彩超引导下的粗针穿刺活检术在腮腺肿瘤诊断中的应用

目的:探讨彩超引导下粗针穿刺活检在腮腺肿瘤术前诊断中的应用。方法:回顾2013~2015年于湖北省恩施州中心医院术前行彩超引导下粗针穿刺活检的腮腺肿瘤患者63例,将彩超引导下粗针穿刺活检的结果与术后组织病理学结果进行比较并统计。结果:63例腮腺肿瘤患者中,彩超引导下粗针穿刺活检诊断良性肿瘤56例,其中有1例术后病理检查报道为粘液表皮样癌,彩超引导下粗针穿刺活检诊断符合率98.2%;彩超引导下粗针穿刺活检诊断恶性肿瘤7例,彩超引导下粗针穿刺活检诊断符合率100%。彩超引导下粗针穿刺活检术术后发生并发症11例,术区疼痛6例,术区肿胀5例,无面神经损伤病例。结论:彩超引导下粗针穿刺活检术在腮腺肿瘤诊断中准确率高,术后并发症少,无不可逆性损伤。     

细针吸取细胞学在口腔颌颈部包块诊断中的应用

目的:探讨细针吸取细胞学检查(FNAC)对口腔颌颈部包块的诊断价值.方法:运用细针穿刺器对195例口腔颌颈部包块进行FNAC检查,并与包块切除术后病理组织学(HPD)的诊断结果进行对比.结果:FNAC检查定性诊断准确率90.8%,误诊率9.2%:HPD的结果与FNAC的组织学结果相比两者间无差异性(p＞0.05).FNAC检查后无并发症发生,也未发现肿瘤转移与复发.结论:细针穿刺器吸取细胞对口腔颌颈部包块诊断具有安全,简便等优点,有较高的诊断准确率.     

口腔颌面部横纹肌肉瘤及综合治疗

目的　探讨口腔颌面部横纹肌肉瘤的诊疗方法。方法　选择1981~2001年在四川大学华西口腔医院颌面外科治疗的横纹肌肉瘤患者共74例,按WHO(1972)的横纹肌肉瘤TNM分期和国际横纹肌肉瘤协作组(1988)对该瘤的临床分期进行分期,探讨横纹肌肉瘤病理分型,临床分期及治疗方法与预后的关系。结果　74例患者中,有 34例行扩大切除术,18例行局部切除术,术后所有患者均接受了不同剂量的放疗,另有22例患者因病变范围广或是儿童而只接受了放疗或者放、化疗联合治疗。随访病例的5年生存率随病期和治疗方案的不同而有显著差异, 肿瘤复发和手术切除边缘及临床分期明显相关。结论　采用扩大切除术加术后放疗对提高本病的治愈率,减少复发有明显效果;晚期或儿童患者采用局部切除联合放、化疗对于提高5年生存率有良好效果。     

应用细针穿刺制作细胞块技术诊断腮腺区肿块的临床意义

目的 探讨超声引导下细针穿刺制作细胞块在诊断腮腺区肿块方面的应用价值。方法在彩色超声仪引导下,对285个腮腺区肿块进行细针穿刺,将穿刺标本制成细胞块,以进行病理学诊断。对非肿瘤性肿块采取保守治疗,囊肿与肿瘤性肿块采取手术治疗。对术后病理确诊为腺样囊性癌（ACC）与多形性腺瘤（PA）对应的细胞块行干细胞因子受体CD117免疫组织化学检测。结果标本制作满意率为95.1%（271/285）,诊断准确率为94.5%（256/271）;诊断敏感度为87.0%（67/77）,特异度为98.1%（157/160）。CD117在ACC中的阳性表达率为95.2%（20/21）,在PA中为20.3%（25/123）,ACC中阳性表达率明显高于PA,二者差异有统计学意义（P<0.01）。结论超声引导下腮腺区肿块细针穿刺制作细胞块结合分子标志物检测,对腮腺区肿块的诊断具有重要意义。     

