下咽癌误诊分析

目的　提高下咽癌的早期诊断 ,减少误诊。方法　对 32例下咽癌的临床资料和误诊情况进行回顾性的分析。结果　下咽癌出现症状较晚 ,其咽部不适、咽痛、痰中出血、颈部肿块等症状为非特异性 ,易误诊为其他炎症性疾病。结论　对 5 0～ 70岁患者有上述症状者 ,一定要仔细检查咽部 ,尤其是哪些当作慢性炎症多次治疗无效者     

Hypopharyngeal perforation: an uncommon cause of pneumoperitoneum

Endotracheal intubation is common practice being performed both electively and as an emergency. Complications of this procedure are uncommon. A case is described of hypopharyngeal rupture after emergency intubation that presented with a pneumoperitoneum. The clinical signs, relevant investigations and management options are discussed for this injury and the need is emphasised for a high index of suspicion in order to make an early diagnosis.     

下咽癌甲状腺转移的临床与病理学分析

目的：探讨下咽癌甲状腺转移规律及下咽癌手术中甲状腺叶切除的适应症。方法：对27例下咽癌甲状腺切除标本进行病理学研究，分析下咽癌甲状腺转移与下咽癌原发部位、TNM分期和分化程度的关系。结果：甲状腺转移性鳞状细胞癌5例，转移率18．5％。其中，梨状窝癌3例（T3N2N0、T4N2M0和T4N3M0各1例，I级、Ⅱ级和Ⅲ级各1例），环后癌2例（T4N0M0，Ⅱ级）。结论：下咽癌甲状腺转移金刚了于晚期梨状窝癌和环后癌。下咽癌手术中是否同时切除患侧甲状腺叶应根据手术指征来决定，但晚期梨状窝癌和环后癌，应预防性切除患侧甲状腺叶。     

CT诊断下咽恶性肿瘤累及周围结构的价值

目的：探讨下咽恶性肿瘤侵犯周围结构的CT诊断价值。材料与方法：对33例经喉镜和／或手术病理证实的下咽恶性肿瘤CT扫描进行分析，并与喉镜对照。结果：CT发现病灶部位：梨状窝14例、环后区4例、咽后壁1例、梨状窝＋咽后壁8例、梨状窝＋环后区＋咽后壁6例，CT还可观察到深部结构及淋巴结转移，而喉镜只对其中14例单纯梨状窝肿瘤做正确定位，但喉镜可直接观察到病灶表面情况且均可做活检。结论：CT较喉镜能更全面地判断下咽恶性肿瘤对其周围结构的侵犯、明确受侵器官和淋巴结情况。     

下咽癌根治性调强放疗联合化疗30例临床观察

【目的】探讨下咽癌手术及放化疗的临床效果。【方法】回顾性分析2008年6月至2010年10月本院收治的70例下咽癌病例的临床资料,70例患者根据2002年国际抗癌联盟分期标准,Ⅰ期3例,Ⅱ期10例,Ⅲ期22例,Ⅳ期35例。根据不同的治疗方法,将70例患者分为两组,根治性调强放疗＋化疗组（A组,30例）,手术＋术后常规放疗组（B组,40例）,术后2～4周伤口完全愈合后进行放疗,比较两组治疗后总生存率和局部控制率。【结果】70例患者的1、3、5年总生存率分别为82．9％（58/70）,61．5％（43/70）,38．5％（27/70）。A组和B组局部控制率分别为66．7％（20/30）,70．0％（28/40）,两组相比较差异无显著性（ P ＞0．05）。A组和B组1、3、5年总生存率分别为83．3％（25/30）,63．0％（19/30）,38．0％（11/30）和82．5％（33/40）,58．5％（23/40）,39．0％（15/40）。两组1、3、5年生存率相比较差异均无显著性（ P ＞0．05）。【结论】根治性调强放疗＋化疗能获得同手术一样的疗效,且更好地保留了患者的喉功能,提高了生活质量。     

Hypopharyngeal perforation following minor trauma: a case report and literature review

Hypopharyngeal perforation is mainly reported in association with high velocity road traffic accidents, or with low velocity direct blows to the neck. We report a case of hypopharyngeal perforation following a low velocity motorcycle accident where neither of these mechanisms of injury was apparent. A 52 year old man was referred from the emergency department (ED) with a sore throat and dysphagia, following a low speed side impact accident. A gastrograffin swallow demonstrated a posterior pharyngeal wall tear. After 11 days of conservative hospital treatment, he recovered and was discharged. The presumed mechanism of injury in this case was cervical spine hyperextension without cervical compression.     

