颈部囊性淋巴管瘤患者术后疗效观察

目的:探讨囊性淋巴管瘤的治疗方法及疗效。方法:10例颈部囊性淋巴管瘤患者于1998-07-2008-03接受改良手术切除,即敞开囊腔后,在直视下行囊外切除。1例外院手术后腮腺深叶复发患儿及1例1岁患儿接受平阳霉素局部注射治疗。结果:10例患者肿瘤完全切除,未出现神经损伤等明显并发症,随访0.5～9.0年无复发;2例局部注射治疗者,肿物基本消失。结论:颈部囊性淋巴管瘤应以手术治疗为主,开囊直视下手术有利于肿瘤完全切除而又不会损伤周围组织。     

颈部淋巴管瘤1例

淋巴管瘤是淋巴管发育畸形所形成的一种良性肿瘤，常见于儿童及青少年，颈部淋巴管瘤多见于成人，以囊性水瘤居多。我院2005年10月收治的一典型病例，现报告如下。     

头颈部淋巴管瘤超声检查3例

淋巴管瘤多发于头颈部,儿童多发.张家口市第四医院2003～2009年收治患者3例,均使用彩色多普勒超声诊断仪超声直接法检查颈部肿物,术后病理诊断为颈部淋巴管瘤,报告如下.     

颈部囊性淋巴管瘤8例临床分析

目的 总结颈部囊性淋巴管瘤的临床特点和诊治过程。方法 分析8例手术效果。结果 8例术后随访1－5年，无1例复发，结论 早期彻底切除囊肿是本病有效的治疗方法。     

成人颈部囊性水瘤1例诊治经验

颈部囊性水瘤是淋巴管瘤的一种,是发生在淋巴系统的良性肿瘤〔1-2〕,常见于2岁以下的儿童,成人颈部囊性水瘤非常罕见〔3-4〕。现将上海市嘉定区中心医院2012年6月收治的1例成人患者报告如下。1资料与方法患者,女,60岁。3年前无明显诱因下出现咽部不适,偶有阵发性刺痛。当时未予重视,未正规治疗。近来患者自觉症状加重,遂来我科就诊。体检：右颈部可扪及局限性隆起,上界为右侧下颌角,下界为舌骨水平,外侧为右侧胸锁乳突肌后缘,内侧为右侧气管旁线。肿块质软,不易活动。     

平阳霉素治疗颈部囊性淋巴管瘤11例临床报告（摘要）

平阳霉素治疗颈部囊性淋巴管瘤１１例临床报告（摘要）李军，沈宁，徐孔礼我院１９９０年１月至１９９４年１２月应用国产平阳霉素（ＢｌｅｏｍｙｃｉｎＡ５）瘤腔内注射治疗颈部囊性淋巴管瘤１１例，疗效显著。本组１１例，男７例，女４例；年龄最大３５岁，最小１岁，平...     

颈部神经鞘瘤的诊断与治疗

目的总结颈部神经鞘瘤的诊断和治疗经验.方法 回顾分析21例颈部神经鞘瘤的临床资料.结果患者在行B超和CT检查后,手术治疗, 随访9个月～19年,无1例复发.结论 B超和CT有助于诊断,手术切除是有效的治疗方法.     

头颈外科

20020850颈部续肿与痰管的诊断和治疗/蔡建峰…//山东医大基础医学院学报一2001,15(6)一356~357 目的:总结颈部囊肿与痪管的诊治经验。方法:93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘩管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌管囊肿37例,甲状舌管凄管25例,癌性淋巴液囊肿1例,随访1一10年。结果:93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂屡管2例3次手术,甲状舌管屡管1例复发,鳃裂屡管术后1例迟发性面瘫,一次手术治愈,无术后并发症。结论:颈部囊肿与痊管的诊断除依据术前检查外,主要是依据术…     

小儿头颈部囊状淋巴管瘤15例临床分析

目的:探讨小儿头颈部囊状淋巴管瘤的诊断和有效的治疗方法。方法:回顾分析我院15例经病理确诊的小儿头颈部囊状淋巴管瘤的临床资料,对其临床特点、治疗方法以及随访结果进行分析。结果:所有患者手术前均行B超或CT等检查,了解病变位置、大小和范围。15例皆经手术切除,其中14例完整切除,1例行次全切除。术后1例出现轻微口角偏斜,1例出现Horner综合征,1例气管切开患儿在出院前已拔套管。13例完整切除者随访6个月～8年,均未见复发;1例次全切除者随访2年未见复发;1例失访。1例轻微口角偏斜经康复治疗有所好转,1例Horner综合征患儿经康复治疗未能好转。结论:B超及CT检查是小儿头颈部囊状淋巴管瘤的有效诊断方法,也是术前手术安全性评估的依据;手术治疗是囊状淋巴管瘤的有效治疗方法,为了避免并发症产生,术中允许少量残留。     

颈部囊肿与瘘管的诊断和治疗

目的总结颈部囊肿与瘘管的诊治经验.方法93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1～10年.结果93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症.结论颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查.B超、CT等是有效的辅助检查手段.治疗上应彻底切除囊壁与瘘管,避免复发.术中应避免损伤颈部的大血管和神经.甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键.     