CT灌注成像与细针穿刺细胞学检查在涎腺肿瘤诊断中的应用

目的:探讨CT灌注成像与细针穿刺细胞学检查对涎腺肿瘤良恶性的鉴别诊断价值.方法:36 例涎腺肿瘤(腮腺26 例,下颌下腺8 例,舌下腺1 例,腭部1 例)患者,术前均行细针穿刺细胞学检查和CT灌注扫描,并取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),所有涎腺肿瘤术后均行病理检查.结果: 36 例患者中,最终病理确诊为涎腺恶性肿瘤者13 例,细针穿刺细胞学检查对恶性肿瘤检测的敏感性为84.6 %(11/13),特异性为95.7% (22/23),符合率为91.7%(33/36).CT灌注成像恶性肿瘤组BF、BV、PS值均高于良性肿瘤组(P<0.05),而2 组之间的MTT参数则无统计学差异(P>0.05).其诊断恶性肿瘤的敏感性为92.3%(12/13),特异性为86.9%(20/23),符合率为88.9%(32/36).细针穿刺细胞学检查假阴性的涎腺恶性肿瘤可通过CT灌注成像检查得到正确诊断.结论:CT灌注成像能提供涎腺肿瘤微循环灌注方面的信息,有利于肿瘤良恶性的鉴别,与细针穿刺细胞学检查并联应用,能够明显提高涎腺肿瘤诊断的准确性.     

左面颊部颗粒细胞肉瘤1例

粒细胞肉瘤是一种局限性的原始粒细胞肿瘤 ,以往认为常发生于儿童及青年人 ,好发生于各种扁骨。近年亦有报道发生于眼眶、宫颈、睾丸、小肠等。证实此肿瘤可发生于任何部位。本院去年收治 1例中年男性患者 ,发生于颌面部的粒细胞肉瘤。初诊为非何杰金氏恶性淋巴瘤及胚胎性横纹肌肉瘤。后经免疫组织化学诊断为粒细胞肉瘤。现报告如下 :患者男性 ,44岁 ,因左面颊部包块 2 0余天入院。查体 :左面部有一约蚕豆大包块 ,质硬 ,压痛 ( +) ,活动度差。手术所见 :瘤位于颧弓与上颌外侧壁之间 ,约 3ｃｍ× 4ｃｍ× 4ｃｍ ,质硬 ,中心液化 ,周围未见骨…     

口腔颌面部软组织肉瘤的手术治疗

本文报告口腔颌面部软组织肉瘤102例,其中男性63例、女性39例,平均年龄33.3岁(3～64岁)。病期:≤三月者17例,>3个月～2年者43例,复发病例42例。原发部位依次为上颌区、下颌区、颊、腮腺等。病理类型依次为纤维肉瘤、横纹肌肉瘤、神经纤维肉瘤、滑膜肉瘤、恶性纤维组织细胞瘤、血管肉瘤、脂肪肉瘤。本组病例均施行手术治疗,局部切除者68例,扩大切除者34例,其中42例作了颈清扫术,术后病检证实颈淋巴转移率为23.8％。随访:三年、五年、十年、十五年的生存率分别为:46.3％、34.8％、38.8％、38.9％。文章讨论了组织学类型的临床意义,临床表现的诊断价值,手术与临床表现的关系,术前活检和术后标本的差异,颈淋巴清扫术的临床应用,术后复发病例的再治疗评价。     

儿童口腔及颌面部胚胎性横纹肌肉瘤

儿童时期发生于口腔及颌面部的横纹肌来源的肿瘤比较少见。国外文献中 Yamamoto等报告1例,国内曾今表等曾报告1例发生于下唇的横纹肌肉瘤。由于本瘤的发生率低,组织病理形态复杂,因而在口腔颌面外科临床及口腔病理科方面的误诊、漏诊情况屡有发生。本文报告原发于口腔及颌面部小儿胚胎性     

儿童颌面部腺泡型横纹肌肉瘤1例及文献回顾

横纹肌肉瘤(rhabdomyosarcoma,RMS)是起源于横纹肌细胞或向横纹肌细胞分化的间叶细胞的恶性肿瘤,是儿童和青少年最常见软组织恶性肿瘤,它具有高度可变的生物学行为 [1],临床表现不典型,影像表现缺乏特异性,早期诊断及合理治疗对病人的预后至关重要.现将本院收治的1例儿童腺泡状横纹肌肉瘤报告如下.     

口腔颌面部间叶组织恶性肿瘤

本文回顾性分析了口腔颌面部间叶组织恶性肿瘤７５例。分析结果：①以２０￣４９岁为此类肿瘤高发期共５０例，占７０．７％；②临床病理分类类型较多，以颌骨肉瘤、软骨肉瘤、横纹肌肉瘤最多见，共５４例，占７２％；③以上、下颌骨最常见，共４９例，占６５．３％；④病程最短３周，最长２０年，绝大多数为２￣３个月；⑤９例手术治疗后复发，３例两次复发行第三次手术，１例第三次复发行第四次手术，复发时间多数在术后半年左右。     

