鼻腔及鼻窦恶性肿瘤中p53基因突变的检测

目的探讨p53基因突变在鼻腔、鼻窦恶性肿瘤发生发展中的突变状况及其意义.方法用聚合酶反应-单链构象多态性分析(PCR-SSCP)方法测定36例鼻腔、鼻窦恶性肿瘤中p53基因4个突变热点,第5～8外显子.结果鼻腔及鼻窦恶性肿瘤p53基因突变率为38.9%(14/36)与正常鼻粘膜组织相比,与慢性鼻炎粘膜组织相比有显著性差异(χ2=11.874,P<0.05).淋巴结转移阳性组突变率为66.7%(10/15),阴性组突变率为19%(4/21),两者相比有显著性差异(χ2=10.219,P<0.05)但与临床分期、病理分型无关.结论 p53基因突变可能在鼻腔、鼻窦恶性肿瘤发生发展过程中是一个重要的分子事件,淋巴结转移和晚期有上升趋势.     

p53、p63、p73在鼻腔鼻窦恶性肿瘤中表达的临床意义

目的:探讨p53、p63、p73在鼻腔鼻窦恶性肿瘤中表达的临床意义及相关性。方法:用免疫组织化学方法检测67例鼻腔鼻窦恶性肿瘤、36例癌旁组织和36例鼻腔鼻窦的非癌组织中p53、p63和p73的表达。结果:p53、p63在鼻腔鼻窦恶性肿瘤中的阳性表达率明显高于癌旁和非癌组织(均P<0.01),p53与p63在鼻腔鼻窦恶性肿瘤中的表达存在正相关(P<0.01);p73在鼻腔鼻窦恶性肿瘤、癌旁和非癌组织中的表达差异无统计学意义(P>0.05)。结论:p53与p63在鼻腔鼻窦恶性肿瘤的发生发展过程中可能存在相关性,是鼻腔鼻窦恶性肿瘤发生过程中的重要因素之一,而p73在鼻腔鼻窦恶性肿瘤的发生过程中可能不发挥作用。     

晚期鼻腔鼻窦恶性肿瘤手术疗效及预后因素研究

目的 探讨晚期鼻腔鼻窦恶性肿瘤手术疗效及预后因素,旨在为手术方案选择及预后预测评估提供更多参考。方法 回顾性纳入2010年1月～2019年1月于内蒙古医科大学附属医院行手术治疗晚期鼻腔鼻窦恶性肿瘤患者117例,分析临床特征资料和随访生存资料,采用单因素和多因素法评估晚期鼻腔鼻窦恶性肿瘤手术预后独立影响因素。结果 117例患者术后随访5年无进展生存率和总生存率分别为48.71%和62.39%,中位无进展生存时间和总生存时间分别为32.48个月和39.80个月。单因素以及多因素分析结果显示,年龄、病理组织学类型、切缘状态及是否接受辅助治疗均是晚期鼻腔鼻窦恶性肿瘤术后无进展生存时间及总生存时间独立影响因素（P均<0.05）。结论 晚期鼻腔鼻窦恶性肿瘤手术疗效良好,且预后与年龄、切缘状态及是否接受辅助治疗有关。     

