鼻咽部的动脉来源和分布

为了给鼻咽癌治疗提供解剖学依据,采用肉眼解剖,过氧乙烯铸型和酸性染料灌注等方法,共观察了鼻咽部动脉标本81侧。结果表明;供应鼻咽部的动脉来自咽升动脉,腭升动脉和上颌动脉,它们在起源和分布具有各种变化。本文从解剖学角度就鼻咽癌的动脉插管化疗和大出血时的急速止血问题进行了讨论。     

大鼠鼻咽三型上皮的组织化学研究

本文对新生、15,30、60天和成年组大鼠鼻咽上皮内 LDH 及其同功酶、ATPase、ALP、ACP、SDH 和 MDH 进行了组织化学研究。结果表明,鼻咽假复层纤毛柱状上皮中以纤柱细胞顶部酶活性最强,在不同年龄组酶活性呈递增趋势。复鳞上皮、中间型上皮内 LDH 及其同功酶、ATPase、ACP 以基部细胞呈阳性反应,SDH、MDH 则分别以表层细胞和中层细胞胞质内活性最强,这些酶的活性程度和分布特征均有年龄性变化。     

A Decade of Radiotherapy in Head and Neck Cancer in South Australia

The results of treatment in 368 patients with head and neck cancer treated in the decade 1970–1980 are presented. Patients with six of the most common malignancies, namely carcinoma of the Tongue, Tonsil, Nasopharynx, Pyriform Fossa, Supraglottic and Glottic Larynx, who have been treated primarily by radiation or where radiation has been used as a part of a planned combined approach, have been included in this report. Results have been presented in both crude and actuarial form and are discussed in the light of changing management trends during the decade.     

鼻咽结核的临床与病理特征(附42例报告)

报告经病理证实的鼻咽结核42例，男20例，女22例，平均年龄30.5岁。指出：（1）近年来鼻咽结核有增加趋势，尤以原发性病例居多;（2）组织病理以增殖型为主，占64.25％（27／42）;（3）临床上鼻咽结核多以局部表现的症状为特征，预淋巴结肿大发生率高达73.81％;（4）鼻咽结核在临床上误诊率较高，尤应注意与鼻咽癌等鉴别。文内还浅析了本病的误诊原因。     

经面罩鼻咽部加压预防高压舱耳气压伤

目的:探讨人体在高压舱进行环境增压时,鼻咽部压力大于咽鼓管通气阻力能否预防耳气压伤。方法:咽鼓管通气阻力<6kPa的男性健康志愿者8例,分为4组,每组2例,互为被试者和对照者。被试者经面罩给予6kPa的鼻咽部正压,对照者正常呼吸,高压舱以0.5kPa/s的速率增压至5kPa,被试者和对照者均不采用其他任何主动或被动开放咽鼓管的措施,测鼓室腔压力;高压舱以同样速率增压至20kPa,被试者条件不变,对照者可进行主动或被动开放咽鼓管的措施,测鼓室压。结果:高压舱增压至5kPa时,被试者和对照者鼓室压分别为(-11.2±5.3)daPa和(-168.6±71.5)daPa,差异有统计学意义(P<0.01);增压至20kPa时,被试者和对照者鼓室压分别为(-8.3±6.1)daPa和(-7.6±6.4)daPa,差异无统计学意义(P>0.05)。结论:当人体的环境压力增加时,经面罩提供大于咽鼓管通气阻力的鼻咽部压力可预防耳气压伤的发生。     

Juvenile nasopharyngeal angiofibroma: Comparison of blood loss during removal in embolized group versus nonembolized group

Purpose This retrospective study was performed to assess the beneficial effect of preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) in terms of blood loss during surgery.Methods Intraoperative blood loss in a group of 7 patients who underwent 10 procedures for JNA without preoperative embolization was compared with the blood loss of 13 patients who underwent 16 procedures after embolization of one or both external carotid arteries.Results Mean blood loss was 5380 ml in patients with-out embolization and 1037.5 ml in those with embolization. This difference was not statistically significant because of the high standard deviation in the nonembolized group. However, when data were analyzed by tumor stage, a significant difference was noted between the embolized and the nonembolized patients with high-grade tumors but not between those with low-grade tumors.Conclusion Preoperative embolization of the branches of the external carotid appears to facilitate removal of high grade tumors. The benefit of embolization in those with low-grade tumors is less clear cut, probably because there is less vascularity in low-grade tumors and so removal is easier.     

