽性淋巴結的口腔癌患者，並與當前的淋巴結分期系統作比較。方法：在這個回溯性研究中我們收集了彰化基督教醫院2004年1月和2008年12月共596例口腔頰膜癌且接受單側或雙側的頸淋巴廓清術的病患進行分析。此外，排除標準包括：1.有其他部位例如唇、臼齒後三角區、口腔底、硬腭及舌前三分之二發生口腔惡性腫瘤者2.接受過術前化療者3.沒有作根治性或功能性頸淋巴廓清術（level 1-5）者4.做雙側頸淋巴廓清術者5.廓清術之淋巴結未呈現陽性反應者6.術前已有遠端轉移者7.資料不全或手術後未追蹤者。排除以上條件不符者，本研究共計收錄了103名病患。結果：自2004年1月到2008年12月之間，符合本研究的病人共計有103名單側頰耳其癌且接受口腔腫瘤切除，併單側根治性或功能性頸淋巴擴清手術且發現有淋巴結呈陽性反應的病人，其中男性102名而女性有1名， 平均年齡約58歲。若以TNM staging system來作分析，T1-2有45名，而T3-4占了58人，N1占了44人，N2占了59人。在此研究中死亡共67人，存活有36人，整體平均追蹤時間為37.611個月，整體區域性淋巴結檢查數目為35.84個，整體平均區域性陽性淋巴結數目為2.67個，淋巴結密度範圍在0.013到0.417之間，平均淋巴結密度為0.092，中位數為0.057。在腫瘤分期（T1-2&T3-4）及淋巴密度上用克氏比例風險迴歸模式分析來做單變數分析，再用多變數分析做調整，都有達統計上明顯的意義。此外，淋巴結密度與無病存活率無論在單變數分析或多變數分析都有達統計上明顯的意義。結論：本研究的主要目的是驗證淋巴結密度是一個很好的評估工具，用於評估頰癌的存活率並結合AJCC淋巴結分期系統作分析。然而，必須排除NO和N3的患者。因為研究中顯示N1和N2組患者似乎有較好的準確性。因此以Tumor-node-metastasis（TNM）淋巴結分期系統作為評估工具，提供醫師更多的預後信息的角色，仍然無法完全被取代。

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Efficacy and Safety of Transoral Endoscopic Microdebrider-assisted Adenoidectomy

OBJECTIVE: The aim of the study was to evaluate the efficacy of transoral endoscopic microdebrider-assisted adenoidectomy (TEMA) compared to a combined method of conventional adenoidectomy with transnasal endoscopic adenoidectomy (CCTEA) for one year follow-up.METHODS: We enrolled 120 children with obstructive adenoid hypertrophy in the study. All patients had chronic nasal obstruction; they were randomly classified into the TEMA and CCTEA groups, each comprising 60 patients. Using a 90-degree endoscope, the patients in the CCTEA group underwent adenoidectomy using an adenoid curette transorally, whereas patients in the TEMA group underwent adenoidectomy using microdebrider transorally. Surgical outcomes were assessed with respect to operating time, blood loss, patency of the posterior choana, visual analogue scale. Assessments were conducted prior to and one year subsequent to surgery completion.RESULTS: The operative time for TEMA group was shorter than that of CCTEA. (p ＜ 0.001) The TEMA group had less blood loss than that of CCTEA group. (p ＜ 0.001) Four of the 60 patients in CCTEA had postoperative hemorrhage, while none of the TEMA group had. Compared to preoperative values, subjective complaints (nasal obstruction, rhinorrhea, and snoring) showed significant improvement 1 year postoperatively in both groups (p ＜ .05 for both). No significant difference was noted among the subjective complaints between TEMA and CCTEA.CONCLUSIONS: TEMA was equally effective in relieving nasal obstruction 1 year after surgery, compared to CCTEA. Furthermore, it provides a better option for prevention of complications than CCTEA because of its better control of manipulation.

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Risk Factors of Surgical Site Infection After Total Laryngectomy

BACKGROUND: The aim of this study is investigating the risk factors of postoperative surgical site infection (SSI) after total laryngectomy. We also examine if previous neck dissection was associated with an increased SSI rate in patients who underwent total laryngectomy.METHODS: We retrospectively reviewed over 800 chart records of laryngectomized patients from March 1994 to December 2010. Basic data along with relevant tumor and surgical variables were collected. The SSI rate was calculated and compared between those had previous neck dissection and those who did not. Chi-square test or Student's t-test was used to investigate the differences between patients with SSI and those without. Logistic regression model was applied to identify independent risk factors of SSI of patients after total laryngectomy.RESULTS: A total of 602 patients were enrolled for final analyses. The overall postoperative SSI rate was 37%. After adjusting for other variables, the independent risk factors associated with postoperative SSI after total laryngectomy included diabetes mellitus, preoperative radiotherapy, prolonged operative duration, peri-operative blood transfusion, postoperative serum albumin level ＜ 2.9 g/dl, and previous neck dissection. The SSI rate for patients who had previous neck dissection was higher than that for patients without previous neck dissection (odds ratio: 2.188, 95% confidence interval: 1.067~4.488, p = 0.033).CONCLUSIONS: Identification of the relevant factors may help surgeons determine which patients may be at high risk of developing postoperative SSI. Meticulous surgical technique and postoperative treatment are essential in patients with an increased risk of postoperative SSI.

