重视头颈部肿瘤气管旁及上纵隔淋巴结的处理

头颈部恶性肿瘤的颈淋巴结转移一直是临床研究的热点,影响预后的关键因素是有无局部复发和淋巴结转移,正确的颈廓清术对防止肿瘤转移,提高患者的生存率和生存质量有重要意义,不断学习和掌握有关头颈肿瘤患者颈廓清术的新观念和新技术十分必要。     

NOX4在鼻咽癌组织中的表达及临床意义

目的研究NOX4在鼻咽癌组织中的表达情况,并分析NOX4与鼻咽癌患者临床病理特征、放射治疗(简称放疗)敏感度及生存预后的关系。方法通过免疫组织化学方法检测97例鼻咽癌及20例正常鼻咽黏膜组织中NOX4的表达情况,分析NOX4与鼻咽癌患者性别、年龄、吸烟史、病理类型、临床分期、复发、远处转移等临床病理特征的关系,进一步分析NOX4与鼻咽癌患者放疗敏感度及生存预后的相关性。结果NOX4在鼻咽癌组织中的表达高于正常鼻咽部黏膜组织(P=0.008)。临床分期(P=0.003)和复发(P=0.007)与NOX4的表达有关,性别、年龄、吸烟史、病理类型、远处转移与NOX4表达无关(P<0.05)。放疗抵抗组NOX4表达高于放疗敏感组(P<0.001),logistic回归单因素和多因素分析显示NOX4是鼻咽癌放疗敏感度的独立预测因素(P<0.001)。Kaplan-Meier法绘制生存曲线,结果显示NOX4低表达的鼻咽癌患者生存明显好于NOX4高表达的患者(P<0.001),进一步Cox回归分析表明NOX4是鼻咽癌患者生存预后的独立预测因素。检测同一患者初发和复发鼻咽癌组织中NOX4的表达,结果显示复发鼻咽癌组织中NOX4表达高于初发鼻咽癌组织(P=0.002)。结论NOX4在人类鼻咽癌组织中高表达,与肿瘤放疗敏感度、复发及生存预后相关。     

喉癌前哨淋巴结定位和活检的临床初步研究

目的探讨喉癌前哨淋巴结定位和活检技术的可行性及其对颈淋巴结转移癌的预测价值.方法采用1%专利兰(Patent blue V dye),对31例颈淋巴结N0的喉癌患者进行术中前哨淋巴结定位研究,且对术中前哨淋巴结及颈清扫术切除淋巴结进行常规病理检查和对比,观察前哨淋巴结对颈淋巴结转移癌的预测值.结果3l例中21例找到前哨淋巴结,成功率67.7%,前哨淋巴结对颈淋巴结转移癌的预测值为95.2%.结论喉癌前哨淋巴结的定位和活检技术切实可行,且前哨淋巴结检测能够准确预测颈淋巴结转移癌的状况.     

巨噬细胞阳性蛋白-3α、半胱氨酸蛋白酶抑制剂A及前梯度蛋白-2在鼻咽癌患者中的表达及预后判断

目的 研究巨噬细胞炎性蛋白-3α(MIP-3α)、半胱氨酸蛋白酶抑制剂A(cystatin A)及前梯度蛋白-2(AGR-2)在鼻咽癌患者中的表达情况及用于判断预后的价值。方法 选择2012年1月~2013年1月于陕西省核工业二一五医院就诊的鼻咽癌患者90例,采用免疫组织化学方法检测患者癌组织及癌旁组织MIP-3α、cystatin A及AGR-2的表达。利用Kplan-Merier曲线和Cox比例风险模型分析MIP-3α、cystatin A及AGR-2评估鼻咽癌预后的价值。结果 癌组织MIP-3α阳性患者49例(54.4%),cystatin A阳性59例(65.6%),AGR-2阳性53例(58.9%),分别显著多于癌旁组织MIP-3α阳性22例(24.4%,χ²=23.320, P<0.001),cystatin A 25例(27.8%,χ²=25.804,P<0.001),AGR-2 28例(31.1%,χ²=14.029,P<0.001)。MIP-3α、AGR-2阳性患者的总生存率(OS)、无远端转移生存率(DMFS)差于MIP-3α阴性患者(P<0.005),cystatin A阳性患者的OS、局部无复发生存率(LRFS)、DMFS均差于cystatin A阴性患者(P<0.005)。Cox风险比例发现,MIP-3α、cystatin A及AGR-2可以作为鼻咽癌患者预后的有效预测因子。结论 MIP-3α、cystatin A及AGR-2在鼻咽癌患者癌组织中高表达,与鼻咽癌患者预后相关,可以作为一种标记物判断患者预后。     