下咽及食管异物多排螺旋计算机断层摄影诊断

  目的  探讨下咽及食管异物多排螺旋计算机断层摄影(multi-slice spiral computed tomography, MSCT)影像征像及诊断要点。  方法  回顾性分析25例经临床证实的急诊下咽及食管异物患者的临床及MSCT图像资料, 观察MSCT图像上食管异物的位置、形态, 测量异物的最长径以及异物中心距离环状软骨下缘的距离, 并观察食管边缘清晰程度、与邻近解剖结构的关系以及有无气肿并发症。  结果  MSCT能清晰显示所有患者下咽或食管异物的位置、大小以及与周围解剖结构的关系。25例患者异物位置以食管上段及食管下咽交界处为主。食管异物平均长度为(20.4±7.4)mm(5.4~42.0 mm), 异物中心距离环状软骨下缘平均约(13.1±17.0)mm(-5.0~30.0 mm)。  结论  MSCT可从异物位置、大小、与周围解剖结构关系及有无其他并发症多个方面为临床异物取出提供清晰的影像信息。     

螺旋CT对下咽癌的诊断价值

[目的]探讨螺旋CT对下咽癌的诊断价值.[方法]将30 例下咽癌行螺旋CT扫描,并将CT诊断与手术病理结果进行对照分析.[结果]螺旋CT判断下咽癌侵犯声门旁间隙、会厌前间隙、甲状软骨、环状软骨、杓状软骨、杓会厌皱襞及声带的准确率分别为93.3%、100%、71.4%、100%、50.0%、91.7%及60.0%,判断下咽癌侵犯喉结构总的准确率为85.5%.[结论]螺旋CT对下咽癌的诊断及鉴别诊断有重要价值.     

下咽癌患者咽后淋巴结转移情况及临床特征分析

[目的]探讨下咽癌患者咽后淋巴结转移情况及临床特征.[方法]回顾性分析本院收治的136例下咽癌患者的一般资料,TNM分期以及临床病灶分布的情况,根据患者咽后淋巴结转移情况将患者分为咽后淋巴结转移组和未转移组,比较两组患者的临床特征、术后区域复发情况以及生存率.[结果]136例下咽癌患者中,26例患者出现淋巴结转移(转移...     

Impact of FDG-PET on Prediction of Clinical Outcome after Concurrent Chemoradiotherapy in Hypopharyngeal Carcinoma

Purpose  

To evaluate prognostic value of pretreatment and posttreatment 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) in advanced hypopharyngeal carcinoma treated by chemoradiotherapy.     

颈阔肌皮瓣重建下咽癌切除后颈段食管缺损的护理

颈阔肌皮瓣重建颈段食管缺损是自行设计的新手术方法。术前做好心理护理、口腔护理 ,防止呼吸道感染发生 ,加强营养 ,全面做好手术准备。术后密切观察颈部伤口 ,固定好重建食管腔内支架管 ,加强口腔、鼻咽部护理 ,严格气管造口管理 ,做好饮食护理 ,以减少术后并发症的发生。     

自体空肠移植重建下咽颈段食管的临床疗效分析(附九例报道)

目的:探讨自体空肠移植重建下咽颈段食管的应用及临床疗效。方法:回顾性分析自体空肠移植重建下咽颈段食管的9例病例,均为下咽癌,其中1例癌肿侵及颈段食管。术中切除全下咽、颈段食管、全喉,同时行颈淋巴清扫,用自体空肠移植进行消化道重建。结果:术后移植肠管全部成活,随访1~22个月,未出现癌肿复发和死亡。结论:对于下咽颈段食管等部位肿瘤,根治后形成环周缺损,用自体空肠移植进行消化道重建,是一个较好的选择。     

MEK in cancer and cancer therapy

The mitogen-activated extracellular signal-regulated kinase (MEK) pathway is one of the best-characterized kinase cascades in cancer cell biology. It is triggered by either growth factors or activating mutations of major oncogenic proteins in this pathway, the most common being Ras and Raf. Deregulation of this pathway is frequently observed and plays a central role in the carcinogenesis and maintenance of several cancers, including melanoma, pancreatic, lung, colorectal, and breast cancers. Targeting these kinases offers promise of novel therapies. MEK inhibitors (MEKi) are currently under evaluation in clinical trials and many have shown activity. In this review, we comprehensively examine the role of the MEK pathway in carcinogenesis and its therapeutic potential in cancer patients, with a focus on MEKi. We describe the clinical perspectives of MEKi in the two main models of Ras–ERK driven tumors, BRAF-mutant (“addicted” to the pathway) and KRAS-mutant (non-“addicted”). We also highlight the known mechanisms of resistance to MEKi and emerging strategies to overcome it.     

Neuromuscular complications of cancer and cancer treatments

Death rates related to cancer have steadily decreased over the past few decades, and as a result, the number of survivors has exponentially increased. Increasingly, more and more secondary complications caused by cancer and its treatments are being recognized. Neuromuscular complications related to the underlying cancer itself, or caused by associated treatments, such as chemotherapy and radiation therapy, are common but are likely underreported. While neurologic involvement can occur in both the central and peripheral nervous systems at any level, this article focuses on the effects of cancer on the peripheral nervous system.