声门上型喉癌颈部淋巴结转移N1的处理与转归

为探讨声让上型喉型癌颈部淋巴结转移更好的处理方法，回顾性分析了９１７９年－１９９０年１１１例声门上型喉癌ｃＴ１－４Ｎ１患者病例资料，通过对颈部淋巴结的处理方式与转移或复发部位之间关系的探讨，发现Ｎ１病变对侧颈部淋巴结的潜在性转移有较高比例，其中尤以同侧颈清扫标本阳性的Ｔ３，４病变明显，为３８．６％。     

声门上型喉癌N0前放疗的随机对照研究

声门上型喉癌临床Ｎ０１００例，随机对照研究术前放疗４０Ｇｙ对控制颈部淋巴结隐匿性转移的作用，放疗加手术（综合治疗组）４６例，单纯手术５４例，随诊３－１２年。综合治疗组颈部复发率为１５％（７／４６），单纯手术２６％（１４／５４），但无统计学意义，提示４０Ｇｙ的剂量可能对颈部转移的控制不够。放疗加手术组Ｔ４颈部复发率３３％，比Ｔ１－３的３．６％明显增高。因此，建议Ｔ４声门上型喉癌应常规做一侧传统的根治     

头颈部鳞状上皮细胞癌部N0的处理——声门上型喉癌

对声门上型喉癌颈部无肿大转移淋巴结患者，进行回顾性分析，探讨适宜的处理方案。我院自１９７６年至１９９０年共外科治疗１６２例Ｔ１￣４Ｎ０患者。原发处进行各类学术治疗，颈部做上颈淋巴结切除术。有１３例冰冻病理检查阳性，即做颈清扫术。１４９例病理阴性者观察随诊５年。颈部复发或转移者１５例，颈部失败率为１０．１％。全组５年生存率：Ｔ１Ｎ０为９２．８％，Ｔ２Ｎ０为８６．５％，Ｔ３Ｎ０为６９．７％，Ｔ４Ｎ０为     

声门上型喉癌N_0术前放疗的随机对照研究

声门上型喉癌临床Ｎ＿０１００例，随机对照研究术前放疗４０Ｇｙ对控制颈部淋巴结隐匿性转移的作用。放疗加手术（综合治疗组）４６例，单纯手术５４例，随诊３～１２年。综合治疗组颈部复发率为１５％（７／４６），单纯手术２６％（１４／５４），但无统计学意义，提示４０Ｇｙ的剂量可能对颈部转移的控制不够。放疗加手术组Ｔ＿４颈部复发率３３％，比Ｔ＿（１～３）的３．６％明显增高。因此，建议Ｔ＿４声门上型喉癌应常规做一侧传统的根治性颈清扫术（ＲＮＤ），增加术前或术后放疗剂量到５０Ｇｙ。     

声门上型喉癌颈淋巴结处理的新进展

声门上型喉癌Ｔ１－２Ｎ。病变手术切除原发灶的同时对同侧颈癌选择性手术治疗，Ｔ３－４Ｎ０病变手术切除原发灶的同时对双侧颈部选择性手术治疗。     

头颈鳞癌颈部N0的局限性颈清扫术

目的：头颈部肿瘤颈部Ｎ０的处理有不同意见。本文提供两组病例：一组为１４９例喉癌声门上型;一组为２１９例舌活动部癌。试图从这两组患者治疗结果讨论了Ｎ０适宜治疗。方法;我科于１９７６－１９９０年外科或综合治疗声门上型喉癌１４９例１９６０－１９９３年外科或放射治疗舌活动部鳞癌２１９例。这两类病种均易有颈淋巴结转移,均为Ｔ１－４Ｎ０病例。声门上癌颈部做上颈清扫术。     

