咽旁间隙肿瘤的诊断及手术入路

目的：探讨咽旁间隙肿瘤的诊断与手术人路。方法：对1997年-2007年32例咽旁间隙肿瘤的临床资料进行回顾性分析。结果：32例中良、恶性肿瘤分别占84．38％、15．62％，其中以神经源性及涎腺来源最为常见。术前CT、MRI明确肿瘤的大小、位置、侵犯范围以及与周围组织关系。手术采用口内径路1例，颈侧径路27例，颈外及下颌骨外侧裂开3例，颈腮腺径路1例。结论：颈部CT、MRI是诊断、鉴别诊断的良好手段，颈侧径路则是最常用且安全有效的手术径路方式。     

咽旁间隙肿瘤治疗相关问题探讨

目的 探讨咽旁间隙肿瘤治疗方案选择.方法 回顾我科1970年1月-2000年1月收治165例咽旁间隙肿瘤的治疗资料,108例单纯手术,44例术后放疗,13例术后放、化疗.颈侧入路111例,下颌骨裂开入路15例,腮腺入路31例,口腔软腭人路8例,3例术后气管切开.结果 165例患者中108例为良性肿瘤,57例为恶性肿瘤.良性肿瘤术后复发9例,恶性肿瘤术后复发18例,远处转移5例.57例恶性肿瘤随访5年以上,24例存活,5例失随,5年生存率为51.2﹪.手术并发症神经麻痹29例,伤口积液感染8例,术后出血2例.结论 手术是咽旁间隙肿瘤治疗的主要方法.手术入路应根据肿瘤的大小、位置和重要血管之间的关系及肿瘤的良恶性来选择,颈侧入路是咽旁间隙肿瘤手术的主要入路,咽旁间隙恶性肿瘤应采用综合治疗.     

下颌升支截断切除咽旁间隙巨大肿瘤

目的:探讨咽旁间隙巨大肿瘤的最佳手术入路。方法:经颈侧入路,切除腮腺浅叶同时切断下颌升支,切除咽旁间隙巨大肿瘤12例,肿瘤切除后复位固定下颌升支。术后下颌骨X-线摄片。结果:12例均完整切除肿瘤,1例术后出现Horner综合征,暂时性面瘫11例,无永久性面瘫和其他并发症。术后咬合关系正常,下颌骨对位良好。结论:经颈侧下颌升支截断切除巨大咽旁间隙肿瘤,视野良好、易于暴露,手术并发症少。     

颈部神经鞘瘤32例临床分析

目的　探讨颈部神经鞘瘤的诊断和选择最佳手术入路。方法　对 1 987年 8月～1 997年 9月收治 32例患者进行临床回顾性分析。结果　神经鞘瘤的良性居多占 96.8% ,应用CT及 MRI对临床诊断及手术径路的选择有指导作用。采用颈外切开径路者占 84.3% ,所有病例随访 2年～ 1 2年。结论　应根据肿瘤部位、侵犯范围及病理类型选择式术。我们体会对多数颈神经鞘瘤采用颈外切开入路可彻底切除肿瘤又可防止损伤神经血管等重要结构 ,是较佳的手术入路。     

咽旁肿瘤切除术(附29例)

目的探讨如何根据术前诊断选择最佳的手术进路,提高疗效,减少并发症和后遗症。方法本组29例,男性16例,女性13例,年龄18~57岁,中位年龄45。均采用手术治疗及术后化疗或放疗。手术进路:口腔入路、颌颈入路、颈侧高位切开下颌骨外旋入路、颌咽入路、上颌骨掀翻入路、上颌骨加咽旁肿瘤切除。结果病理类型:良性21例,恶性8例,随访5年,良性肿瘤均未见复发,骨肉瘤1例术后2个月复发,上颌窦癌1例术后2年复发,口咽侧壁粘液表皮样癌1例术后6年复发,再次术后2年复发,颌下腺腺样囊性癌术后4年复发并肺转移,未继续治疗,恶性淋巴瘤2例化疗后5年无复发。手术均未出现并发症,术后有暂时性的神经功能障碍,均在半年内恢复。结论口腔入路仅适用于紧邻咽粘膜下小肿瘤、颌颈入路适用于咽旁混合瘤、神经鞘瘤和颈动脉体瘤、颈侧高位切开下颌骨外旋入路适用于腮腺深叶肿瘤及高位神经鞘瘤、颌咽入路适用于恶性肿瘤连同下颌升枝一并切除、上颌骨掀翻入路及上颌骨适用于晚期的上颌窦癌及颅底肿瘤侵入咽旁。     