二维及彩色多普勒超声在颌面部间隙感染诊断中应用价值的探讨

目的:探讨二维及彩色多普勒超声在颌面部间隙感染诊断及鉴别诊断中的应用价值.方法:回顾性分析90 例间隙感染及肿瘤的超声表现,并对误诊及漏诊的病例进行分析,以提高超声诊断的准确率.结果: 90 例中,87 例间隙感染53 例有脓腔形成,全部经手术切开引流及穿刺证实;2 例为非霍奇金淋巴瘤,1 例为鳃裂囊肿伴感染.超声表现:①间隙感染回声较肿瘤回声强, 95%(83/87)的间隙感染为暗淡/中等光点,而肿瘤 2 例回声均为无明显光点;②肿瘤周围组织一般不肿胀,回声正常;而间隙感染与周围组织无明显边界,软组织肿胀明显;③间隙感染病变区血流少占87%(76/87),肿瘤内血流均较多;④抗炎治疗后复诊,病变区会明显缩小,血流也会减少,回声增强;肿瘤患者抗炎治疗后均无改变.结论:二维及彩色多普勒超声诊断间隙感染符合率高达92.2%,对于颌面部间隙感染与肿瘤伴感染的鉴别诊断有一定价值,检查费用低,可以作为临床首选检查.     

腮腺肿瘤112例临床分析

目的：对腮腺肿瘤的临床和病理学特点进行分析，探讨诊断和治疗中的注意事项。方法：对1985～2005年间收治的112例腮腺肿瘤病例的临床和病理学特点进行回顾性分析。结果：112例腮腺肿瘤男性多于女性。年龄14～80岁。良性肿瘤84例，占75％，恶性肿瘤28例，占25％。B超诊断符合率86．4％。细针吸细胞学定性诊断符合率92．9％，组织类型鉴别较困难。24例腮腺良性肿瘤直径〈2cm者行肿瘤加瘤周正常腺体切除术，获得随访18例，1例腺淋巴瘤在其它部位复发。结论：术前定性诊断应根据肿瘤的部位、大小及患者的情况选择合适的检查方法，疑难病例手术中冰冻活体组织检查是确诊的可靠依据。小的腮腺良性肿瘤实施瘤周正常腺体切除术，不增加复发率，并能减少腮腺手术的并发症。     

Comparison of Tru-Cut Biopsy and Incisional Biopsy in Achieving Prompt Diagnosis of Maxillofacial Pathology

Tru-cut (core needle) biopsy has many advantages over open biopsy. It is quick and easy to perform, may be carried out in the outpatient department, avoids incision through previously irradiated skin and has few complications. The purpose of this study is to compare the two available biopsy techniques that are Tru-cut biopsy and incisional biopsy in achieving prompt diagnosis of maxillofacial pathology. A prospective study was conducted in 25 patients reported to our department. The Tru-cut biopsy was performed by using 14 gauge disposable Tru-cut biopsy needles (Baxter, made in the USA) by means of two successive insertions with different angulations of the needle into the core of the lesion followed by incisional biopsy. The diagnostic criteria which were evaluated include: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Tru-cut biopsy had sensitivity of 68.42%; specificity of 83.33%; PPV of 92.86%; NPV of 45.45% with accuracy rate of 72%. The Tru-cut biopsy method was evaluated as a very helpful method for prompt diagnosis of maxillofacial pathology since it is practical to perform, causes minimum trauma to the tissue, decreases the metastatic risk of malignant lesions during the procedure and relatively free from complications.     

磁共振导航下细针穿吸诊断头颈深部肿块的应用价值

目的:评价磁共振导航下细针穿吸诊断头颈深部肿块的应用价值。方法:对12例头颈深部肿块患者行磁共振导航定位引导下细针穿吸细胞学检查,男9例,女3例,年龄15-63岁。肿块位于颞下窝6例,腮腺深叶3例,翼下颌间隙2例,咽旁间隙1例。结果:所有12例肿块经磁共振导航下穿吸针均显示达到肿块中心;穿吸细胞学检查6例与术后病理符合,1例不符:另5例穿吸细胞学为炎症,未进行手术探查,现随访正常。穿吸诊断准确率为91.67％,敏感度为80％,特异度为100％;穿吸过程中无明显并发症。结论:磁共振导航下细针穿吸细胞学检查是一种定位准确、诊断准确率高且安全的检查方法,尤其适应于头颈部深部肿块的诊断。     