头颈鳞癌颈部N_0的局限性颈清扫术

目的：头颈部肿瘤颈部Ｎ０的处理有不同意见。本文提供两组病例：一组为１４９例喉癌声门上型;一组为２１９例舌活动部癌。试图从这两组患者治疗结果讨论Ｎ０适宜治疗。方法：我科于１９７６～１９９０年外科或综合治疗声门上型喉癌１４９例;１９６０～１９９３年外科或放射治疗舌活动部鳞癌２１９例。这两类病种均易有颈淋巴结转移,均为Ｔ１～４Ｎ０病例。声门上癌颈部做上颈清扫术;舌癌大部做全颈清扫术。两组原发灶以手术或放射治疗。利用手术标本病理检查及随诊资料进行分析讨论。结果：声门上型喉癌Ｎ０上颈清扫术后,病理无淋巴结转移者１４９例（病理有转移者立即做全颈清扫,不包括在这一组内）,５年观察后有１５例（１０．１％）出现颈转移。和文献报告全颈清扫后复发率可以相比。２１９例舌癌患者１１６例做全颈清扫,病理阳性率为１９．８％（２３／１１６）。３年观察后颈部复发的病例如下：原发与颈部放疗者１７．２％（１０／５８）;颈部无治疗者１６．１％（５／３１）;颈清扫病理阴性者１２．０％（１０／８３）。统计学上无差别。结论：对Ｎ０患者,无需做经典性全颈清扫术。对声门上型患者,上颈清扫（Ⅱ组淋巴结）做为诊断措施可以解决问题,进一步可以考虑肩胛舌骨肌上清扫     

喉癌颈部的手术治疗

本文综述喉癌伴临床阴性及阳性颈部淋巴结转移颈部处理的最新概念，对声门上型T2～T4、声门及声门下型T3～T4病变，在治疗喉部病灶的同时，应对颈部淋巴结采用手术或放射治疗，但放疗最好用于原发肿瘤也采用放疗的患者.选择性颈廓清术中，淋巴结是否有隐匿性转移、其数量多少、部位及状况可为喉癌的预后及治疗方案提供重要的信息.     

单蒂胸骨舌骨肌瓣在舌根肿瘤手术中的应用

作者自１９９２年以来，用单蒂胸骨舌骨肌瓣修复舌根异位甲状腺、喉癌侵犯舌根手术后的缺损，取得了比较满意的效果。１ 临床资料 ２例舌根部异位甲状腺患者均为女性，年龄各为１３岁和２９岁。同位素扫描示颈部甲状腺正常，完整切除舌根异位甲状腺。术后甲状腺功能无异常，吞咽、呼吸及发音功能良好，顺利拔除气管套管。 ４例晚期声门上型喉鳞癌均为男性，年龄５０～７７岁。ＴＮＭ分类分别为：Ｔ４Ｎ２Ｍ０、Ｔ４Ｎ１Ｍ０、Ｔ３Ｎ０Ｍ０、Ｔ３Ｎ０Ｍ０。其中２例有颈淋巴结转移者手术同时行颈廓清术。术后并发症：１例发生咽瘘，１例出现…     

声门上喉鳞癌临床颈淋巴结阳性患者术前放疗对颈部复发的影响…

声门上型喉鳞癌临床颈淋巴结阳性患者８１例，随机对照研究术前放疗４０Ｇｙ对控制颈部复发的意义。放疗加手术３２例，单纯手术４９例，随诊３年以上。颈部为复发的主要部位占６２．９％，放疗加手术组颈部复发率２１．８％，单纯手术组３０．６％，但无统计学差异（Ｐ＝０．９）。两组颈部复发率与Ｔ分期和Ｎ分期（除Ｎ２外），大小无明显关系。因此术前４０Ｇｙ对颈部复发无显著意义，建议对所有患者做临床阳性侧颈清扫术，术前放     

Voice prostheses: long-term follow-up retrospective study (three- to sixteen-year follow-up of 22 patients)

BACKGROUND: Thirty-five patients using tracheoesophageal voice with a 3- to 16-year follow-up were investigated. We analyzed functional voice outcome, voice prosthesis (VP) lifespan, and VP-related complications. METHODS: Between 1987 and 2001, 81 patients underwent total laryngectomy (TL). The 35 currently surviving patients (31 men, 4 women) were studied for VP lifespan and VP-related complications encountered up to 16 years after surgery. For voice rehabilitation, the 35 laryngectomies of our study required 178 prostheses. Short- and long-term voice results of 22 patients were compared by objective voice examination: maximum phonation time (MPT), intensity range (Int.), fundamental frequency (F0), frequency analysis (FA), and voice handicap index (VHI). RESULTS: Long-term results are: F0=131 (range: 30-250); Int=22.5 dB (range: 17-35 dB); MPT=4 sec (range: 2-12 sec); FA=3 (range: 1-4); VHI=38/120 (range: 8-73). Short- vs long-term outcome comparison shows the following values: F0: 93 vs 135 Hz; Int: 25 vs 24 dB; FA: 1 vs 3; and MPT: 21 vs 4 sec. The mean VP lifespan is 165.5 days for Provox (range: 2 days-30 months); 143.5 days for Blom-Singer (range: 10 days-24 months); and 195 days for VoiceMaster (6-7 months). Postoperative complications involved 12 cases of periprosthetic leakage (6.74%); 31 granulomas (17.4%); 3 partial stenoses of the tracheoesophageal tract (1.6%); and 1 temporarily removed VP (0.5%). CONCLUSIONS: Complications are generally resolved during standard office-setting examination. The commercially available VPs are complementary, used according to the diverse characteristics of each VP.     