鼻腔鼻窦恶性肿瘤细胞凋亡的临床意义

目的探讨肿瘤细胞自发性凋亡与鼻腔鼻窦恶性肿瘤临床病理参数及预后的关系,为临床判断预后提供依据。方法回顾性分析解放军总医院1991~2000年收治的48例原发性鼻腔鼻窦恶性肿瘤患者。所有患者均进行根治性手术,44例术后均行放疗,其中2例加行化疗。所有患者均随访3年以上,25例健在无肿瘤复发(52.1%);3例肿瘤复发或远处转移带瘤生存(6.3%);2例死于其他疾病(4.2%);14例死于原发病(29.2%),4例失访(8.3%),按死于原发病局部复发计算。TUNEL结合PI及HE染色检测肿瘤细胞自发性凋亡情况。Log-rank进行生存率的比较,Cox回归进行影响患者预后的多因素分析,以P<0.05为有统计学意义。结果48例肿瘤标本中44例(91.67%)发现凋亡细胞,早期肿瘤(T1、T2)凋亡指数高于晚期(T3、T4),两者比较有统计学意义(P<0.05)。以AI中位数2为界将48例鼻腔鼻窦肿瘤分为高AI(AI≥2)和低AI组(AI<2),高AI组(AI≥2)总生存率、无瘤生存率和局部控制率均高于低AI组(P<0.05)。结论细胞凋亡可能参与了鼻腔鼻窦恶性肿瘤的发生和发展。临床检测肿瘤治疗前的凋亡指数有可能成为临床上用来筛选具有高复发和死亡风险性的鼻腔鼻窦恶性肿瘤患者的生物学指标。     

鼻腔鼻窦恶性肿瘤的诊疗进展

鼻腔鼻窦恶性肿瘤恶性程度较高,缺乏典型特异性临床症状,临床不易早期诊断,治疗比较棘手,术后患者生活质量多欠佳,预后亦较差,近年来其诊疗取得了一定的进展。本文将对一些主要的鼻腔鼻窦恶性肿瘤诊疗进展予以综述。     

存活素在鼻腔鼻窦恶性肿瘤中表达的临床意义

目的 探讨细胞凋亡抑制蛋白——存活素（survivin）在鼻腔鼻窦恶性肿瘤中的表达及其与肿瘤细胞自发性凋亡、患者临床病理参数和预后的关系，为临床筛选高危患者提供一定的参数。方法 回顾性分析解放军总医院1991-2000年收治的48例原发性鼻腔鼻窦恶性肿瘤患者。所有患者均进行根治性手术，术后除4例患者未行放射治疗或化学治疗外，其余44例均行术后放疗，其中2例加行化疗。患者均随访3年以上，中位随访时间60．5个月。末端脱氧核苷酸转移酶介导的缺口末端标记法（terminal deoxynucleotidyl transferase—mediated dUTP nick end lablling，TUNEL）结合碘化丙啶（propidium iodide，PI）及HE染色检测肿瘤细胞自发性凋亡情况，过氧化物酶标记的链霉卵白素法（streptavidin—pemxidase—biotin，SP）检测存活素的表达。用Spearman相关进行存活素蛋白表达与凋亡指数的相关分析，采用Log-rank进行生存率的比较，采用Cox回归进行影响患者预后的多因素分析。结果48例中共有25例（52．08％）健在无肿瘤复发，3例（6．25％）肿瘤复发或远处转移带瘤生存，2例（4．17％）死于其他疾病，14例（29．17％）死于该病，4例（8．33％）失访，按死于该病局部复发计算。48例中23例（47．92％）肿瘤组织存活素表达阳性，阳性染色主要位于细胞质，呈颗粒状或棕黄色着色，偶有胞核着色，而癌旁正常组织未见表达。存活素阳性组的凋亡指数（2．2）低于阴性（0．7）组表达（P〈0．05）。存活素阳性表达与凋亡指数呈负相关（r=-0．393，P=0．006）。晚期肿瘤（T3＋T4）存活素表达高于早期肿瘤（T1＋T2，χ^2=3．944，P=0．047）。存活素阳性表达组总生存率明显低于阴性表达组（P〈0．05）。多因素分析结果表明，存活素表达和肿瘤的组织学类型是影响患者预后的独立因素（P值分别为0．027和0．002）。结论 存活素过度表达可能与鼻腔鼻窦恶性肿瘤的发生有关。存活素可能通过抑制肿瘤细胞凋亡参与肿瘤的发生和发展。临床检测存活素表达有助于筛选具有高复发和死亡风险性的鼻腔鼻窦恶性肿瘤患者。     

