彩色多普勒血流成像对鼻咽癌放疗后椎动脉狭窄的诊断价值分析

目的 探讨彩色多普勒血流成像对鼻咽癌放疗后椎动脉狭窄的诊断价值。方法 择取2016年1月—2020年1月,进行放疗同时生存期>2年的鼻咽癌患者(n=15),作为研究组,同时将初治尚未进行放疗的鼻咽癌患者(n=15),作为对照组。统计两组颈动脉狭窄情况,记录血管内径、收缩期峰值流速、舒张末期血流速度。结果 对照组放疗前后颈总动脉、颈内动脉、颈外动脉狭窄比较,差异无统计学意义(P>0.05);内径<15.00%分析中,研究组颈总动脉、颈内动脉狭窄度高于对照组(P<0.05);颈外动脉比较,两组比较形成差异性(P<0.05);颈动脉内径>50.00%分析中,两组颈总动脉、颈内动脉有显著差异(P<0.05);颈外动脉内径比较不具有统计学意义(P>0.05)。结论 行放疗处理后的鼻咽癌患者,放疗后颈动脉狭窄相对多见,狭窄多发于颈总动脉及颈内动脉。     

彩色多普勒超声诊断检查喉癌的意义评价

目的 分析在喉癌患者诊断中彩色多普勒超声诊断的意义。方法 遴选本院治疗的57例喉癌患者为对象实施研究,全部患者诊疗资料均完整保存,研究起止时间段为2019年10月-2020年10月,全部患者均通过病理检查确诊为喉癌,研究过程中均实施彩色多普勒超声检查,将病理检查作为诊断金标准,分析彩色多普勒超声检查符合率、漏诊率、特异性、灵敏度,同时对于诊断情况进行分析,应用“χ²”实施统计学处理。结果 彩色多普勒超声检查符合率低于病理检查,漏诊率高于病理检查,数据差异不存在统计学意义,P>0.05;彩色多普勒超声检查灵敏度为82.63%,特异度为90.29%;彩色多普勒超声显示声门型12例,声门上型15例,声门下型14例,声门旁型16例。结论 在喉癌的诊断中,彩色多普勒超声具有重要的诊断意义,可有效观察肿瘤周边组织情况、肿块与颈部血管关系、颈部淋巴结转移情况,具有操作简单、经济、准确性高、可重复性理想等优势,可为临床诊断恶性占位性病变提供重要参考,具有独特的临床诊断价值。     

彩色多普勒超声诊断喉癌的有效性及准确性探究

目的 从有效性和准确性的角度评价彩色多普勒超声对喉癌的诊断价值.方法 选择2019年10月～2020年10月期间就诊的25例疑似喉癌患者,给予彩色多普勒检查,将检查结果与术后病理结果——金标准进行对照,计算彩色多普勒超声的诊断准确率、误诊漏诊率、特异性、敏感性.结果 25例患者中有21例经术后病理确诊.彩色多普勒超声检...     

二维超声和彩色多普勒超声诊断甲状腺良恶性结节的诊断效果分析

目的 了解在甲状腺良恶性结节诊断中二维超声、彩色多普勒超声的价值。方法 将病例纳入研究时段定为2021年6月-2022年6月,选择本院在该时间段内收治的70例甲状腺结节患者为探究主体,全部患者均实施二维超声、彩色多普勒超声检查,以手术结果作为诊断金标准,了解不同诊断方式的诊断结果（准确性、漏诊率、误诊率）、诊断效能（灵敏度、特异度）、超声征象、良恶性结节血流分型。结果 彩色多普勒超声诊断准确性明显高于二维超声（P<0.05）,误诊率、漏诊率低于二维超声（P>0.05）;彩色多普勒超声诊断灵敏度、特异度明显较二维超声高（P<0.05）;良性结节边界清晰、结节囊实质、形态规则检出率较二维超声高,低回声、微钙化、纵横比≥1检出率较二维超声低（P<0.05）。结论 在甲状腺良恶性结节的超声诊断中,彩色多普勒超声诊断价值显著优于二维超声,可有效鉴别良恶性,临床应用价值理想。     