STAT3及其靶基因STAT3在声门上喉癌手术切缘组织中蛋白的表达及与预后的关系

目的 探讨声门上喉癌患者STAT3的表达与手术切缘长度、术后复发及临床病理因素的关系。方法 应用免疫组化SP法检测82例声门上喉癌患者病理阴性边缘标本中STAT3的表达情况。结果 喉癌原发灶中STAT3的阳性表达率为83%(68/82)。手术切缘STAT3阳性表达组与阴性表达组的复发率差异有统计学意义(P<0.05)。分析手术切缘长度与术后复发率的关系,得出以STAT3表达判断肿瘤边缘安全手术边缘为5 mm。随访3年,生存分析结果显示STAT3手术切缘阴性表达组的生存率明显高于阳性表达组(P<0.05)。淋巴结转移组手术切缘STAT3的阳性表达率明显高于无淋巴结转移组(P<0.05),临床分期T3、T4组明显高于临床分期T1、T2组(P<0.05)。不同病理组织学分级的手术切缘STAT3阳性表达率差异无统计学意义(P>0.05)。结论 STAT3蛋白可作为评估手术切缘和预后的重要分子标志物。     

鼻咽癌原发灶的挽救性手术进展

鼻咽癌是中国南方地区发病率较高的头颈恶性肿瘤,主要治疗方法是放射治疗(简称放疗),但约20％鼻咽癌患者在首次治疗后会出现原发灶局部残留或复发.原发灶残留或复发鼻咽癌患者主要的治疗方法是手术和再程放疗.本文对鼻咽癌原发灶挽救性手术治疗进展进行综述,以了解鼻咽癌挽救性手术治疗存在的问题及今后的研究方向.     

Ki67和nm23蛋白在鼻咽癌中的表达及临床意义

目的：通过观察Ki67、nm23蛋白在鼻咽慢性炎症、鼻咽癌组织中的表达,探讨Ki67、nm23与鼻咽癌临床病理特征的相关性。方法采用免疫组织化学方法（ SP法）检测23例鼻咽慢性炎症组织和59例鼻咽癌病理组织中Ki67、nm23的表达情况,再对Ki67、nm23的不同程度表达与鼻咽癌患者的临床分期、淋巴结转移、远处转移及5年生存率之间的关系进行统计学分析。结果①与鼻咽黏膜慢性炎症组相比,鼻咽癌患者中Ki67的阳性表达率较高,nm23阳性表达率较低,差异有统计学意义（P＜0．01）。②鼻咽癌患者中Ki67阳性表达与临床分期及远处转移之间呈正相关;生存期＞5年的患者Ki67阳性率低于生存期＜5年的患者。③鼻咽癌患者nm23基因的阳性表达与临床分期、颈淋巴结转移及远处转移之间呈负相关;生存期＞5年的患者nm23阳性率高于生存期＜5年的患者。④Ki67与nm23两者的表达有相关性。通过生存曲线分析发现,Ki67蛋白低表达同时nm23蛋白高表达患者比Ki67蛋白高表达同时nm23蛋白低表达患者的生存时间更长。结论鼻咽癌中Ki67、nm23的表达与肿瘤的浸润、转移密切相关,两者有望成为评估预后的相关指标。（中国眼耳鼻喉科杂志,2015,15：20-24）     

鼻腔黏膜恶性黑色素瘤活化细胞外调节蛋白激酶表达及临床特征分析

目的观察鼻腔黏膜恶性黑色素瘤活化细胞外调节蛋白激酶(extracellular regulated protein kinases,ERK)的表达,分析ERK活化与临床特征之间的关系。方法从20例鼻腔黏膜恶性黑色素瘤患者的肿瘤新鲜冻存组织中提取总蛋白,并采用蛋白印迹方法检测活化ERK的表达。对20例患者进行随访,观察肿瘤复发及颈淋巴结转移情况。结果 20例鼻腔黏膜恶性黑色素瘤组织中,活化ERK表达阳性12例,其中9例术后复发,3例发生颈淋巴结转移;在8例活化ERK表达阴性患者中,2例术后复发,1例发生颈淋巴结转移。活化ERK表达阳性患者的复发情况高于ERK表达阴性的患者,差异有统计学意义(P<0.05);而两者间颈淋巴结转移差异无统计学意义(P>0.05)。结论鼻腔黏膜恶性黑色素瘤活化ERK表达阳性患者更易复发。     