鼻咽癌后程三维适形与传统放疗剂量对比分析

目的比较鼻咽癌后程三维适形(3-dimensionalconformalradiotherapy,3DCRT)和传统放疗(2-dimensionalradiotherapy,2DRT)在靶区和周边重要器官的不同剂量分布并探究3DCRT的潜在优势.方法比较和分析5例鼻咽癌7野后程3DCRT和其相应的2DRT在各靶区和重要器官的剂量体积直方图(dosevolumehistogram,DVH)的各项指标值.结果与2DRT相比,3DCRTPTV的Dmean从92.7%提高至96.1%;剂量不均匀度(DI)从84.1%降至59.3%;90%等剂量线适形指数(CI)从0.32提高到0.51;但两者PTV接受90%处方剂量的体积均小于90%;在颈动脉鞘区,3DCRT的Dmean提高了5%但Dmax达117.2%.3DCRT和2DRT相比,串行器官如视神经、脑干和颞叶的Dmax分别为:33.5%和104.3%,11.7%和26.4%,97.6%和103.2%;但在晶体、眼球和下颌骨则分别为:16.1%和2.8%,21.3%和8.7%,115.3%和104.2%.在并行器官的Dmean,颞颌关节:68.5%和93.3%;耳蜗:58.5%和69.0%;而腮腺则为59.8%和43.3%。结论与传统放疗相比,鼻咽癌后程3DCRT降低了视神经、脑干、颞叶、颞颌关节和耳蜗的剂量,但却增加了晶体、眼球、下颌骨和腮腺的剂量.3DCRT使靶区剂量的适形性分布有所改善,潜在可能使颈动脉鞘区受累的鼻咽癌患者受益.但靶区剂量覆盖仍显不足,通过调强放疗有望达到更理想的剂量分布.     

Prognostic factors in metastatic nasopharyngeal carcinoma

BACKGROUND: The current retrospective study aimed to identify some determinants of survival in metastatic NPC. METHODS: The study concerned 95 patients with metastatic nasopharyngeal carcinoma treated between 1993 and 2001. Statistical comparison between patients subgroups survival was carried out employing the log-Rank test (statistical significance was defined as p45 years and25 years), gender, performance status at diagnosis of metastatic disease (PS 0-1 or 2-3), time of metastasis diagnosis(at presentation or later), number of metastatic sites (single or multiple), specific metastatic sites(bone, liver, lung, distant nodes), number of bone metastasis (single or multiple), disease free survival (DFI) (6 months), prior chemotherapy, radiotherapy of metastatic sites. RESULTS: Negative prognostic factors in univariate analysis were: poor PS (>or=1), multiple metastatic sites, multiple bone metastasis, previous chemotherapy, visceral or node metastasis and non irradiated metastasis. Poor PS, multiple metastatic sites, and prior chemotherapy were independently significant negative prognostic factors in multivariable analysis. CONCLUSIONS: In this study we identified new prognostic factors in univariate and multivariate analysis. A regular and careful follow-up of patients treated for NPC is then recommended in order to detect early metastatic dissemination (with minimal localizations) while patients have still a good PS.     

Maximum likelihood estimation of dose-response parameters for therapeutic operating characteristic (TOC) analysis of carcinoma of the nasopharynx

A Therapeutic Operating Characteristic (TOC) curve for radiation therapy plots, for all possible treatment doses, the probability of tumor ablation as a function of the probability of radiation-induced complication. Application of this analysis to actual therapeutic situations requires that dose-response curves for ablation and for complication be estimated from clinical data. We describe an approach in which “maximum likelihood estimates” of these dose-response curves are made, and we apply this approach to data collected on responses to radiotherapy for carcinoma of the nasopharynx. TOC curves constructed from the estimated dose-response curves are subject to moderately large uncertainties because of the limitations of available data. These TOC curves suggest, however, that treatment doses greater than 1800 ret may substantially increase the probability of tumor ablation with little increase in the risk of radiation-induced cervical myelopathy, especially for T1 and T2 tumors.