吉西他滨和顺铂联合放疗治疗中晚期鼻咽癌的临床观察

目的：观察吉西他滨和顺铂联合放疗治疗中晚期鼻咽癌的临床疗效及其毒副反应。方法：2006年1月至2007年12月对39例鼻咽癌采取吉西他滨1 000mg/m^2,d1、8,顺铂20mg/m^2,d1-5,每3周为一周期,两周期后序贯放疗70～72Gy/7～8周。结果：39例患者中,CR16例,PR18例,有效率为87.1%,主要毒副作用是骨髓抑制,其他毒副作用均较轻,可耐受,不影响治疗。结论：吉西他滨和顺铂联合放疗治疗中晚期鼻咽癌是一较好方案,毒副反应较轻。     

面中掀翻结合鼻内镜手术治疗鼻腔鼻窦鼻咽肿瘤16例临床分析

目的观察面中掀翻结合鼻内镜手术治疗鼻腔、鼻窦、鼻咽肿瘤的临床疗效及其技术优势。方法2000～2004年间收治的16例鼻腔、鼻窦、鼻咽肿瘤患者,包括鼻腔内翻性乳头状瘤6例,鼻咽部纤维血管瘤Ⅲ期1例,上颌窦鳞癌2例,鼻腔黑色素瘤2例,蝶窦黑色素瘤1例,蝶窦原位癌2例,筛窦腺样基底细胞癌2例。均采用面中掀翻结合鼻内镜手术进行治疗。结果16例患者手术均成功,术中术野清晰,肿瘤暴露清楚,切除彻底,止血直观,复发率低,面部不遗留瘢痕。结论面中掀翻结合鼻内镜的手术方式增加了手术的精确性和安全性,是手术治疗鼻腔、鼻窦、鼻咽肿瘤的有效术式之一。     

慢性鼻窦炎患者鼻咽部表面活性物质磷脂构成的测定

目的：探讨慢性鼻窦炎对鼻咽部表面活性物质磷脂的构成是否产生影响，并对磷脂成分进行研究。方法：采集慢性鼻窦炎患者（慢性鼻窦炎组）和健康人（对照组）鼻咽部灌洗液，用高效液相色谱方法对表面活性物质磷脂4种成分即磷脂酰丝氨酸（PS）、磷脂酰乙胺醇（PE）、磷脂酰胆碱（PC）和鞘磷脂（SP）的构成比进行测定。结果：①鼻咽部存在表面活性物质，磷脂4种成分均可测出；②慢性鼻窦炎组与对照组比较，PS的构成比差异有统计学意义（P〈O．05），含量最多的主要成分PC差异有统计学意义；③慢性鼻窦炎Ⅲ型与对照组PS比较，构成差异有统计学意义（P〈O．05），随鼻窦炎分型分期的进展，其构成比有逐渐降低的趋势。结论：①鼻咽部存在表面活性物质，其磷脂成分有PS、PE、PC和SP，PC构成比最多，对鼻咽部表面活性物质的活性起决定作用；②慢性鼻窦炎可引起鼻咽部表面活性物质磷脂部分成分减少；③随分型分期进展，部分磷脂成分的构成比逐步降低，进一步表明可能引起咽鼓管表面活性物质磷脂成分的改变，引起中耳、咽鼓管功能不全。     

经腭径路摘除鼻咽颅底脊索瘤

为了寻求安全可靠的手术径路，本文报告６例经口腭手术径路治疗的鼻咽颅底脊索瘤病例的经验。此径路可充分暴露手术术野，以利肿瘤的完全切除。３例存活５～１０年无复发；１例术后２年带瘤存活；另２例分别于术后１年和２年死亡。该径路安全、可靠。     

Management of nasopharyngeal salivary gland malignancy

OBJECTIVE: The objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy. STUDY DESIGN: Retrospective case review at tertiary care skull base center. METHODS: Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan-Meier and Cox proportional hazards methods. RESULTS: Histological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a significantly poorer outcome (P =.035) with a relative risk of 4.6 compared with low-grade disease. Local control was seen to be 77% at 5 years. CONCLUSIONS: Planned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro-omental free flap.     

Virtual endoscopy of the nasopharynx in the evaluation of its normal anatomy and alterations due to lymphoid hyperplasia: preliminary report

The purpose of this study was to evaluate the diagnostic usefulness of virtual endoscopy in establishing the anatomic appearance of nasopharynx, both normal and affected by lymphoid hyperplasia. Thirty-seven patients affected by chronic rhinosinusal and otomastoid pathology, all studied by rhinoscopy, were examined with multislice computed tomography (CT) and virtual endoscopy of the nasopharynx. Rhinoscopy showed a completely normal nasopharynx in 15 cases and a variable grade of lymphoid hypertrophy in 22 patients. A general agreement was observed between traditional and virtual endoscopy findings in both subgroups. The tasca of Luschka was detected in 13/15 of normal subjects and only in 3/22 patients. The Rosenmuller fossae appeared deeper in normal subjects and their symmetry could be considered an important criterion of normality. In all cases, a good evaluation of the tubaric ostium was obtained. Differentiation between hyperplasic lymphoid tissue and neoplasms is possible only in lymphoid hyperplasia characterized by median crest-like swelling with a narrow base. In most cases, differential diagnosis cannot be based only on morphological criteria of virtual endoscopy, but it should be evaluated considering the overall CT findings and clinical presentation.     