Is Ki67 a marker for the transformation of laryngeal dysplasia to carcinoma?

CONCLUSION: Ki67 is not a reliable marker of malignant transformation in laryngeal dysplasia. OBJECTIVES: No reliable means of predicting which cases of laryngeal dysplasia will undergo malignant transformation currently exists. Our aim was to evaluate Ki67, a marker of cell proliferation, as a potential marker for the transformation of laryngeal dysplasia to squamous cell carcinoma. PATIENTS AND METHODS: Eighty consecutive cases of previously untreated patients with a histological diagnosis of laryngeal dysplasia from 1987 to 1993 were identified from the pathological archives. Standard immunohistochemical techniques were used to identify Ki67-positive cells and activity was scored on a scale of 0-4 using defined criteria. RESULTS: Of the 80 cases there were 24 females and 56 males with a mean age of 56 years (range 29-80 years). Twenty cases subsequently transformed to a squamous cell carcinoma. For each Ki67 score (0-4), the rate of malignant transformation was: 0, 1 of 6 patients (17%); 1, 7 of 33 patients (21%); 2, 5 of 22 patients (23%); 3, 4 of 13 patients (31%); and 4, 3 of 6 patients (50%). A higher Ki67 score seemed to correlate with a higher likelihood of malignant transformation but this did not reach statistical significance (p=0.17, Pearson chi(2) test). Considering a score of 3 or 4 as positive for predicting malignant transformation produced a test of relatively high specificity (80%) but poor sensitivity (35%).     

Experience in the treatment of 98 carcinomas of the nasopharynx. Long-term follow-up and analysis of prognostic factors

This was a retrospective study of 98 patients (pts.) with histologically confirmed nasopharyngeal carcinoma. The clinico-demographic characteristics were: median age of 53 years (11-83); 74 males and 24 females (ratio 3:1); histology subtype OMS 2-3 in 89 pts. (90.8%); cranial nerve deficits in 11 pts. (11.2%); 50 (51%) were stage T3T4; 68 pts. (69.4%) N2N3 and 77 pts. (78.6%) stage IV. The therapeutic modalities were: radical radiotherapy (RT) alone in 42 pts., chemotherapy (CT) alone in 4 pts., RT + adjuvant CT in 10 pts. and neoadjuvant CT + RT in 42 pts. RT was delivered in wide fields, doses between 50-75 Gy with conventional fractionation. CT consisted in cisplatinum-based schedules (PF in 34 pts., BEC in 9 and others in 13 pts.). Analyzed by treatment, more males and stages N2N3 and IV were accrued in neoCT + RT arm (p < or = 0.05). For the entire population, the overall complete response was achieved in 65 pts. (66.3%); in 27/35 pts. (77.1%) of the RT group and 30/51 pts. (58.8%) of CT + RT group (p 0.07) of pts. with III-IV stages. With a median follow-up of 74.5 months, 32 pts. (32.65%) are alive and free of disease. The projected OS for all pts. was 40 months (m), 51.4% at 3 years (y) and 45.5% at 5 y with a disease free survival of 37 m (0-236). No differences between treatment arms were found (p 0.4). In univariant analysis for OS in stage III-IV pts., age > 50 y, histology OMS1, cranial nerve deficits, stage T3T4 and N2N3, were considered adverse prognostic factors (p < or = 0.05). In multivariant analysis, only age > 50 y and stages T3-T4, N2-N3 were significant (p < or = 0.05). In conclusion, we demonstrated good long term survival without any differences among treatment modalities in pts. with advanced nasopharyngeal carcinomas. New therapeutic approaches are warranted in order to improve the outcome of this patients.     