微小型甲状腺乳头状癌颈淋巴转移的临床研究

目的探讨微小型甲状腺乳头状癌颈淋巴转移的临床意义.方法回顾性分析1998年5月～2001年12月住院治疗的27例微小型甲状腺乳头状癌患者,其中23例行颈清扫术,并与同期住院治疗的144例非微小型甲状腺乳头状癌进行对比.结果微小型与非微小型甲状腺乳头状癌颈部淋巴结转移分别为12/23(52.2%)、108/144(75.0%),淋巴结阳性率分别为29.7%、37.8%;Ⅵ区淋巴结转移分别为9/23(39.1%)、43/58(74.1%),淋巴结阳性率分别为32.0%、58.4%;Ⅰ-Ⅴ区淋巴结转移分别为11/23(47.8%)、93/144(64.6%),淋巴结阳性率分别为15.2%、34.9%,三者统计学均有显著性意义.10例临床颈部N0微小型甲状腺乳头状癌患者,6例病理检查发现淋巴结转移.结论微小型甲状腺乳头状癌患者颈淋巴结转移比非微小型低,以颈静脉链为常见部位,其次是气管食管沟.对一个确诊为微小型甲状腺乳头状癌患者,都应行颈清扫术.     

成人分泌性中耳炎预后相关因素及临床疗效研究 △

目的 分析成人分泌性中耳炎(OME)临床因素与预后的关系,找出影响成人OME治疗疗效的相关因素。方法 收集291例(342耳)成人OME患者的基本资料,了解患者30 d内上呼吸道感染史、变应性疾病史、鼻及鼻窦疾病病史,评估患者咽鼓管功能。统计各临床因素与治疗有效率的相关性。比较上呼吸道感染是否合并咽鼓管功能不良与鼻及鼻窦疾病病史是否合并咽鼓管功能不良疗效的差异。结果 ①单因素分析显示,患者的性别(P=0.974)、单双侧发病情况(P=0.296)差异无统计学意义,与疾病疗效无明显相关性。而上呼吸道感染病史(P=0.049)与患者的疗效及预后呈正相关;鼻及鼻窦疾病病史(P=0.005)、咽鼓管功能状况(P=0.001)与患者的疗效及预后呈负相关,差异均有统计学意义。②多因素分析显示,上呼吸道感染病史(P=0.019,RR=1.692)、鼻及鼻窦疾病病史(P<0.001,RR=0.392)、咽鼓管功能不良(P<0.001,RR=0.248)仍与患者治疗疗效及预后相关。③鼻-鼻窦疾病病史合并咽鼓管功能不良治疗有效率明显降低(与鼻及鼻窦疾病病史且咽鼓管功能正常、上呼吸道感染合并或不合并咽鼓管功能不良相比,差异有统计学意义;慢性中耳炎发生率及鼓膜置管率明显升高,差异有统计学意义)。结论 成人OME的危险因素为上呼吸道感染、鼻-鼻窦疾病、咽鼓管功能不良。鼻-鼻窦疾病合并咽鼓管功能不良是成人OME保守治疗效果欠佳的重要因素。     

Clinical utility of 18 Fluorodeoxyglucose (FDG)-PET/CT scans in patients with suspect ocular tuberculosis

Systemic imaging of patients with suspect ocular tuberculosis include chest X-rays and computed tomography (CT) scans. Reports have suggested a role for 18 fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) scans. We report on the clinical utility of 18 FDG PET/CT in two patients. Case 1: A 38-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active supraclavicular and chest lymph nodes. An aspiration cytology of the cervical lymph node revealed caseating granulomas suggestive of tuberculosis. Case 2: A 58-year-old female patient presented with recurrent anterior uveitis. A 18 FDG-PET scan revealed metabolically active lymph nodes in the neck. A biopsy of the cervical lymph node revealed epithelioid granulomas suggestive of tuberculosis. Both patients were started on standard antitubercular therapy with a subsequent marked reduction of activity. PET/CT scans may suggest the sites of safe high-yield biopsies.     

Guiding function of positron emission tomography-computed tomography examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma

AIM: To explore the role of positron emission tomography-computed tomography (PET-CT) examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma (OAML). METHODS: The general clinical data, postoperative PET-CT results, treatment regimens, and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected. Among the 21 patients, five patients underwent surgical treatment alone, 13 patients underwent surgical treatment combined with radiotherapy, and three patients underwent surgical treatment combined with chemotherapy. RESULTS: The follow-up period ranged from 8 to 79mo, with four cases of recurrence and no deaths. Through PET-CT examination, two patients exhibited both local ocular metabolic elevation and systemic metastasis, and one of these patients had cervical lymph node metastasis, while the other had submandibular and parotid gland metastasis. Nine patients showed only local ocular metabolic elevation, while 10 patients had no abnormal metabolic activity locally. CONCLUSION: PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection, aiding in precise disease staging, and facilitating the development of personalized treatment plans, ultimately improving patient prognosis.     