颈部神经鞘瘤32例临床分析

目的：探讨颈部神经鞘瘤的诊断和选择最佳手术入路。方法：对1987年8月－1997年9月心治32例患者进行临床回顾性分析。结果：神经鞘瘤的良性居多占96．85，应用CT及MR泽临床诊断及手术径路的选择的指标作用，采用颈外切开径路者占84％，所有病例随访2年－12年。结论：应根据肿瘤部位，侵犯范围及病理类型选择式术，我们体会对多数颈神经鞘瘤采用颈外切开入路可彻底切除肿瘤又可防止损伤神经血管等重要结构，是较佳的手术入路。     

甲状腺癌再手术中的应用方法和价值

摘 要：［目的］ 分析喉返神经监测在甲状腺癌再手术中的应用方法和价值。［方法］ 回顾性分析128例经治的甲状腺癌再次手术患者资料,其中39例术中使用喉返神经监测显露寻找喉返神经的为观察组,89例未使用喉返神经监测的为对照组,观察组患者与对照组患者的基线数据建立倾向评分匹配模型,对两组数据中患者年龄、性别、术前是否有声带麻痹、甲状腺癌病理类型、是否包膜外侵犯、是否有中央区淋巴结转移、是否行颈侧淋巴结清扫术等协变量进行1∶1配对,分析两组的手术方法,比较两组的喉返神经显露成功率、新发喉返神经损伤率、术后气管切开率、长期气管切开率。［结果］ 观察组喉返神经显露成功率高于对照组（38例 vs 28例）,而新发声带麻痹发生率低于对照组（P=0.027）,两组间气管切开率和长期气管切开率差异无统计学差异。［结论］ 甲状腺癌再手术时使用喉返神经监测结合精细操作手术技巧有助于显露喉返神经,提高了手术成功率,减少了手术并发症,值得推广应用。     

颈部神经鞘瘤19例临床分析

从1986～1997年10月,我院共手术治疗并病理确诊颈部神经鞘瘤19例,现报告如下:1 临床资料1.1 一般资料本组中,男7例,女12例;年龄20～67岁,平均41岁.均经病理证实为神经鞘瘤.肿瘤发生部位是颈侧上部、咽旁间隙和颌下区.肿块常前后移动而上下活动受限.发生于迷走神经7例,颈丛神经5例,颈交感神经和舌下神经各2例,3例来源不明.其首发症状一般为颈部不明原因无痛性包块,咽部异物感等.所以就诊时肿块已为核桃大或鸡蛋大甚至于更大,本组病例中最大者为9cm×7cm×6cm.9例患者行穿刺活检,有6例阳性者.1.2 手术治疗1.2.1 颈侧上部 本组肿瘤向外生长者有8例,主     

颈椎旁神经源性肿瘤手术入路的探讨

背景与目的：颈椎旁神经源性肿瘤多起源于脊神经背根，与颈动脉三角区的颈总动脉，颈内静脉，迷走神经及椎动脉等重要血管神经相互毗邻。其特殊的解剖位置使得手术难度增加，手术进路的选择也就显得尤为重要。本文旨存探讨颈侧手术入路对颈椎旁神经源性肿瘤切除的可行性及其治疗效果。方法：回顾性分析经颈侧入路于术治疗的从1971～2006年我院29例颈椎旁神经源性肿瘤患者的临床资料。结果：本组病例中，良性肿瘤20例，占70．37％（19／27），恶性肿瘤9例，占29．63％（8／27）。本组29例病例中，经颈侧进路切除肿瘤28例，经颈项部切门进路枕部下横切口1例。27例肿瘤全切除的病例中，经颈侧切口进路肿瘤全切除26例，其中胸锁乳突肌前缘切口12例，胸锁乳突肌后缘切口7例，颈胸切口1例，下颌角下做横切口4例，锁上弧形切口2例；经颈项部进路切除肿瘤1例。经颈侧进路肿瘤全切除26例．大部分切除2例，肿瘤全切除率为92．85％（26／28）；在肿瘤全切除病例中，有3例局部复发，1例局部复发伴双肺转移。肿瘤全切除病例的局部复发率为14．81％（4／27）。结论：颈椎旁肿瘤经颈侧切口进路手术具有术野暴露清楚，肿瘤全切除率较高等优点，应为颈椎旁肿瘤切除手术切口进路的首选。     