鼻腔,鼻窦恶性肿瘤侵犯眼眶55例报告

报告５５例鼻腔，鼻窦恶性肿瘤侵犯眼眶患者的临床资料。５５例中３２例为复发性肿瘤，３０例接受第２次手术。３年生存率为７８．１％。５年生存率４３．８％。并且提出，在以手术治疗此种患者时，对眶内膜已受肿瘤侵犯者，应行眶内窜物全切术，否则短期内易复发。     

鼻腔及鼻窦肿瘤前颅底手术

我科与神经外科协作对７例侵犯前颅底的鼻腔及鼻窦肿瘤病人进行手术治疗，其中鼻中隔软骨瘤恶变，上颌窦筛窦前颅窝黑色素瘤、蝶骨嵴神经纤维瘤、额窦横纹肌肉瘤，筛窦骨瘤并脑脊液漏各１例，嗅沟脑膜瘤２例。结果６例存活，随访３￣５年以上无复发，其中１例术后半年肿瘤复发死亡。本文对侵犯前颅底肿瘤的手术指征，诊断方法，手术进路及术式结合病例进行了讨论。     

Mucosal melanoma of the nasal cavity and paranasal sinuses

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.     

Masses of nasal cavity, paranasal sinuses and nasopharynx: A clinicopathological study

An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Amongst the 240 cases studied, there were 144 cases (60%) of non-neoplastic lesions, 56 cases (23.33%) of benign lesions and 40 cases (16.67%) of malignant lesions. All age groups were involved and the mean age of presentation with the increasing age were: — non-neoplastic (22.5 years), benign tumors (26.8 years) and malignant tumors (35.3 years). The male to female ratio was 1.7:1 for non-neoplastic lesions; 3:1 for benign tumors: and 2.3:1 for malignant lesions. In this study maximum number of cases were present in nasal cavity (65%) followed by paranasal sinuses (20%) and least number of cases involved the nasopharynx (15%). The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.     

人鼻气流动力学研究仿真模型的建立与应用

目的 研制鼻腔鼻窦仿真模型,并验证其在鼻气流动力学实验研究中的可行性和可靠性.方法 ①用正常成人鼻腔鼻窦作为灌注模板,以透明树脂和琼脂为灌注材料,制作出鼻腔鼻窦透明仿真树脂模型;②用鼻内镜检查和CT扫描确定模型内部结构符合人鼻腔鼻窦正常形态与结构;③用鼻声反射仪检测确定模型的截面积和容积曲线并与正常人鼻声反射结果比较;④使用摄像机记录烟雾在鼻腔鼻窦模型内的流动方式与分布范围,以检测其透明性和直观性,其结果可经计算机处理.结果 成功制作出鼻腔鼻窦模型.模型具有仿真性强、透明性高的特点.模型的内部结构、形态、声反射图形与正常人鼻腔鼻窦检查与测试结果相近.从外部可观测烟雾在鼻腔鼻窦模型内的走向与分布,并可用高速摄像机记录.鼻吸人气流以两种主要流动方式到达后鼻孔:气流流过鼻阈后,大部分气流直接冲击中鼻甲前端,在中鼻甲前端形成漩涡;气流大部分经总鼻道和中、下鼻道呈半弧线型,小部分经鼻腔中上部呈抛物线型到达后鼻孔.快速吸气时鼻腔中上部的气流迅速增加;在鼻阈后中鼻甲前端和鼻咽部两处气流出现漩涡.呼吸时气流可直接进入上颌窦,呼吸时上颌窦内的气流均形成漩涡.结论 ①研制的仿真透明树脂鼻腔鼻窦模型可用于鼻气流动力学的实验研究;②鼻吸入气流以两种主要流动方式到达后鼻孔:大部分经总鼻道和中、下鼻道,小部分呈抛物线型经鼻腔中上部;③鼻吸入气流主要冲击部位是中鼻甲前端和下鼻甲,呼吸时上颌窦内的气流均形成漩涡.     