Locally Advanced Sebaceous Cell Carcinoma (T3) of Eyelid: Incidence and Pattern of Nodal Metastases and Combined Modality Management Approach

Background: Sebaceous carcinoma (SbCC) is a rare malignancy that often mimics benign conditions. Lymphatic involvement, large T3 tumors herald a dismal survival for patients. We present our series of 13 cases of locally advanced SbCC of the eyelid treated at a surgical oncology unit and describe the clinical profile, patterns of nodal spread and recurrence pattern in this subset of SbCC.

Methods: A retrospective analysis of case records was carried out for patients presenting with orbital tumors between January 1997 and April 2010 in the department of Surgical Oncology, AIIMS, New Delhi, India. All patients underwent orbital exenteration and superficial parotidectomy with neck dissection was added to patients with clinically significant lymphadenopathy. All patients who underwent OE after 2002 were advised radiotherapy as adjuvant therapy. The end point was development of recurrence or end of two year follow up period which ever occurred earlier.

Results: Thirteen patients underwent orbital exenteration. Eleven patients had clinically palpable lymphadenopathy. Ten patients (76.9%) had pathologically confirmed metastatic nodes. Parotid lymph node involvement was present in all patients (100%); two of these ten patients also had level II b cervical lymph node involvement. Recurrence was observed in seven patients (53.8%). All recurrences were loco-regional only and no systemic metastases was seen. There were only two recurrences in the group that received PORT.

Conclusions: Eyelid SbCC is a loco-regionally aggressive malignancy and adequate disease control can be achieved with combined modality approach of radical surgery followed by post operative radiotherapy.     

血清促甲状腺激素水平与分化型甲状腺癌的相关性研究

目的 探讨术前血清促甲状腺激素(TSH)水平与分化型甲状腺癌(DTC)发病的关系。方法 回顾分析2011年6月~2016年5月上海交通大学附属第一人民医院耳鼻咽喉头颈外科收治的1 434例甲状腺结节患者的血清TSH水平、性别、年龄、肿瘤直径、有无淋巴结转移,探讨其与DTC发生之间的关系。结果 术后病理确诊甲状腺良性结节(BTN,包括结节性甲状腺肿、甲状腺腺瘤等)915例,分化型甲状腺癌(乳头状癌、滤泡状癌)519例。男性426例,其中DTC 152例、BTN 274例;女性1 008例,其中DTC 367例、BTN 641例,2组间甲状腺癌的发病率差异无统计学意义(P=0.79)。DTC患者的平均年龄为(46.925±13.980)岁,小于BTN患者的平均年龄(53.936±11.956)岁,差异有统计学意义(P<0.05)。DTC患者术前血清TSH平均水平(2.488 5±1.577 2)μIU/mL与BTN患者(2.458 6±2.694 7)μIU/mL相比,差异无统计学意义(P=0.79),但随着TSH水平(即使在参考值范围内)的升高,甲状腺癌所占的比例也升高,差异有统计学意义(P<0.05)。DTC患者中颈淋巴结转移阳性组、阴性组和BTN组,术前TSH水平在三者之间无明显差异(P=0.82)。DTC患者中肿瘤直径≤10 mm、>10 mm和BTN组,3组间术前TSH水平无明显差异(P=0.68)。Logistic回归分析显示,DTC的发生与年龄呈负相关(OR=0.673,P<0.05),而与性别、TSH水平无相关性。结论 血清TSH水平高、低龄、女性可能是预测分化型甲状腺癌风险的指标。TSH可能与甲状腺癌的发生有关,而与其发展无关。     

Studies on the lymph drainage of the eye 5. Quantitative registration of the lymph drainage from the subconjunctival space with a radioactive tracer (author's transl)

In 7 rabbits the drainage from the subconjunctival space to the cervical lymph nodes was observed after subconjunctival injection of 99mTc-micro-colloid. Measurements of the activity distribution were made in vivo with an Anger type camera (pho-Gamma-IV Hp, Searle Nuclear Chicago) and in vitro after dissection with a sodium iodine crystal well counter (Clinimat-200, Picker). 6 hours after the injection into the subconjunctival space of the right eye an average of 53.7% of the applied activity had drained off. A significant accumulation of activity could constantly be registrated in the cervical lymph nodes. Its amount was generally up to 2.08% of the applied total activity per animal, with a large individual spreading. In detail, activity was found in all 7 cases in the right superficial cervical lymph node, in 5 cases moreover in the right mandibular lymph node, additionally in 2 animals in the right or left deep cervical lymph node respectively and in one animal as well in the right as in the left deep cervical lymph node. Besides, in all cases high activity was registered in the right retrobulbar and subconjunctival spaces just as in the right eye. A small activity in the right optic nerve could be pointed out in three of our seven cases.     