彩色多普勒超声在甲状腺肿瘤诊断中的应用

目的 探讨彩超对甲状腺肿瘤中的临床应用价值。方法 对2001年1月～2002年12月153例甲状腺肿瘤患者术前行彩超检查,术后经病理诊断的甲状腺肿瘤进行分析。结果 术前彩超提示为良性肿瘤的135例中,术后病理诊断为甲状腺腺瘤的69例,结节性甲状腺肿63例,结节性甲状腺肿并甲状腺癌2例,微小癌1例：术前彩超提示为甲状腺恶性肿瘤的18例,术后病理诊断为甲状腺乳头状癌者16例,甲状腺腺瘤者2例。彩超对甲状腺良性肿瘤的诊断符合率为97．8％(132／135),恶性肿瘤的诊断符合率为88．9％(16／18),总的诊断符合率为96.7％(148／153)。结论 彩超对甲状腺肿瘤的诊断与鉴别诊断有很大的价值,可为甲状腺肿瘤治疗方案的选择提供可靠信息。     

彩色多普勒超声在甲状腺腺瘤与结节性甲状腺肿鉴别诊断中的价值

目的 研讨彩色多普勒超声在甲状腺腺瘤与结节性甲状腺肿鉴别诊断中的价值.方法 随机选择2020年2月～2021年2月间我院收治的经病理检查确诊为甲状腺腺瘤的36例患者为A组,同期选取确诊为结节性甲状腺肿的36例患者为B组,两组患者均进行了彩色多普勒超声检查,比较两组多普勒超声结果以及血流情况.结果 A组病人的回声多为实性...     

彩色多普勒超声在扁桃体周围脓肿诊断中的应用

目的 研究彩色多普勒超声在扁桃体周围脓肿诊断中的应用。方法 择取在本院就诊的50例疑似扁桃体周围脓肿患者,接收时间段介于2020年1月至2021年12月间。所有研究对象均进行彩色多普勒超声检查,观察检查结果。结果 45例患者经诊断性穿刺确诊,彩色多普勒超声检查的检出率为88.00%,诊断的敏感度数据、特异度数据、准确性数据、阳性预测值、阴性预测值依次为93.33%、60.00%、90.00%、95.45%、50.00%。结论 对于诊断扁桃体周围脓肿而言,彩色多普勒超声检查具有操作简单、无创、准确性较高等优势,临床推广应用价值高。     

多普勒超声心动图对心耳并列的诊断价值

目的探讨多普勒超声心动图对心耳并列的诊断价值。方法选取北京安贞医院2007年5月~2016年5月收治的心耳并列患儿16例,应用VIVID7彩色多普勒超声心动图仪行超声心动图检查,并进行MRI、心血管造影检查或外科手术病理分析,最后明确诊断。结果 16例患儿均为右心耳左侧并列合并复杂的先天性心血管畸形,其中6例患儿合并右室双出口,4例患儿合并肺动脉闭锁,4例患儿合并完全性大动脉转位,2例患儿合并三尖瓣发育不良趋闭锁并肺动脉狭窄,分别占总数的37.5%、25.0%、25.0%及12.5%;12例患儿为剑突下两房观,10例患儿为左心室长轴观,10例患儿为胸骨旁大动脉短轴观,8例患儿为胸骨旁四腔观,分别占总数的75.0%、62.5%、62.5%及50.0%;10例患儿经超声心动图检查明确诊断,4例患儿无法确诊,2例患儿漏诊,分别占总数的62.5%、25.0%及12.5%。MRI、心血管造影检查后再对患者进行超声心动图检查,14例患儿明确诊断,2例患儿仍然无法确诊,这是因为只显示异常走形的房间隔,没有良好显示心耳,分别占总数的87.5%及12.5%。结论多普勒超声心动图对心耳并列具有较高的诊断价值,值得在临床推广。     

Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron^®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron^® followed by the application of mitomycin-C and stenting has been shown to be an effective option.     