腺样体肥大儿童睡眠结构的分析

目的:研究腺样体肥大(AH)对儿童睡眠结构的影响。方法:通过多导睡眠图分析了47例AH患儿(AH组)睡眠结构,并与11例同龄儿童(正常组)睡眠结构正常值进行比较。结果:与同龄儿童睡眠结构正常值相比AH组的睡眠结构存在如下异常:①S1期所占比例增加:AH组15.4±9.3,正常组7.9±6.8(P<0.01);S2期所占比例减少:AH组41.8±9.7,正常组46.7±7.6(P<0.01);Delta期所占比例增加:AH组26.2±10.6,正常组23.3±8.7(P>0.05);REM期所占比例减少:AH组7.7±4.9,正常组27.3±5.6(P<0.01)。②总醒觉指数:AH组32.8±26.03,高于正常儿童18.3±12.2(P<0.05)。③REM潜伏期:AH组(157.1±71.4)min,比正常儿童(84.5±36.5)min延长约2倍(P<0.01),AH组睡眠效率(89.6±8.4)%,略低于正常值的(90.2±8.7)%(P>0.05)。结论:AH主要引起睡眠结构紊乱、醒觉的指数增加、REM睡眠剥夺睡眠片段,但深睡眠时间增加。     

Advantages and disadvantages reported by some of the better cochlear-implant patients

An open-ended questionnaire was administered to 53 of some of the better patients using five different kinds of cochlear implants. The subjects listed the advantages and disadvantages of their cochlear implant. Patients were asked about the time from implantation until maximum benefit and effect of the cochlear implant on tinnitus. Advantages were reported in (1) speech perception when speechreading can be used (85%); (2) environmental sound perception (75%); (3) psychologic effects (70%); (4) speech perception when speechreading cannot be used (64%); (5) lifestyle and social effects (42%); and (6) speech production (32%). Disadvantages were reported in (1) use of equipment (79%); (2) environmental-sound perception (47%); (3) speech perception when speechreading may be used (17%); (4) psychologic effects (11%); (5) speech perception when speechreading is not used (9%); (6) lifestyle and social effects (3.8%); and (7) speech production (1.9%). Ninety-one percent of the subjects indicated that they achieved maximum benefit in the first 7 months of cochlear-implant use. Eighty-one percent of the subjects with tinnitus indicated that the cochlear implant had a positive effect on their tinnitus. In 17 percent of the cases the cochlear implant had no effect on their tinnitus and in 2 percent of the cases it made the tinnitus worse.     

广西地区222例感音神经性聋患者常见耳聋基因筛查结果分析

目的：分析广西地区222例感音神经性聋患者常见耳聋基因的突变特点,为临床防聋及治聋提供参考。方法采用晶芯.十五项遗传性聋基因检测试剂盒（微阵列芯片法）对广西地区222例感音神经性聋患者进行常见的4种耳聋基因的15个突变位点检测：GJB2（35del G、235delC、176del16、299del AT ）、SLC26A4（2168A＞G、IVS7－2A＞G、1174A＞T、1226G＞A、1229C＞T、1975G＞C、2027T＞A、IVS15＋5 G＞A）、线粒体DNA12SrRNA （1494C＞T、1555A＞G）和GJB3（538C＞T）,对未确诊的阳性结果进行基因全序列分析。结果222例患者中23例（10．36％,23／222）被检测出耳聋基因突变,其中,GJB2235delC 纯合突变3例（1．35％）,杂合突变8例（3．60％）,GJB235delG杂合突变2例（0．90％）,GJB2235delC／109A＞G 复合杂合突变2例（0．90％）;SLC26A4 IVS7－2 A＞G杂合突变2例（0．90％）,SLC26A41229C＞T纯合突变2例（0．90％）,IVS7－2A＞G／IVS11＋47T＞C／1548insC复合杂合突变2例（0．90％）;GJB3538C＞T 杂合突变1例（0．45％）;线粒体DNA12SrRNA 1555A＞G异质突变1例（0．45％）;1例（0．45％）同时携带GJB2235delC杂合突变及SLC26A41226G＞A杂合突变。结论本组广西地区感音神经性聋患者耳聋基因突变率低于全国水平,主要以 GJB2基因突变为主,其次是SLC26 A4基因突变。     