经胸联合后正中径路切除后纵隔哑铃状神经源性肿瘤

目的探讨后纵隔哑铃状神经源性肿瘤的切除方法.方法1994年6月～2003年5月经胸联合后正中径路切除后纵隔哑铃状神经源性肿瘤4例,其中神经纤维瘤3例,神经鞘瘤1例.全部病人均选择经胸联合后正中径路切除肿瘤.结果4例肿瘤均全部切除,症状均有不同程度改善,术后病人均能正常生活,未见肿瘤复发.结论经胸联合后正中径路一期切除后纵隔哑铃状神经源性肿瘤是安全可靠的手术方式.     

Surgical Management of Parapharyngeal Space Tumors: Our Experience

The purpose of this study is to evaluate parapharyngeal space (PPS) tumors with regards to clinico-pathological features and pre-operative assessment and also to analyze the benefits of transcervical approach in the management of PPS tumors. We performed retrospective analysis of patients who had undergone transcervical resection of PPS tumors from May 2006 to May 2009 at KLES Dr. Prabhakar Kore Hospital and M. R. C, Belgaum. Patients were diagnosed on the basis of clinical examination, FNAC and magnetic resonance imaging. All patients were observed with an annual follow-up of at least 3 years by physical examination and ultrasonographic evaluation. The total number of patients were four; with three males and one female patient. Their age varied from 20 to 55 years with a mean age of 36 years. There were two cases of neurilemomas, one case of carotid body tumor and one case of pleomorphic adenoma. All four patients underwent surgical excision of tumor by transcervical approach. There were no major post-operative complications. All four patients are alive with no recurrence in the 3 year follow-up period. Transcervical approach is versatile, flexible and provides good access to the narrow PPS. This approach also provides good vascular control and reduced risk of post-op complications. We recommend transcervical approach even for large sized pre-styloid and post-styloid compartment benign tumors which are free from deep lobe of parotid.     

Surgical Management of Parapharyngeal Space Tumours in a Single Tertiary Care Center

Because of the inaccessibility and overcrowding of the vital neurovascular structures, management of the parapharyngeal space (PPS) tumour is always a challenge to the surgeons. Here we have discussed the clinical findings and management of the PPS tumours with special concern to the surgical approaches. It is a retrospective study containing 14 patients of PPS tumour from June 2015 to January 2018 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. 14 consecutive patients with PPS tumours were included in the study. The retrospective clinical data, diagnostic procedures, surgical approaches and the complications were analyzed after 12 months of surgery. Of 14 patients included in the study, 10 patients were males and 4 were females. Prestyloid and poststyloid spaces were involved in 28.57% and 71.42% cases respectively. Transcervical excision of the tumours were performed in 10 patients, 2 patients had undergone transcervical-transoral approach. Transcervical transmandibular and transcervical transparotid excision of tumours were performed in one patient each. Facial nerve injury was detected in 3(21.42%) patients. Injury to the internal carotid artery and wound infection were detected in one patient each. Radiological imaging, especially the MRI helps by narrowing the spectrum of the differential diagnosis distinguishing the benign from malignant lesions, especially in cases where FNAC is contraindicated. Although the transcervical approach is commonly practiced, the combined surgical approach can be effectively applied specially for extensive PPS tumours associated with satisfactory clinical outcomes.     

True Parapharyngeal Space Tumors: Case Series from a Teaching Oncology Center

The Parapharyngeal Space (PPS) tumors are rare tumors accounting for 0.5% of the tumors in head and neck region. A retrospective study conducted at Department of Surgical oncology, Vydehi institute of Medical Sciences & Research center, Bengaluru, between 2010 and 2015 identified nine cases treated for PPS tumors. Patients are diagnosed on the basis of clinical examination fine needle aspiration cytology and imaging and considered for excision by one of the varied surgical approaches {transoral(1), transcervical(4), transparotid(0), transcervical-transparotid(1), transmandibular(3) or intratemporal(0) approach}. The choice of approach is defined by the size of the tumor, suspicion of malignancy and the position of the tumor with regard to the superior extent and proximity to the skull base as well as its relation with neurovascular bundle.     