Radiation acute carotid blowout syndromes of the ascending pharyngeal and internal carotid arteries in nasopharyngeal carcinoma

Acute carotid blowout syndrome (CBS) was defined as free rupture of the carotid artery associating with catastrophic hemorrhage. Most radiation acute CBSs in nasopharyngeal carcinoma (NPC) are found in petrous segment of the internal carotid artery (ICA) because of high-dose radiation in this area associated with nearby osteonecrosis. The occurrence of acute CBSs in the small branch of the external carotid artery and cervical ICA following radiotherapy in NPC patient is very rare. We present a rare case of NPC with radiation acute CBSs in the ascending pharyngeal and cervical ICA in a 3-month interval that were successfully managed by endovascular embolization.     

鼻咽癌放疗后鼻咽部出血原因分析及治疗对策探讨

目的探讨鼻咽癌放疗后鼻咽部出血的原因及治疗对策。方法回顾性分析2012年1月—2017年12月住院的25例鼻咽癌放疗后导致鼻咽部出血患者的临床资料,治疗方法主要包括鼻咽鼻腔填塞、鼻内镜下鼻咽痂皮及坏死肉芽清创、介入治疗、低温等离子手术止血、鼻内镜下鼻咽肿瘤切除术。结果25例患者中,由鼻咽癌复发引起鼻咽出血8例,其中3例大出血死亡;5例由假性动脉瘤引起,其中3例大出血死亡,2例经介入治疗止血;11例为鼻咽放疗后痂皮及肉芽出血,其中有7例经低温等离子手术成功止血,3例经介入后止血,1例经填塞止血;1例不明原因大出血窒息死亡。结论鼻咽癌放疗后鼻咽部出血是致死率高的并发症, 其中以鼻咽癌复发及假性动脉瘤危险性最高。积极检查明确出血原因,采取有针对性的治疗措施,能够有效降低鼻咽癌放疗后出血的死亡率。     

Late complications of radiotherapy for nasopharyngeal carcinoma

Objective

To evaluate and assemble late complications of radiotherapy in cases of nasopharyngeal cancer.

Methods

From October 2003 to January 2005, a prospective cohort study was done in a tertiary center, Chiang Mai University Hospital. Two hundred patients were evaluated for late complication according to the RTOG/EORTC late radiation morbidity scoring criteria.

Results

Of 200 patients, 131 were male (65.5%) and 69 female (34.5%). The mean age was 49.7 ± 13.5 years (11–78). The mean pre- and post-treatment body mass indexes (BMI) were 22.5 ± 4 (15–35.6), and 19.8 ± 3.2 (12.9–34.5; P < 0.05). Mean post-radiation period was 3.6 ± 3.4 years (0.3–18.6 years). The radiation dosage ranged from 60 to 76 Gy (mean 69 Gy). Most of the patients (92%) had undifferentiated (50.5%) and poorly differentiated (41.5%) squamous cell carcinoma. Eighty-eight percent of the patients were in Stage III and IV. Chemotherapy was given to 145 patients (72.5%). The mean post-radiation period in the added chemotherapy group was lower than the group treated with radiation alone (2.9 ± 2.7 years vs. 5.4 ± 4.4 years, P < .05). The most common complication was dryness of mouth (97.5%); followed by hearing impairment (inner ear 82.5%). Added chemotherapy increased the complication severity significantly for the skin (P < 0.05). The mean number of complications was 6.3 ± 2.2 (range from 1 to 12).

Conclusion

In this study, every patient had a more or less adverse reaction to radiation. Doctors need to be aware of these complications in order to prevent serious ones and to improve the patients’ quality of life in the long term.     

Incidence of long-term ipsilateral and contralateral ototoxicity following radiotherapy for nasopharyngeal carcinoma

Objective

To characterize the long-term adverse effects of radiotherapy on the ears in patients with nasopharyngeal carcinoma (NPC), we investigated ipsilateral and contralateral ototoxicities in the external, middle, and inner ear.