Indications of cone beam CT in head and neck imaging

Conclusion: Cone Beam Computed Tomography (CBCT) can be widely used in imaging of bony structures of the anterior and lateral skull base. Significant differences of applied dosages result from the different protocols of the various indications. Objectives: CBCT is increasingly being used in head and neck imaging. Until now, no precise knowledge about its dedicated usage existed. Methods: All CBCT of 2012 and 2013 were analysed with regard to the technical parameters, the performance, and the indication for imaging. Results: In total, 1862 patients were examined in 2012 and 2013. The top eight indications of the anterior skull were (1) chronic rhinosinusitis with disturbed nasal breathing (30.3%); (2) chronic rhinosinusitis (17.6%); (3) midfacial traumatology (13.7%); (4) disturbed nasal breathing (12.8%); (5) acute rhinosinusitis (7.9%); (6) polyposis nasi (6.3%); (7) search for focus (3.9%); and (8) persistent rhinorrhea (1.2%). For the lateral skull base, the top eight were (1) control after cochlear implantation (28.4%); (2) cholesteatoma (19.7%); (3) visualization of ear anatomy (8.7%); (4) chronic otitis media mesotympanalis (6.3%); (5) conductive hearing loss (5.1%); (6) suspected mastoiditis (4.8%); (7) pathology of external auditory canal (4.8%); and (8) otosclerosis (3.3%). Applied dosage for the anterior skull base was significantly lower than for the lateral skull base (2.90 mGy vs 5.92 mGy, p < 0.05); 2.4% and 3.6% of patients’ images, respectively, had to be repeated.     

The causes and complications of late diagnosis of foreign body aspiration in children. Report of 210 cases

Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.     

Anatomic measurements for the endoscopic modified Lothrop procedure

BACKGROUND: The aim of this study was to introduce preoperative radiographic frontal recess and sinus anatomic measurements to assist in the selection of patients considered for the modified Lothrop procedure. METHODS: Data were collected from sagittally reconstructed computed tomography (CT) scans of seven cadaver heads. Four anatomic parameters for measurement were defined as follows: (1) thickness of the nasal beak (desirable < 10 mm); (2) midsagittal distance from nasal beak to skull base (adding 1 and 2 provides the anterior-posterior (AP) space at the cephalad margin of the frontal recess; desirable, > or = 15 mm); (3) accessible dimension (in a parasagittal plane through the frontal ostium; the distance between two lines drawn parallel to the plane of the anterior skull base and perpendicular to the line of the insertion of the nasal endoscope during surgery; the posterior line is drawn at the skull base and the anterior line is drawn at the posterior margin of the nasal beak; the distance between the lines indicates the space available for instrumentation; desirable, > 5 mm); (4) AP dimension of each frontal sinus. RESULTS: The average and the range of each parameter measured were as follows: (1) nasal beak thickness = 8.0 mm (5.0-10.4 mm); (2) nasal beak-skull base = 7.9 mm (2.5-14.1 mm); (3) accessible dimension, 6.1 mm (0.9-9.6 mm); (4) AP diameter of the frontal sinus, 9.7 mm (5.2-14.1 mm). Four specimens were considered candidates for modified Lothrop and three were not. CONCLUSION: Preoperative radiographic frontal recess and sinus anatomic measurements may assist in the selection of patients considered for the endoscopic modified Lothrop procedure.     

微波消融治疗不同初始体积甲状腺实性结节的疗效研究

目的 探讨微波消融治疗不同初始体积甲状腺实性结节的有效性及安全性。方法 回顾性分析超声引导下微波消融治疗的68例患者82个甲状腺良性结节,消融术后第1、3、6、12个月随访复查,计算体积缩小率(VRR)及并发症情况。将结节按照初始体积分为>12 cm³、9～12 cm³、4～8 cm³及<4 cm³四组,比较四组结节消融治疗有效性及安全性。结果 甲状腺实性结节微波消融术后体积较术前呈进行性缩小,术后1、3、6、12个月VRR分别为(37.93±19.48)%、(61.69±14.76)%、(74.27±12.93)%、(84.92±10.35)%,差异有统计学意义(P<0.05)。体积>12 cm³组结节与9～12 cm³、4～8 cm³及<4 cm³组比较,消融时间长、消融能量大,术中疼痛评分高,差异有统计学意义(P<0.05)。术后1个月体积>12 cm^3<...