The pectoralis major myocutaneous flap. Use in surgery of the lower neck and superior mediastinum

Surgery of the lower neck and superior mediastinum is most frequently performed for parastomal recurrence of laryngeal carcinoma. It has been associated with a high incidence of complications, often leading to fatal innominate artery rupture. The use of the pectoralis major myocutaneous flap has permitted wide en bloc resections of the superior mediastinum in ten patients without a major complication. Several technical innovations add versatility to the pectoralis major myocutaneous flap, including tailor fitting each skin paddle and incorporating the pectoralis minor into the muscular pedicle. Superior mediastinal resection should be performed in conjunction with laryngectomy and cervical lymph node dissection in patients who are at high risk for parastomal recurrence. We also recommend that patients with parastomal recurrence undergo this procedure for salvage.     

Sclerotherapy for lymphangioma in children

Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of lymphangioma has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of bleomycin and OK-432 sclerotherapies for treating lymphangioma in children. Fifteen patients were enrolled in the study conducted between 1998 and 2002. All patients were hospitalized. Bleomycin or OK-432 was injected into the lesion. Patients were observed in the hospital for 1 day. The response was considered as excellent in cases with total disappearance of the lesion. If the lesion was regressed more than 50% of the original size, the response was considered as good. Little or no change in the size of lesion was considered to be a poor response. Ten girls and five boys with ages ranging from 4 days to 12 years were treated. Five patients had been operated previously for lymphangioma. Most of the lesions were located only in the cervical region (n=13). Other cases revealed extensions into the mediastinum (n=1) or axilla (n=1). Bleomycin (n=8, 2.87+/-2.03 inj.), OK-432 (n=5, 2+/-1 inj.) or both in order (n=2, 6 and 16 injs.) were injected. No allergic reaction, scar formation or pulmonary complication was encountered. Fever (11%), local reactions (4%) and vomiting (2%) were encountered following a total of 55 injections. After a follow-up period of 6-36 months, the responses were excellent in 53.4%, good in 26.7% and poor in 6.6%. Macrocysts disappeared in the remaining 13.3% of patients who had mixed cervicofascial lymphangioma. Lower success rates were encountered among patients who had undergone prior surgery. Sclerotherapy with bleomycin and OK-432 is effective in the treatment of lymphangioma in children. Adverse effects are minor and rarely encountered. However, the surgeon should be alert for the possible serious complications. Sclerotherapy can be also used as an adjunctive therapy in the treatment plan of widespread or mixed forms of lymphangiomas. In the light of our results, sclerotherapy should be preferred as the primary mode of treatment in childhood lymphangiomas.     

Cervical cystic lymphangioma in children

INTRODUCTION: Cervical cystic lymphangioma are rare and benign, but the prognosis can be serious in terms of its development and management. OBJECTIVES: To describe the epidemiological, clinical and therapeutic characteristics. MATERIALS AND METHODS: A retrospective study of eight cases. RESULTS: The mean age was 7 years, with a slight female predominance. Ultrasound scanning was sufficient to establish the diagnosis. CT scan or MRI scan was used if parapharyngeal or a mediastinal extension was suspected. All patients in this series underwent surgical excision. There were no postoperative complications or recurrence at one year post-surgery. DISCUSSION: These lesions present as soft compressible cervical swellings of variable size. Radiological imaging (CT, MRI) aid diagnosis and demonstrate extent, however final diagnosis is made by histopathological examination. The treatment of choice is surgical excision. Another option is the use of sclerosing agents. These are used by some surgeons as a first line treatment and also for surgical recurrence.     

Extensive lymphangioma presenting with upper airway obstruction

OBJECTIVE: To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. DESIGN: Retrospective review of files from January 1983 to September 1998. SETTING: Pediatric otolaryngology departments from 2 referral centers. PATIENTS: Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. INTERVENTIONS: Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. MAIN OUTCOME MEASURES: Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. RESULTS: The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. CONCLUSIONS: Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.     

