术前放疗控制声门上型喉癌患者的颈部复发(附201例随机对照研究)

目的研究术前放疗对声门上型喉癌患者颈部淋巴结转移的控制作用。方法随机对照的声门上型喉癌患者共２１０例，９例失随，不包括在此分析中，其余２０１例均随诊３年以上或到死亡，其中放疗＋手术９９例（包括１５例未完成治疗），术前放疗量４０Ｇｙ。单纯手术１０２例。结果两组Ｋａｐｌａｎ－Ｍｅｉｅｒ生存曲线差异无显著性；采用Ｃｏｘ回归模型分析发现，与单纯手术组相比，放疗＋手术组颈部复发的相对危险性有下降趋势（Ｐ＝０．１５７）。放疗＋手术组中Ⅰ～Ⅲ期患者的颈淋巴结复发率明显低于单纯手术组Ⅰ～Ⅲ期患者（Ｐ＝０．０１９８），后组颈部复发的相对危险性是前组的１．７６６倍。但Ⅳ期患者两随机组颈部复发率相似。在多因素分析中，只有ＴＮＭ分期和病理有无颈淋巴结转移是影响颈部复发有意义的因素。颈清扫对侧或未清扫侧颈部淋巴结复发是颈部复发的主要部位，占６９％。对侧颈部复发较多地发生于晚期（Ｐ＝０．０２０）和未接受过放射治疗的患者（Ｐ＝０．０１８）。结论研究表明，术前放疗４０Ｇｙ对Ⅰ～Ⅲ期患者颈部淋巴结复发控制有效，但对Ⅳ期患者作用不大。     

Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion

In a double-blind randomised study, we compared conditions during insertion of the laryngeal mask airway in 150 patients who received either fentanyl 1 microg.kg-1, mivacurium 0.04 mg.kg-1 or normal saline, before induction of anaesthesia with propofol 2 mg.kg-1. Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or limb movement and ease of insertion, were each graded using a three-point scale. The median (interquartile range) summed insertion scores were more favourable with the use of fentanyl [8.0 (7.0-9.0)] and mivacurium [7.5 (6.8-8.3)] than with normal saline [9.0 (7.8-10.3); p < 0.01]. Fentanyl and mivacurium decreased swallowing and head or limb movement, and mivacurium improved mouth opening. Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol.     

内皮抑素治疗人喉癌裸鼠模型的实验研究

目的 研究内皮抑素对裸鼠喉鳞状细胞癌皮下移植模型的抑瘤作用,探讨其抑瘤机制及人喉癌生物治疗新方法。方法 建立人喉癌Hep-Ⅱ细胞株裸鼠皮下接种模型。应用内皮抑素治疗,观察肿瘤生长情况,对用药后肿瘤组织进行病理学检查,通用型二步法免疫组化检查及电镜观察。计数微血管密度(microvessel density,MVD),计算增殖细胞核抗原(proliferationg cell nuclear antigen,PCNA)和血管内皮生长因子(vascuoar endothelial growth factor,VEGF)阳性率。结果 在实验组与对照组之间,鼠净重、瘤重、瘤体积及瘤重/鼠净重,经t检验P值<0.05或<0.01,差异均有显著性意义,抑瘤率为45.9％。病理学检查及电镜观察表明,实验组应用内皮抑素治疗肿瘤生长受到抑制,细胞分裂少见,可见肿瘤细胞的坏死凋亡,新生血管明显减少。MVD、PCNA及VEGF表达在实验组明显低于对照组,经t检验P值分别为<0.01、<0.05、<0.05,差异均有显著性意义。结论 内皮抑素可显著抑制人喉癌裸鼠模型肿瘤的生长和发展,其可能机制为抑制肿瘤血管生成。     

微血管密度在声门上型喉鳞状细胞癌中的分布及其预后

目的 :研究微血管密度 (MVD)在声门上型喉鳞状细胞癌 (SGLSCC)中的分布及对预后的影响。方法 :应用CD31两步系统免疫组织化学染色方法研究 5 9例手术治疗的原发SGLSCC标本 ,并以 19例声带息肉(VCP)标本做良性对照。结果 :SGLSCC的间质中可见大量微血管存在 ,而VCP上皮下结缔组织中微血管数明显减少。Kendall等级相关分析表明 ,在SGLSCC各临床病理参数中 ,MVD仅与淋巴结转移有中等程度的正相关 (P <0 .0 1)。N0 与N 、SGLSCC与VCP间的MVD值差异经独立样本均数 t检验显示均有统计学意义 (均P <0 .0 1)。Kaplan Meier生存分析显示 ,MVD与SGLSCC患者术后累积生存率有统计学意义 (P <0 .0 1)。结论 :血管生成在肿瘤形成、侵袭与转移中有重要作用 ;MVD对颈淋巴结转移有预示作用 ;MVD与SGLSCC患者的预后有关。     