Neoadjuvant chemotherapy in the management of sebaceous gland carcinoma of the eyelid with regional lymph node metastasis

A 55-year-old Asian Indian woman who had recurrent sebaceous gland carcinoma of the left lower eyelid with orbital extension and regional lymph node metastasis was treated with neoadjuvant chemotherapy, using a combination of carboplatin and 5-fluorouracil. Eyelid-sparing orbital exenteration was performed after 3 cycles of chemotherapy, followed by radiotherapy to the regional lymph nodes. Subsequently, 3 cycles of adjuvant chemotherapy were administered. Significant eyelid and orbital tumor volume reduction was achieved with neoadjuvant chemotherapy, making eyelid-sparing orbital exenteration possible. Chemotherapy also spared the patient from radical neck dissection. The patient had limited morbidity and was free of local, regional, and systemic disease at 26 months of follow-up.     

Patterns of regional and distant metastasis in patients with conjunctival melanoma: experience at a cancer center over four decades.

OBJECTIVE: The regional lymph nodes generally are believed to be the most common first site of metastasis for conjunctival malignant melanoma, but the pattern of nodal metastasis in this disease has not been well established. The goal of this study was to determine the frequency, location, and timing of regional lymph node metastasis in patients with conjunctival melanoma treated at one cancer center over four decades. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-seven patients. METHODS: The clinical records of 27 patients with conjunctival malignant melanoma were reviewed retrospectively. MAIN OUTCOME MEASURES: The rates of local conjunctival recurrence, regional nodal metastasis, and distant metastasis were analyzed along with overall survival. The follow-up time ranged from 2.5 to 17 years (median, 6 years). RESULTS: Eleven patients (41%) experienced clinical regional lymph node metastasis 1.5 to 6.0 years (mean, 3.2 years) after the initial diagnosis. The involved lymphatics were the preauricular (parotid) nodes in 8 patients (73%), the submandibular nodes in 1 patient (9%), and the deeper cervical nodes in 2 patients (18%). In seven patients (26%), distant metastasis developed without evidence of prior or concurrent regional nodal disease. Patients in whom distant metastasis developed without clinical evidence of regional nodal involvement were more likely to have had local conjunctival recurrence (P = 0.03) and a higher number of local recurrences (P = 0.05) compared with patients with regional lymph nodes as the site of first metastasis. The 5- and 10-year overall survival rates were 74% and 41%, respectively. CONCLUSIONS: Regional lymph node metastasis occurred in a higher percentage of patients with conjunctival malignant melanoma than has been reported previously. Preauricular lymph nodes were most commonly involved. Distant metastasis without prior or concurrent lymph node involvement was not a rare event.     

碘海醇复合染料定位兔舌癌前哨淋巴结

目的 研究碘海醇(欧乃派克)复合染料定位兔舌癌前哨淋巴结的可行性.方法 健康成年新西兰白兔14只,分为正常对照组(A组)3只、兔颈淋巴结炎性肿大模型组(B组)8只和兔VX2舌癌颈淋巴结转移模型组(C组)3只.B组6只和C组3只采用碘海醇和亚甲蓝(美蓝)混合液行间接淋巴造影,B组另外2只采用碘海醇和纳米炭混合液行间接淋巴造影.根据CT扫描和染色定位前哨淋巴结.结果 兔一侧舌腹外侧注射碘海醇后,只有同侧淋巴管和颈淋巴结增强显影.注射造影剂后双侧淋巴管及颈部淋巴结明显增强显影.在所有实验兔中,每侧颈部仅有一枚淋巴结增强显影,增强显影的淋巴结位于喉气管旁.在CT扫描定位指引下,采用碘海醇和亚甲蓝混合液造影的9只兔均在喉气管旁找到一枚蓝染淋巴结,另外2只采用碘海醇和纳米炭混合液造影的兔也均在喉气管旁找到一枚黑染淋巴结.该蓝染或黑染淋巴结实际位置与间接淋巴造影CT位置一致.结论 碘海醇复合染料定位可准确定位兔舌前哨淋巴结.