原发性肺肉瘤19例临床分析

背景与目的原发性肺肉瘤(primary pulmonary sarcoma,PPS)是一种极少见的肺部原发性恶性肿瘤,起源于肺间叶组织,极易误诊,本研究旨在探讨原发性肺肉瘤的临床特点,以期为临床早期诊断及治疗提供更全面的参考依据。方法分析总结四川大学华西医院1996年-2011年经病理证实的19例PPS患者的临床资料并进行文献复习。结果 19例患者中男性12例,41岁-68岁患者占57.9%,平均年龄41岁。主要症状为咳嗽、咳痰以及咯血;影像学表现中8例见"毛刺征",5例见"分叶征",主要病理学类型为滑膜肉瘤、平滑肌肉瘤以及恶性纤维组织细胞瘤。手术治疗17例,化疗1例。随访17例,随访率89.5%,中位生存时间为18个月。结论原发性肺肉瘤临床及影像学均无特征性表现,易被误诊,死亡率高。     

Improved Prognostication for the Updated AJCC Breast Cancer Pathological Prognostic Staging Varied in Higher-Stage Groups

BackgroundIn addition to TNM-based anatomical staging (AS), a novel pathological prognostic staging (PPS) has been proposed by the American Joint Committee on Cancer (AJCC). PPS demonstrated better prognostication, but its superiority in breast cancer subtypes and related to staging discrepancies between AS and PPS are not clear.MethodsA cohort of 1729 patients with breast cancer was staged into AS and PPS according to the latest AJCC staging. Patient characteristic and restaging outcomes were compared.ResultsCompared with AS, 799 and 135 cases were upstaged and downstaged respectively in PPS, mostly involved stage I cases. For the overall cohort, PPS demonstrated superior prognostic power over AS in both disease-free survival (DFS) and breast cancer–specific survival. However, such superiority was found mainly in estrogen receptor (ER)/progesterone receptor (PR)+ but not ER−PR− cancers. Comparing the restaged cases within the same PPS, PPS 1A cases showed similar survival irrespective of the original AS. Interestingly, in other PPS groups (PPS 1B and higher), there was a difference in outcome among patients with same PPS but different AS. Within PPS 1B patients, downstaged cases from higher AS showed worse DFS (3A>1B vs. 2A>1B: χ² = 4.732, P = .030).ConclusionsPPS may provide a more accurate prognostication, mostly among ER/PR+ cancers and with PPS 1A patients. Patients restaged to higher PPS stages showed significant differential survival even within the same PPS. Also, only limited improvement was observed for ER–PR– cancers. Caution needs to be exercised in using PPS for patient prognostication, as in some cases the outcome can be variable with the same PPS.     

鼻咽癌咽旁侵犯程度划分方法对预后的影响

目的:探讨咽旁侵犯对鼻咽癌预后的影响,并对多种咽旁侵犯程度的划分方法进行比较,以寻求能较好反映预后的划分。方法:2000-01-2000-07经病理确诊的初治M0期鼻咽癌患者176例纳入研究。根据4种咽旁划分方法(闵氏、Sham氏、肖氏和Heng氏建议的划分)对咽旁间隙的侵犯程度划分,前瞻性研究其对鼻咽癌预后的影响。结果:鼻咽癌咽旁侵犯的发生率为81.8%(144/176)。有咽旁侵犯和无咽旁侵犯的5年总生存率分别是68.1%和90.2%(P=0.010),5年无瘤生存率分别是66.1%和87.2%(P=0.013),5年无远处转移生存率分别是76.7%和93.6%(P=0.032),5年无局部复发生存率分别是84.9%和93.1%,P=0.220。Cox模型多因素分析显示,咽旁是否侵犯并不是独立预后因素,然而根据程度分级后的咽旁侵犯是影响预后的独立因素。4种咽旁划分同时纳入Cox多因素分析显示,闵氏划分的咽旁侵犯是影响总生存的独立预后因素(HR:2.231;P=0.001),Sham氏划分的咽旁侵犯是影响无瘤生存(HR:1.487;P=0.010)和远处转移(HR:1.246;P=0.009)的独立预后因素...     