鼻腔鼻窦软骨肉瘤9例临床分析

目的：提高对发生于鼻腔鼻窦的软骨肉瘤的诊治水平。方法：回顾性分析9例鼻腔鼻窦软骨肉瘤患者的临床资料。结果：鼻腔鼻窦软骨肉瘤的临床病理特征复杂且差别较大，4例继发性鼻腔鼻窦软骨肉瘤患者比原发性患者病变广泛且接近颅底，预后较差，不规则的斑块状钙化点是本病典型的影像学特点。9例均是经行部分或全部肿块切除后病理确诊，病理学分级以I级多见。结论：结合既往史，临床表现和CT检查，尽早手术探查行部分或全部肿块切除术有助于早期诊断和提高疗效。     

Treatment of carcinoma of the nasal cavity and paranasal sinuses

The results of the radical treatment of 528 cases of carcinoma of the nasal cavity and paranasal sinuses are presented. These cases were analysed according to treatment modes of surgery or radiotherapy alone and surgery, radical or subradical, with radical radiotherapy. Of necessity the survey is retrospective but the results can be interpreted as demonstrating that while surgery without radiotherapy is appropriate to certain tumours near the nasal vestibule, to transitional cell carcinoma in men, and to some salivary carcinomas, for the remainder surgery, either radical or subradical with radiotherapy, is appropriate. No significant difference can be shown between radical and subradical surgery, when combined with radiotherapy. Radiotherapy alone appears inappropriate.     

Role of skull base surgery for local control of sarcomas of the nasal cavity and paranasal sinuses

Sarcomas of the nose and paranasal sinuses are rare neoplasms and comprise less than 1% of the malignancies arising in the sinonasal tract. From 1977 to 1989, we had the opportunity to treat 15 patients presenting with these tumors at The Eye & Ear Institute of the University of Pittsburgh. The clinical charts of these patients were reviewed retrospectively for demographic data, characteristics of disease, treatment considerations and clinical outcome. Data were also analyzed with special attention to the role of skull base surgery for the local control of tumors. Seven patients underwent cranial base surgery as part of their original therapy. Two of these patients are alive with no evidence of disease, one patient died of other causes, and four are dead of disease. Two patients died with local disease. Although not statistically significant due to the small number of patients, these data suggest that cranial base surgery can improve the local control of sarcomas of the sinonasal tract that approach or invade the skull base.Supported by a grant from the Mary Hillman Jennings Foundation and the John R. McCune Charitable Trust. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the above Foundations.     

鼻腔鼻窦恶性黑色素瘤23例临床分析

探讨鼻腔鼻窦恶性黑色素瘤的临床特征、诊断、治疗方法及预后,以提高对该病的诊疗水平。     

经鼻内镜治疗鼻腔鼻窦内翻性乳头状瘤18例

探讨内镜下切除鼻腔鼻窦内翻性乳头状瘤的效果。方法：对18例鼻腔鼻窦内翻性乳头状瘤患者行鼻内镜手术。结果：随访1～4.5年,仅1例复发。结论：鼻内镜治疗鼻腔鼻窦内翻性乳头状瘤有多视角、清晰度高、损伤小、不毁容等优点。     

鼻腔鼻窦腺样囊性癌的临床分析

目的 探讨鼻腔鼻窦腺样囊性癌(ACC)的临床特点及手术疗效分析。方法 回顾性分析云南省第三人民医院2010年6月—2017年6月收治的31例病理确诊为鼻腔鼻窦ACC患者主要临床表现及生物学特性,针对不同部位、分期患者进行不同方式的手术及术后放疗。结果 31例鼻腔鼻窦ACC患者随访30例,1例失访;3年生存率为87.1%(27/31),5年生存率为71.0%(22/31),3年局部复发率为16.2%(5/31),5年局部复发率为25.8%(8/31)。结论 鼻腔鼻窦ACC生长部位深在,毗邻结构复杂,肿瘤的高侵袭性和沿神经浸润生长的习性,手术彻底切除较难,易复发。传统手术结合鼻内镜颅底技术以及神经追踪技术是减少复发、提高生存率的有效方法。