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

The Veneto region’s database of hospital discharge records was queried for ICD-9 codes corresponding to: peritonsillar abscess (PTA), PTA incision and drainage, tonsillectomy, pharyngeal-retropharyngeal abscess, cervical phlegmon, cervical abscess, and mediastinitis recorded from 1997 to 2006. All these codes were considered to identify cases of PTA recurrence and severe infectious complications occurring in conservatively treated patients. Among 4,199 patients whose PTA was incised and drained on admission to hospital, 1,532 were treated with tonsillectomy, while 2,667 were treated conservatively (without tonsillectomy). Abscess tonsillectomy was carried out almost exclusively in children (0–14 years of age), and only in 40 young and adult patients (0.95 %). The relapse rate after a single episode of PTA was 11.7 %, while potentially fatal complication occurred in 0.41 % of cases. Incidence of PTA hospital admission has remained stable in the considered period despite a 45 % reduction in the tonsillectomy rate. In conclusion, our data seem to show that conservative treatment for PTA is not associated with a significant risk of recurrence (and becomes minimal after 6–12 months), provided that patients have not suffered from previous PTA episodes.     

The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review

PurposeDetermine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.Materials & methodsRetrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.Results75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.ConclusionParotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.     

Lymphovascular invasion is associated with lateral cervical lymph node metastasis in papillary thyroid carcinoma

OBJECTIVES: The objective of this retrospective study to evaluate whether lymphovascular invasion (LVI) is associated with lateral cervical lymph node metastasis and tumor recurrence in papillary thyroid carcinoma (PTC). METHODS: We evaluated the medical records of patients with PTC who had undergone total thyroidectomy and subsequent I remnant ablation at Asan Medical Center, Seoul, Korea, from January 1997 thorough December 2000. RESULTS: A total of 662 patients (585 women and 77 men; mean age, 44.8 years) with PTC were enrolled in the study. Of these patients, 33 were found to have LVI. We found a significant association between LVI and lateral cervical lymph node metastasis at the time of initial surgery (P = .001). Multivariate analyses adjusting for clinicopathologic parameters known to predict recurrence such as age, gender, tumor size, extrathyroid extension, and multifocality also showed a significant association between LVI and lateral cervical lymph node metastasis. For the 633 patients without distant metastasis at the time of initial surgery, LVI was also significantly associated with tumor recurrence during the follow-up period (median, 68 months; range, 3-108 months): 29% versus 13.6% for patients with and without LVI, respectively (P = .048 by log-rank test). However, this association was lost on multivariate analyses adjusting for conventional clinicopathologic predictors of recurrence. CONCLUSIONS: In patients with PTC, LVI is associated with lateral cervical lymph node metastasis and clinical recurrence.     

自体游离空肠重建喉咽及颈段食管

目的探讨自体游离空肠移植重建喉咽及颈段食管的临床应用。方法回顾性研究1999年8月～2006年8月共进行的9例喉咽和(或)颈段食管肿瘤切除、自体游离空肠移植食管和(或)喉咽重建术病例。总结手术适应证的选择、手术方法、围手术处理方法及手术效果。结果9例患者移植游离空肠全部存活,无咽瘘、颈部感染或吻合口狭窄等颈部并发症。2例成功保留喉功能。9例患者最长随访时间37个月,最短22个月。1例患者术后22个月时发现舌根部肿瘤复发,经放射治疗后好转,术后25个月失访。1例患者术后17个月因肿瘤复发死亡。其余7例存活,无吞咽困难,未见肿瘤复发。结论正确的适应证选择,合理的围手术期处理,以及熟练的小血管吻合技术是游离空肠移植重建喉咽和颈段食管,治疗晚期喉咽癌、颈段食管癌成功的保证;再次证明,游离空肠移植重建喉咽和颈段食管不仅为肿瘤完全切除并一期重建提供技术保障,还能提高患者的无瘤生存率和生存质量。     

喉癌术后复发及颈部转移临床治疗的远期疗效观察

目的：探讨治疗喉癌术后复发及颈部转移的有效方法。方法：回顾性分析我院1990年4月～1998年4月收治的喉癌术后复发及颈部转移患者70例，其中局部复发癌3i例，气管造口复发癌15例，颈淋巴结转移24例。结果：31例局部复发癌中，19例二次手术者术后15例生存，4例死亡；未行手术治疗的12例分别在1～3年内死亡。15例气管造口复发癌中，9例二次手术者术后5例生存，4例死亡；未行手术治疗的6例均在18个月内死亡。24例颈淋巴结转移者中，15例二次手术者术后8例生存，7例死亡；9例未行Ⅱ期手术者2年内死亡。结论：喉癌术后定期复查及系统的临床随访，有利于喉癌术后复发及颈部转移的早期发现和早期治疗；二次手术是喉癌术后复发及颈部转移临床治疗的重要措施；放射治疗或化学治疗作为综合治疗手段有一定疗效，但其疗效有限。