Assessment of progression-free survival as a surrogate end-point for overall survival in patients with metastatic renal cell carcinoma

BackgroundTo determine suitability of progression-free survival (PFS) as a surrogate end-point for overall survival (OS), we evaluated the relationship between PFS and OS in 750 treatment-naïve metastatic renal cell carcinoma (mRCC) patients who received sunitinib or interferon-alpha (IFN-α) in a phase III study.MethodsThe relationship between PFS and post-progression survival (PPS; the difference between PFS and OS) was studied, which correctly removes inherent dependencies between PFS and OS, to properly estimate whether and to what extent PFS can serve as a surrogate for OS. A Weibull parametric model to failure time data was fit to determine whether longer PFS was significantly and meaningfully predictive of longer PPS. In a sensitivity analysis by Kaplan–Meier non-parametric method, PPS curves for three approximately equal numbered groups of patients categorised by PFS were compared by log-rank test.ResultsIn the Weibull parametric model, longer PFS was significantly predictive of longer PPS (P < 0.001). The model also allowed prediction of estimated median PPS duration from actual PFS times. In the Kaplan–Meier (non-parametric) analysis, incrementally longer PFS was also associated with longer PPS, and the PPS curves for the three PFS groups were significantly different (P < 0.0001).ConclusionsA positive relationship was found between PFS and PPS duration in individual mRCC patients randomised to first-line treatment with sunitinib or IFN-α. These results indicate that PFS can act as a surrogate end-point for OS in the first-line mRCC setting and provide clinical researchers with a potentially useful approach to estimate median PPS based on PFS.     

Coblation assisted excision of lingual thyroid

Lingual thyroid (LT) tissue is the most frequent ectopic location of the thyroid gland. We report 5 cases of symptomatic LT and discuss the new surgical approach. Transoral approach and coblation assisted excision of LT was performed. Postoperative follow-up for all patients was like as tonsillectomy management without tracheotomy. It’s seem that this approach is much better than other such as tongue-splitting, transcervical transhyoid, pharyngotomy, with an infrahyoid approach, combined cervical and intraoral approach, Mandibular midline osteotomy.     

Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone

PURPOSE: The objective of this study was to describe the treatment outcomes and treatment-related complications of nasopharyngeal carcinoma (NPC) patients treated with radiotherapy alone. METHODS AND MATERIALS: Retrospective analysis was performed on 849 consecutive NPC patients treated between 1983 and 1998 in our institution. Potentially significant patient-related and treatment-related variables were analyzed. Radiation-related complications were recorded. RESULTS: The 5-year overall and disease-free survival rates of these patients were 59% and 52%, respectively. Advanced parapharyngeal space (PPS) invasion showed stronger prognostic value than PPS invasion. Multiple neck lymph node (LN) involvement was demonstrated to be one of the most powerful independent prognostic factors among all LN-related parameters. External beam radiation dose more than 72 Gy was associated with significantly higher incidence of hearing impairment, trismus, and temporal lobe necrosis. CONCLUSIONS: We recommend that the extent of PPS should be clarified and stratified. Multiple neck LN involvement could be integrated into the N-classification in further revisions of the American Joint Committee on Cancer stage. Boost irradiation is not suggested for node-negative necks. For node-positive necks, boost irradiation is indicated and a longer interval between initial and boost irradiation would reduce the incidence of neck fibrosis without compromising the neck control rate.     

Intraoral approach for the treatment of submandibular salivary gland mixed tumors

Pleomorphic adenoma represents a most common benign neoplasm of major salivary glands. Most occurrences of this benign tumor in the submandibular gland have been treated surgically without difficulty via transcervical approach. However, a few clinical problems in the transcervical approach have been mentioned, such as nerve injury or aesthetic scaring. In this study, we introduced the intraoral approach for the removal of the submandibular mixed tumor. In total, 12 cases of pleomorphic adenoma of the submandibular gland were treated via intraoral approach. The surgical technique and morbidity associated with this approach were reviewed. During surgery the tumor and submandibular gland are easily dissected from surrounding tissue and removed through intraoral incision. Early postoperative morbidity developed, such as a temporary paresis of lingual nerve and a temporary limitation of tongue movement, but recovered within a short-term period. No late complaints appeared, such as neurological discomforts. All patients were followed up for the recurrence of the tumor from 20 months to 10 years. One patient showed a tumor recurrence at the early stage of this approach. We propose that the benign mixed tumor of the submandibular gland could be removed easily via intraoral route without an external scar or nerve injury.