Methods

The records of 48 ears in 24 radiotherapy-treated NPC patients were retrospectively analyzed. Radiotherapy doses varied between 60 and 70 Gy in 2-Gy fractions at 5 fractions/week. Ototoxicities were identified by otoscope and pure-tone audiograms conducted at 2-3 month intervals for ≥12 months. The relationship between radiation dosage and sensorineural threshold deterioration was statistically compared using the Mann-Whitney U-test.

Results

Post-radiotherapy, 50% of all ears (3 of 6) that developed severe otitis externa were on the contralateral side. There was a post-radiotherapy increase in contralateral otitis media with effusion (OME) (1-7 ears), but a decrease in ipsilateral cases (16-12 ears), with 2 ears on either side subsequently developing chronic otitis media (COM). All ears that showed sensorineural hearing loss (SNHL) before radiotherapy exhibited a further threshold deterioration of more than 15 dB. No statistically significant difference (p = 0.086) in average radiation dose was seen between ears with sensorineural threshold deterioration (50.0 Gy) and those without (48.2 Gy).

Conclusion

Long-term ototoxicity following radiotherapy for NPC can occur in either the ipsilateral or contralateral ears. Pathophysiology varies between and within each side. The post-therapy increase in OME on the contralateral side was thought to be due to radiotherapy-induced Eustachian tube damage, and the sensorineural threshold deterioration in at least 4 ears was thought to be due to chronic cochlea damage secondary to COM.     

The prevalence of occult carotid artery stenosis in patients with head and neck squamous cell carcinoma.

OBJECTIVES/HYPOTHESIS: Risk factors for atherosclerotic carotid artery disease (ASCAD) and squamous cell carcinoma of the head and neck region (HNSCCA) are similar. This study was conducted to determine whether patients with HNSCCA have an increased rate of occult ASCAD compared with the general population. STUDY DESIGN: A cross-sectional study was performed to identify the prevalence of clinically significant ASCAD in the specific population of patients with a diagnosis of HNSCCA using noninvasive color flow duplex imaging. In addition, the demographic variables and risk factors for head and neck cancer and for carotid disease, as identified in the literature, were recorded with the use of a questionnaire. METHODS: Forty-nine patients with a diagnosis of HNSCCA completed the questionnaire and then had a duplex screening examination. RESULTS: The most common risk factor identified was tobacco smoking in 41 of 49 patients (84%). ASCAD was identified in one patient (2%). The stenosis in that patient was less than 60%. CONCLUSIONS: We conclude from this study that even though patients with HNSCCA usually have risk factor(s) associated with ASCAD, the rate of occult ASCAD was not different from that found in the general population. Thus, routine screening of patients with HNSCCA with color flow duplex imaging to detect occult ASCAD is not warranted.     

鼻咽癌放射治疗后鼻窦炎相关因素分析

目的　研究鼻咽癌放射治疗后鼻窦炎的发生率、临床特点及相关因素。方法　通过观察 5 13例鼻咽癌放射治疗前后的鼻咽及鼻窦临床症状和影像学改变特点 ,分析鼻咽癌放射治疗后放射性鼻窦炎的发生率和影响因素。结果　 5 13例鼻咽癌患者中 ,放射治疗前 5 1例伴有鼻窦炎(9 9% ) ,4 6 2例无鼻窦炎表现 (90 1% ) ;放射治疗后鼻窦炎发生率为 86 8% (40 1/46 2 ) ,鼻咽癌患者放射治疗前后鼻窦炎发生率差异有显著性 (χ2 =5 33 2 1,P <0 0 1)。 4 0 1例患者先后在放射治疗末期、放射治疗后 3个月、6个月、12个月和 18个月出现鼻窦炎症状 ,发生率分别为 10 7% (43/40 1)、13 7%(5 5 /40 1)、5 8 1% (2 33/40 1)、12 0 % (48/40 1)、5 5 % (2 2 /40 1)。分段放射治疗与连续性全程放射治疗后鼻窦炎发生率分别为 35 7% (14 3/40 1)、6 4 3% (2 5 8/40 1)。结论　放射性鼻窦炎发生率较高 ,放射剂量对其发生率有较大影响 ,与鼻咽肿瘤浸润范围无关。     

Modified radical neck dissection for residual neck disease after radiotherapy of nasopharyngeal carcinoma

Objective

Although radical neck dissection is proposed as a standard salvage procedure for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck, modified radical neck dissection may be appropriate for select patients. This study was designed to evaluate the efficacy of individualized neck dissections based on preoperative imaging studies and intraoperative exploration for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.