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Validation of the Taiwanese Version of the 22-Item Sino-nasal Outcome Test

BACKGROUND: A measure of health related quality of life is important in clinical outcome research for sinonasal diseases. The purpose of this study was to translate the 22-item Sino-nasal Outcome Test into Chinese and assess its validity.METHODS: From August, 2011 to April, 2012, volunteers without sinonasal diseases and patients with allergic rhinitis or rhinosinusitis were enrolled to test the Taiwanese version Sino-nasal Outcome Test-22 (TWSNOT-22) in the study hospital. Two weeks afterwards, 20 patients with allergic rhinitis took the test again if they did not receive treatment and their symptoms did not change. Patients with allergic rhinitis or rhinosinusitis also were assessed with a visual analog scale (VAS) of nasal symptoms and daily impact of nasal symptoms. Fours weeks afterwards, these participants were invited to undergo the same assessment and have the transition of disease status scores graded.RESULTS: Twenty healthy volunteers, 56 patients with allergic rhinitis and 52 patients with rhinosinusitis were enrolled. The median TWSNOT-22 scores of healthy volunteers, patients with allergic rhinitis and those with rhinosinutis were 7.5 (0-28), 33.5 (3-83) and 39 (5-94), respectively. The TWSONT-22 demonstrated good internal consistency (Cronbach's α = 0.937) and test-retest reliability (p ＜ 0.001). There were significant differences in the scores between healthy volunteers and patients with allergic rhinitis as well as those with rhinosinutis (both p ＜0.001). The scores of TWSNOT-22 were significantly correlated to those of VAS of symptoms and daily impact (both p ＜0.001). In addition, TWSNOT demonstrated good responsiveness to the transition of disease status.CONCLUSIONS: The TWSNOT-22 is reliable and valid for measuring healthrelated quality of life in Taiwanese patients with rhinitis and rhinosinusitis.

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超音波導引下細針穿刺切片檢查在小兒族群頸部腫塊的應用

背景：此篇是在未經麻醉鎮靜的小兒族群患者上，針對頸部腫塊進行超音波導引下細針穿刺切片檢查之研究。方法：回顧從2007年7月至2011年10月，年齡小於或等於18歲之病患，期間因為頸部腫塊接受超音波導引下細針穿刺切片檢查的所有病患納入此研究中。結果：共有100名患者納入此研究，平均年齡為13.9±3.5歲，包含46名男性及54名女性。其超音波導引下細針穿刺切片檢查執行之成功率為100%，而其穿刺切片結果顯示良性病灶有87例，惡性病灶有5例，另外檢體不足者有8例；而所有患者之最終診斷則是有95例良性病灶及5例的惡性病灶。最終此檢查在鑑別頸部腫塊是否為惡性病灶的應用上，其敏感度為80%，特異度為95.7%，準確性為92.9 %，陽性預測值為80%，以及陰性預測值為95.7%。在此研究中，兒童及青少年最常見之頸部腫塊可分為三大類，分別為發炎性腫塊（73%）、腫瘤性腫塊（19%），及先天性腫塊（6%）三類。結論：超音波導引下細針穿刺切片檢查在未使用麻醉鎮靜藥物之小兒頸部腫塊的評估上，可以得到良好的檢體採樣率及有效地篩檢出良、惡性病變，減少不必要之手術切片。

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先天性嗅覺全失之磁振造影

背景：先天性嗅覺全失是嗅覺喪失罕見原因之一，可分為兩型：症候群及孤立型。本研究採討我們診斷為先天性嗅覺全失病患的磁振造影表現。方法：從2007年7月至2012年5月在本科共診斷11名先天性嗅覺全失病患。這些病患主訴有記憶以來並未曾問到任何氣味。他們接受理學檢查來排除罹患鼻及鼻竇炎，也排除罹患鼻息肉或腫瘤。如果病患被懷疑罹患鼻及鼻竇炎、鼻息肉或腫瘤，則安排電腦斷層檢查來確定診斷。他們也接受酚基乙基乙醇氣味查覺閾值試驗來檢查嗅覺功能。磁振造影檢查被安排來檢查嗅球、嗅溝及嗅束。結果：11名病患中男性有8名，女性有3名，年齡分布從9歲至50歲，平均24.2歲。理學檢查在鼻腔均未發現有明顯分泌物，也未發現有鼻息肉或腫瘤。所有病患的酚基乙基乙醇氣味查覺閾值試驗均呈現嗅覺全失。磁振造影檢查發現7名病患左右嗅球均未發育，4名病患左右嗅球則發育不良，5名病患左右均未有嗅溝，5名病患只有一邊有嗅溝，9名病患左右均未有嗅束，1名病患只有一邊有嗅束。結論：本研究顯示先天性嗅覺全失病患的磁振造影影像呈現嗅球未發育或發育不良，同時合併嗅溝及嗅束異常。