鼻咽部黏膜相关淋巴瘤4例研究报告

目的探讨鼻咽部黏膜相关淋巴瘤的临床特征及其诊治。方法回顾诊治的4例鼻咽部黏膜相关淋巴瘤的病人并结合文献复习,分析鼻咽部黏膜相关淋巴瘤的特征、诊断和治疗方法。结果4例均具有腺样体肥大的临床症状,均经鼻内镜行肿块部分切除活检术,组织切片经行HE染色、以及免疫组织化学染色．镜下见小淋巴瘤细胞广泛弥漫分布,浸润腺上皮组织。所有4例患者术后均行化疗和放疗,随访6～24个月,1例发生远处转移。结论鼻咽部黏膜相关淋巴瘤在临床表现上无特异性;发现可疑者应尽早切除送病理检查;典型的组织学特征是单核样细胞弥漫性浸润,伴特征性淋巴上皮病变;术后应结合放疗和化疗。     

22例鼻咽非霍奇金淋巴瘤临床分析

目的：分析鼻咽非霍奇金淋巴瘤的发病率、治疗方法、疗效及预后。方法：对22例鼻咽非霍奇金淋巴瘤的临床资料进行回顾性分析。结果：误诊率为90.9%,治疗后CR12例,PR8例,PD2例,有效率（CR＋PR）为90.9%。第1年死亡5例,其中高度恶性占62.5%、T细胞占40.0%、有B症状占50.0%、Ⅲ期4例、Ⅱ期1例;3年生存率为72.7%（16/22）,5年生存率为63.6%（14/22）。存活5年以上的病例均为无B症状,低、中度恶性及Ⅰ、Ⅱ期病例,B细胞占78.6%。化疗加局部放射治疗占85.7%。结论：鼻咽非霍奇金淋巴瘤占同期恶性淋巴瘤的4.68%,占结外淋巴瘤的16.67%,临床极易误诊,高度恶性、T细胞、有B症状者预后较差,分期越早预后越好,化疗加局部放射治疗预后较好。     

A single intramuscular dose of ceftriaxone changes nasopharyngeal bacterial flora in children with acute otitis media

The increasing prevalence of drug-resistant bacteria is attributed to the extensive use of antibiotics, which causes selective pressure on the nasopharyngeal bacterial flora. Shortened courses of antibiotics have been proposed to decrease the development of resistant strains. We determined the effect of a single intramuscular dose of ceftriaxone (50 mg/kg) on the nasopharyngeal bacterial flora in 167 children (median age 13 mo) with acute otitis media. Nasopharyngeal samples for bacterial culture were obtained before and 5 d after treatment with ceftriaxone. Before treatment, Moraxella catarrhalis was isolated in 99 (59%) children, Streptococcus pneumoniae in 87 (52%), and Haemophilus influenzae in 53 (32%). After treatment, M. catarrhalis was found in 62 (37%) children, which constitutes a 37% decrease in the colonization rate by this pathogen (p < 0.001). S. pneumoniae was isolated in 50 (30%; 43% decrease) and H. influenzae in 17 (10%; 68% decrease) children after treatment (p < 0.001 for both). Before treatment, 60% of pneumococcal isolates were sensitive to penicillin, 26% were of intermediate susceptibility, and 14% were penicillin-resistant. Eradication of S. pneumoniae occurred mainly in children with penicillin-sensitive isolates. As a consequence, only 24% of pneumococcal isolates that remained after treatment were sensitive to penicillin, 59% were penicillin-intermediate, and 16% were penicillin-resistant. A single dose of ceftriaxone resulted in significant changes in the nasopharyngeal bacterial flora, increasing the relative prevalence of pneumococcal strains with decreased susceptibility to penicillin.     

两种准直器宽度对鼻咽癌放疗中的剂量学差异影响

目的:研究两种规格（等中心处投影0.5和1.0 cm）多叶准直器（MLC）在鼻咽癌调强放射治疗（IMRT）计划中的区别,从剂量学方面探究MLC的宽度对患者靶区和危及器官的影响。方法:随机选取已完成治疗的31例鼻咽癌患者计划,在放疗处方和物理优化参数不变的情况下分别使用两种规格MLC的加速器射野模型进行重新优化计算,统计靶区及主要危及器官的体积剂量、平均剂量（Dmean）、适形度指数（CI）、均匀性指数（HI）等参数,分析其差异性。结果:全样本分析显示,所有靶区HI和部分靶区（PGTVnx、PCTV2）CI差异有统计学意义（P<0.05）,0.5 cm MLC优于1.0 cm MLC;危及器官中,右侧视神经和视交叉最大剂量（Dmax）、左侧颞叶和右侧颞颌关节Dmean、左右腮腺V30、气管和脊髓Dmean差异有统计学意义（P<0.05）,0.5 cm MLC优于1.0 cm MLC,其他危及器官无统计学差异（P>0.05）;在Pinnacle3和Monaco计划系统中得到了相似结果,两种MLC在靶区适形度和均匀性方面及部分危及器官受量差异有统计学意义（P<0.05）。结论:0.5 cm MLC在鼻咽癌调强计划中能有效提高靶区适形度和均匀性,也能有效降低部分危及器官受量,可以更好地保护与靶区邻近或有重叠的一些危及器官,推荐有条件的医院使用。     

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目的探讨早期骨性Ⅲ类错患者上腭快速扩弓联合前方牵引矫治后咽腔的改变。方法选择2007年6月至2009年5月大连医科大学附属第一医院口腔正畸门诊收治的早期骨性Ⅲ类错患者30例,行上腭快速扩弓联合前方牵引治疗,并测量矫治前后各指标变化。结果与矫治前比较,矫治后上齿槽座点到Y轴的距离(Y-A)增加,下齿槽座点到Y轴的距离(Y-B)和颏前点到Y轴的距离(Y-Pog)减小,上咽腔宽(UPW)、中咽腔宽(MPW)增加,鼻咽部面积(nasopharynx)和口咽上部面积(oropharynx1)增加(均P<0.01);下咽腔宽(LPW)、口咽下部面积(oropharynx2)及头位角(SN-CVT)变化差异无统计学意义(均P>0.05)。结论上颌前方牵引能改变咽腔大小。     

鼻咽癌放射治疗后残留肿瘤观察（附76例分析）

报告２５３例鼻咽癌病人放射治疗后的结果，放射结果时肿瘤未完全消退者７６人，其中原发肿瘤残留者３４人，颈部残留２４人，原发＋颈部残留１８人。随访３个月后原发残留灶均消退，颈部残留者有６例未消退。讨论了对残留病灶的处理。     

鼻咽盐水吸洗法对鼻咽癌放疗并发症防治的探讨

目的探讨鼻咽盐水吸洗法对鼻咽癌放疗并发症的防治作用。方法 6 9例鼻咽癌放疗患者随机分为鼻咽吸洗治疗组 36例和对照组 33例。对治疗组应用生理盐水自前鼻孔吸入 ,经鼻腔 -鼻咽 -口咽吐出 ,对照组用传统含漱方法。结果两组比较表明 ,治疗组较对照组消除减少口臭、咽干、鼻窦炎、鼻腔粘连等有明显的效果 ;结论可有效减少鼻咽喉并发症的发生 ,对提高病人生活质量提出一个新的有效方法。     

Personnalisation de la dose et du fractionnement de la radiothérapie des cancers de la tête et du cou

Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.