Methods

The study included 42 consecutive patients who failed radiotherapy or chemo-radiotherapy for nasopharyngeal carcinoma of the neck and underwent a total of 46 radical neck dissections or modified radical neck dissections. Selection of the proper type of neck dissection was based on preoperative imaging studies and intraoperative exploration. The patients’ clinical features, pathologic characteristics, complications, and treatment outcome were estimated and analyzed.

Results

Radical neck dissection and modified radical neck dissection were performed on 19 and 27 necks, respectively. Thirty-three necks (71.7%) had multiple node metastases. Nineteen necks (41.3%) had node metastases at two or more levels. The overall morbidity rate was 11.9%. The 5-year neck control rate (NCR) was 79.1% for 46 necks. The 5-year overall survival and disease free survival for 42 patients were 58.0% and 44.0%, respectively. No statistically significant differences were found in comparing OS, DFS, NCR between the MRND and RND groups.

Conclusions

Individualized neck dissection based on preoperative imaging studies and intraoperative exploration is appropriate for the management of radiotherapy-resistant nasopharyngeal carcinoma of the neck.     

鼻咽癌放疗后常见并发症的发病机制与康复评定及治疗进展

鼻咽癌大部分发生在我国华南地区,其中广东和广西地区最常见。放射治疗是鼻咽癌的首选治疗方法。鼻咽癌放疗后晚期常出现多种并发症,如吞咽障碍、张口困难、构音障碍、颈部活动障碍、心理障碍等,严重影响患者的生活质量。康复是治疗鼻咽癌放疗后并发症的有效手段,可以控制并发症的发展或加重并预防新的并发症的出现。鼻咽癌放疗后不同的并发症,其发病机制不同,需要进行康复评定,有针对性地选择不一样的康复治疗方法。本文就鼻咽癌放疗后常见并发症的发病机制、康复评定和治疗进展进行综述,以期为鼻咽癌放疗后并发症康复治疗的开展提供理论依据。     

Grayscale,subjective color Doppler,combined grayscale with subjective color Doppler in predicting thyroid carcinoma: a retrospective analysis

IntroductionFine needle aspiration cytology is preferred for thyroid nodules preoperatively, but has disadvantages of false-negative and false-positive results.ObjectiveTo compare the diagnostic performance of grayscale ultrasound, subjective color Doppler ultrasound, and combined features of grayscale ultrasound and subjective color Doppler ultrasound in predicting thyroid carcinoma, using results of the fine needle aspiration cytology as the reference standard.MethodsData from gray-scale ultrasound images, subjective color Doppler ultrasound images, and the fine needle aspiration cytology of 325 nodules of 250 patients (age ≥ 18 years) were collected and analyzed. Hypo-echogenicity than adjacent strap muscle, micro-lobulated or irregular margins, micro- or mixed calcifications, and taller-than-wide shapes were considered as a suspicious malignant nodule in grayscale ultrasound. Marked vascularity was considered as a suspicious malignant nodule in color Doppler ultrasound. The Bethesda system for classification of thyroid nodules was used for cytopathology.ResultsWith respect to the results of fine-needle aspiration cytology for detecting suspicious malignant nodules, for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound, sensitivities were 0.564, 0.600 and 0.691, respectively and accuracies were 0.926, 0.919 and 0.959, respectively. Suspicious malignant nodules detectability for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound were 0.09–0.56 diagnostic confidence, 0.08–0.61 diagnostic confidence, and 0.063–0.7 diagnostic confidence, respectively.ConclusionsThe combined gray-scale with subjective color Doppler ultrasound-guided fine-needle aspiration biopsies are recommended for the diagnosis of thyroid carcinoma.Level of Evidence: III.