Evaluation of biopsy methods in the diagnosis of submandibular space pathology

The aim of this study was to evaluate the performance of fine needle aspiration cytology (FNAC), ultrasound-guided core needle biopsy (USCNB), punch biopsy, and surgical excision biopsy in neoplasms presenting within the submandibular space. A retrospective analysis of all patients with a pathological diagnosis of a submandibular space neoplasm within a 12-year period (February 1999 to June 2011) was performed. Biopsy results were compared to histopathological diagnosis obtained from surgical excision biopsy. Eighty-one specimens from 44 patients met the search criteria (15 FNAC, 24 USCNB, 7 punch biopsy, and 35 surgical excision biopsy). The final diagnosis was established by USCNB, punch biopsy, or surgical excision biopsy and not by FNAC alone. Surgical excision biopsy was performed as a primary diagnostic (n = 8), secondary diagnostic (n = 15), or as a post-diagnostic therapeutic procedure (n = 12). Non-diagnostic results were: FNAC 11/15, USCNB 2/24, and punch biopsy 1/7. Diagnostic results were: FNAC 2/15, USCNB 20/24, and punch biopsy 5/7. No complications were reported. Although punch biopsy demonstrated good yield and accuracy, its use is restricted to a small cohort of patients. USCNB is a safe and accurate technique in the submandibular space, with a low non-diagnostic rate.     

咽旁间隙肿瘤

本文对我院收治的89例咽旁肿瘤作了回顾分析。术前32例病人作了针吸活检，50例作了CT检查；全部病人均行手术治疗，大多数病人经腮腺和经颈部入路手术。结果在32例针吸活检病人中27例诊断正确，50例CT检查中36例可准确判断肿瘤的位置，组织学见良性肿瘤72例（81％），恶性肿瘤17例（19％），咽旁肿瘤中以混合瘤最为多见，共37例（42％）；术后良性肿瘤复发10例（14％），恶性肿瘤12例（74％）。结果显示针吸活检和CT对咽旁肿瘤的术前诊断和评估十分必要和关键，经腮腺入路和经颈部入路是最常用的手术进路，咽旁肿瘤的术后复发率高。     

412例腮腺恶性肿瘤回顾分析

目的:通过回顾性分析,总结腮腺恶性肿瘤的发病特点、临床及影像学表现。方法:收集解放军总医院口腔颌面外科、耳鼻咽喉、头颈外科及大连医科大学附属第一医院口腔颌面外科收治的腮腺恶性肿瘤病例412例,对其临床资料进行回顾分析。结果:构成比占前3位的腮腺恶性肿瘤分别为黏液表皮样癌、腺样囊性癌和腺泡细胞癌;412例腮腺恶性肿瘤中,73.1%有伴随症状或近期生长加快表现;58.0%的恶性肿瘤质地硬,66.2%活动度中等偏差,32.3%边界不清,36.8%有疼痛;74.2%CT显示肿瘤形态不规则,68.7%超声显示肿瘤形态不规则;细针吸取细胞活检和术中快速冷冻检查对腮腺恶性肿瘤的诊断符合率分别为83.7%和91.8%,术中快速冷冻检查对腮腺高度恶性肿瘤的诊断符合率为79.4%。结论:腮腺恶性肿瘤的病理类型复杂多样;综合考虑其发病特点、临床及影像学表现,有助于腮腺恶性肿瘤的诊断;细针吸取细胞活检和术中快速冷冻检查诊断腮腺恶性肿瘤有较高的准确性。     

The application of magnetic resonance imaging-guided fine-needle aspiration cytology in the diagnosis of deep lesions in the head and neck.

PURPOSE: Image-guided fine-needle aspiration cytology (FNAC) may be useful as an alternative diagnostic approach to lesions in the head and neck. This study reports on the use of magnetic resonance imaging (MRI)-guided FNAC for diagnostic evaluation of deep lesions in this region. MATERIALS AND METHODS: This was a prospective study of 12 patients with deep lesions in the head and neck who underwent MRI-guided FNAC at the Shanghai 9th People's Hospital. A 0.2-T open magnet was used for MRI and localization of the 20-gauge MRI-compatible needle. All of the aspirated samples were stained with hematoxylin and eosin and examined by a cytopathologist. RESULTS: The needle in all 12 cases was displayed on MRI in the central portion of the lesion under the guidance of MRI; 12 of 12 patients (100%) had diagnostic aspirations and none needed open biopsy for more specific histologic interpretation. Six of these 12 patients with tumors (4 malignant, 2 benign) underwent operative treatment with positive postoperative pathologic results. One patient had a diagnosis of inflammation. The diagnostic accuracy was 91.67% (11 of 12), the sensitivity was 85.71% (6 of 7), and the specificity was 100% (5 of 5). There were no false-positive results and 1 false-negative result, for a false-negative rate of 14.29% (1 of 7). All aspiration procedures were well tolerated and without complications. CONCLUSIONS: MRI-guided FNAC is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is helpful and accurate in the diagnosis of deep lesions in the head and neck and in follow-up of patients, thereby avoiding further surgical intervention.