鼻咽非霍奇金淋巴瘤的临床与预后分析

目的 探讨鼻咽非霍奇金淋巴瘤的临床特点、治疗及国际预后指数(IPI)的应用价值。方法 回顾性分析1983—1997年间136例首程治疗的鼻咽非霍奇金淋巴瘤患者的临床资料。按照工作分类原则进行分类,高度恶性18例,中度恶性77例,低度恶性2例,未分类39例。根据Ann Arbor分期,Ⅰ期25例,Ⅱ期91例,Ⅲ期12例,Ⅳ期8例。Ⅰ期单纯放疗13例,综合治疗12例;Ⅱ期单纯放疗31例,综合治疗57例,Ⅲ和Ⅳ期以化疗为主。结果 5年和10年总生存率(OS)、癌症相关生存率(CSS)和无病生存率(OFS)分别为56．2％和48．3％,61．2％和58．0％,51．1％和46．5％。IPI为0,1及2～3分的5年CSS分别为70．9％、44．9％、30．0％(P=0．004)。Ⅰ期化放疗综合治疗和单纯放射治疗的5年CSS分别为82．2％和83．1％,10年CSS分别为82．2％和66．4％,差异无显著性(P=0．779)。Ⅱ期综合治疗和单纯放射治疗5年CSS分别为70．9％和46．0％,10年CSS分别为65．4％和46．0％,差异有显著性(P=0．04)。Cox多因素分析显示,影响预后的因素为Ann Arbor分期、B组症状和IPI。结论 IPI是判断原发于鼻咽非霍奇金淋巴瘤预后的重要指标,Ⅱ期鼻咽非霍奇金淋巴瘤应考虑综合治疗。     

Failure of a 3D conformal boost to improve radiotherapy for nasopharyngeal carcinoma

Purpose: To determine whether the use of 3-dimensional (3D) boost for patients with nasopharynx cancer improves local control and reduces the risk of long-term complications.

Methods and Materials: From 1988 to 1998, 68 patients with nasopharynx cancer received conventional external beam therapy followed by a 3D boost. Disease characteristics of treated patients were as follows: WHO I histology 7%, WHO II 62%, WHO III 31%, clinical AJCC stage T1–2 45%, T3–4 55%, N0–1 63%, N2–3 37%, M0 100%. The median radiation dose was 70 Gy (68–75.6 Gy). Thirty-five patients (52%) received cisplatin-based chemotherapy. The median follow-up of surviving patients was 42 months (12–118 months).

Results: Five-year actuarial local control was 77%, regional control was 97%, progression-free survival was 56%, and overall survival was 58%. Stage was the only identifiable prognostic factor: 5-year progression-free survival was 65% for Stages I–III vs. 40% for Stage IV (p = 0.01). The incidence of Grade 3–4 complications was 25% and included hearing loss, trismus, dysphagia, chronic sinusitis, and cranial neuropathy. These results are comparable to outcomes reported with conventional radiation techniques for similarly staged patients.

Conclusion: The lack of a major benefit with the 3D boost may be related to the fact that CT planning was only used for a fraction of the total dose. We are now using intensity modulated radiation therapy to deliver the entire course of radiation. Intensity modulated radiation therapy achieves better conformal distributions than conventional 3D planning, allowing dose escalation and increased normal tissue sparing.     

人鼻咽与鼻咽癌cDNA阵谱中DNA修复相关基因表达差异的初步研究

目的 用cDNA阵卤咽癌组织及正常组织的基因表达谱,研究鼻咽癌组织内修复相关基因的表达差异。方法 Atlas human cancer cDNA expression array 7742-1杂交后,用Atlas Image 1.01a分析滤膜杂交结果,RT－PCR反应验证滤膜杂交结果。结果 在588个肿瘤相关基因中,共有134个基因表达上调,88个基因表达下调。在有DNA损伤应答、修复、重组相关基因的C区中,表达上调的基因有21个,与修复相关的有6个;表达下调的有44个,与修复相关的则有12个。结论 DNA修复相关基因的改变可能在鼻咽癌病理生理过程中起一定作用。     

整体护理对预防鼻咽癌放射治疗患者口腔黏膜炎的效果评价

目的 探讨整体护理对预防鼻咽癌放射治疗患者口腔黏膜炎的应用效果.方法 将102例接受放射治疗的鼻咽癌患者随机分为对照组和干预组,每组51例,对照组采用常规护理,干预组采用整体护理,比较两组患者口腔黏膜炎的发生率及严重程度.结果 干预组口腔黏膜炎发生率明显低于对照组,严重程度较对照组轻,差异有统计学意义(x2 =4.15,P＜0.05).结论 整体护理能降低鼻咽癌放射治疗患者口腔黏膜炎的发生率,减轻口腔黏膜炎严重程度,提高患者生存质量.