喉神经内分泌肿瘤临床特征

目的：探讨喉神经内分泌肿瘤的临床表现、诊断及治疗。方法：回顾分析我科收治的3例喉神经内分泌肿瘤，其中非典型类癌2例，行根治性手术切除及颈廓清术；嗜铬细胞瘤1例，行肿瘤局部切除术。结果：非典型类癌2例，术后随访1年，情况稳定。嗜铬细胞瘤1例，术后随访11年，预后良好。结论：喉神经内分泌肿瘤是一组形态各异的病变，正确诊断有赖于临床特点、光镜、免疫组织化学检查，部分患者需行超微结构检查。不同类型的肿瘤应行不同的治疗方法。     

IL-15cDNA转染人喉癌细胞系的建立及其表达的研究

目的建立转人白细胞介素-15(hIL-15)基因的喉癌细胞株,并研究hIL-15的表达情况。方法将携带人白细胞介素-15的质粒pcDNA3.1( )-hIL-15转导入人喉表皮样癌细胞Hep-2中,G418筛选阳性克隆,RT-PCR、Westernblot和ELISA法对hIL-15的表达进行检测。结果IL-15基因成功地转导入Hep-2细胞中并能高效表达。RT-PCR电泳结果显示hIL-15基因在mRNA水平有表达;ELISA法测得106个转染阳性细胞24h内培养上清液中hIL-15的含量为(185.0±12.2)pg/ml,空载体转染及未转染的细胞未检测到hIL-15。结论hIL-15基因成功转染人喉癌细胞系Hep-2细胞且能持续大量表达。     

肿瘤坏死因子相关诱导凋亡配体与放化疗联用对喉癌细胞的协同杀伤效应及机制

Objective To determine the sensitivity of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induced apoptosis in Hep-2 cells by means of systematically evaluating the cytotoxicity of TRAIL alone and TRAIL in combination with chemotherapeutic agents (cisplatin, paclitaxel) or radiation in Hep-2 cells in vitro, and whether the synergistic killing effects correlated with the expression level of TRAIL receptors and the activity of caspnse-8 or caspase-9. Methods The cytotoxicities of TRAIL, cisplatin and paclitaxel were investigated by cell counting kit-8 (CCK-8) assay. The expression levels of four TRAIL receptors in Hep-2 cells after treated by TRAIL, chemotherapeutic agents or radiation alone and by combined treatments were measured by flow eytometry and Western blotting respectively. The growth inhibition effects of caspase-8 or caspase-9 inhibitor on Hep-2 cells were determined by CCK-8 assay, and the activities of caspase-8, caspase-9 and caspase-3 were measured by Western blotting. Results The half maximal inhibitory concentration(IC50) of TRAIL to Hep-2 ceils on 24 h was 596. 92 μg/L Cisplatin, paclitaxel and radiation had synergistic inhibitory effects with TRAIL on the growth of Hep-2 cell line. After the activity of caspase-9 was inhibited by Z-LETD-FMK, the inhibition effects of TRAIL, cisplatin and paclitaxel on Hep-2 cells decreased significantly (all P < 0. 05). The expressions of caspase-8, caspase-9 and the death receptors (DR4 and DR5) increased significantly (all P < 0. 05) after combined administration. Conclusions Hep-2 cells are resistant to the apoptosis induced by TRAIL and TRAIL can induce the apoptosis of Hep-2 cells through the endogenous apeptotic pathway. The increase of death receptors expression by chemotherapeutic agents or radiation could enhance the sensitivity of Hep-2 cells to TRAIL and the synergistic killing effects.     

喉癌组织中BcL-2和Bax基因的表达

目的探讨喉癌组织BcL2和Bax基因蛋白表达与喉癌发生、发展的关系。方法采用免疫组化SP法测定15例正常人声带组织和73例喉癌组织标本中BcL2和Bax基因蛋白表达。结果喉癌组织中BcL2基因蛋白表达阳性检出率452%,喉癌组织中Bax基因蛋白表达阳性检出率603%,差异有显著意义(P<005)。喉癌组织中BcL2和Bax基因蛋白的表达呈明显的负相关关系(r=-071,P<005)。结论喉癌组织中BcL2和Bax基因蛋白表达的失调可能与喉癌的发生、发展有关。     

针刺治疗声带小结及计算机声学测定疗效评价

目的:评价针刺开音1号穴治疗声带小结的疗效.方法:将80例患者随机分为针刺组(40例)、中药组(20例)、西药组(20例).针刺组针刺开音1号穴为主;中药组口服金嗓散结丸;西药组采用抗生素、激素类药物雾化吸入.观察3组疗效及治疗前后嗓音学参数.结果:针刺组总有效率为92.5%,优于中药组(85.0%)与西药组(85.0%),差异有非常显著性意义(P<0.01);在改善嗓音学方面,针刺组亦优于其他两组(均P<0.01).结论:针刺开音1号穴治疗声带小结疗效确切.