鼻腔及副鼻窦内翻性乳头状瘤的CT诊断

目的：探讨CT检查对鼻腔及副鼻窦内翻乳头状瘤的诊断价值。方法：回顾性分析20例经手术病理检验证实的鼻腔及副鼻窦内翻乳头状瘤的CT表现。结果：病变以中鼻道为中心，呈不规则软组织肿块，肿瘤多位于单侧鼻腔，可同时侵犯同侧上颌窦或累及筛窦。骨质改变以骨质破坏多见。结论：CT能较好显示鼻腔及副鼻窦内翻乳头状瘤的病变部位、范围，及术后有元复发，为临床提供可靠的影像学依据。     

鼻腔及副鼻窦内翻性乳头状瘤的CT诊断

目的:探讨CT检查对鼻腔及副鼻窦内翻乳头状瘤的诊断价值.方法:回顾性分析20例经手术病理检验证实的鼻腔及副鼻窦内翻乳头状瘤的CT表现.结果:病变以中鼻道为中心,呈不规则软组织肿块,肿瘤多位于单侧鼻腔,可同时侵犯同侧上颌窦或累及筛窦.骨质改变以骨质破坏多见.结论:CT能较好显示鼻腔及副鼻窦内翻乳头状瘤的病变部位、范围,及术后有无复发,为临床提供可靠的影像学依据.     

鼻腔及副鼻窦肿物161例CT分析

探讨鼻腔及副鼻窦肿物的CT检查价值及良恶性鉴别诊断。 16 1例鼻腔、副鼻窦肿物 ,术后病理证实良性 12 6例 ,恶性 2 2例 ,炎症 13例 ,进行CT分析统计学处理。累及部位多发、突入临近结构、形态是否均匀、有无骨质破坏和周围脂肪层受侵良恶性之间差异有显著性。CT可作为首选检查方法 ,冠扫优于轴扫 ;病变累及部位、形态、密度、周围骨质及脂肪层变化是良恶性鉴别诊断要点     

鼻腔及副鼻窦肿物161例CT分析

探讨鼻腔及副鼻窦肿物的CT检查价值及良恶性鉴别诊断。161例鼻腔、副鼻窦肿物，术后病理证实良性126例，恶生22例，炎症13例，进行CT分析统计学处理。累及部位多发、突入临近结构、形态是否均匀、有无骨质破坏和周围脂肪层受侵良恶性之间差异有显著性。CT可作为首选检查方法，冠扫优于轴扫；病变累及部位、形态、密度、周围骨质及脂肪层变化是良恶性鉴别诊断要点。     

鼻腔,副鼻窦病变的CT诊断分析

本文作者分析６２例鼻腔、副鼻窦疾病的ＣＴ表现，其中非肿瘤性病变１６例、良性肿瘤１０例、恶性肿瘤３６例。讨论了各类病变的ＣＴ表现和病理的关系。认为骨壁、窦腔改变的ＣＴ征象、考参软组织表现对炎性病变、囊肿、良性肿瘤、恶性肿瘤的鉴别诊断具有较大意义。ＣＴ扫描可清晰显示病变的部位与范围，对提高术前诊断、治疗方法的制定及追踪术后有无残留或复发帮助较大。     

鼻腔及副鼻窦小细胞肿瘤的电子显微镜鉴别诊断

鼻腔及副鼻窦小细胞肿瘤约占该类疾病的4％。光学显微镜下皆以低分化或未分化肿瘤做出诊断,本文通过对鼻腔及副鼻窦小细胞肿瘤在电子显微镜下特征的研究,总结出常见的几种肿瘤类型,从超微结构对该类疾病做出准确诊断,为该病的进一步治疗提供有力的依据。     

螺旋ＣＴ在鼻腔鼻窦骨化纤维瘤诊断中的应用

目的：探讨螺旋ＣＴ诊断鼻腔鼻窦骨化纤维瘤的价值。方法：回顾性分析２０００年７月～２００８年５月我院手术治疗病理确诊的鼻腔鼻窦骨化纤维瘤患者２４例的临床资料及ＣＴ特征。结果：侵犯单个鼻窦肿瘤１２例,其中筛窦８例,上颌窦４例,伴有鼻腔侵犯６例。肿瘤同时侵犯多个鼻窦和鼻腔１２例,其中上颌窦和筛窦８例,筛窦和额窦４例,均有鼻腔侵犯。鼻腔鼻窦骨化纤维瘤的ＣＴ表现为鼻腔鼻窦内单发类圆形或不规则性高密度肿块,部分区域可见低密度影,其周边出现完整骨性包壳,呈膨胀性生长,周边组织受压变形但分界清楚。结论：螺旋ＣＴ扫描是诊断鼻腔鼻窦骨化纤维瘤最常用和有价值的影像检查手段。     

胰腺囊性良恶性病变的CT诊断

目的分析胰腺囊性病变的CT表现, 提高胰腺病变的CT诊断准确率。方法 回顾分析经手术、病理证实的22例胰腺囊性病变的CT表现。螺旋CT机为TOSHIBA Aquilion 16多层螺旋CT机, 采用平扫和双期(动脉期, 门静脉期)增强扫描, 层厚7.0mm, 螺距1.0, 非离子型碘对比剂总量100mL, 注射流率3mL/s, 动脉、门脉期扫描分别为30s和70s。结果 胰腺假性囊肿12例, 平扫为囊状水样密度影, 增强扫描囊壁轻度强化, 内无分隔。胰腺脓肿4例, 平扫为类圆形液性密度, CT值为24Hu左右, 内见小气泡影, 增强扫描囊壁呈环形明显强化。胰腺囊腺瘤4例, 平扫为类圆形的水样或肌肉样密度影, 增强扫描囊壁分隔及壁结节呈不规则强化, 囊壁厚度＜2mm。胰腺囊腺癌2例, 平扫呈囊状水样密度及壁结节, 其内有分隔, 增强扫描囊壁、壁结节及分隔可见不规则明显强化, 囊壁厚度＞2mm, 1例伴有肝内转移及腹膜后淋巴结转移。结论 胰腺囊性病变有各自的CT特征, 但相似之处较多, 结合临床病史、必要时密切随访加以鉴别, 可提高胰腺病变的CT诊断准确率。     

CT对累及眼部的鼻窦病变诊断价值

目的：探讨累及眼部的鼻窦常见良、恶性病变的CT诊断价值。方法：经CT扫描及病理证实的鼻窦肿瘤40例,均以眼部症状首诊,全部行眼眶及鼻窦平扫,平扫加增强扫描27例,轴位加冠状扫描11例。结果：鼻窦黏液囊肿23例,CT主要表现为边界清晰的囊性病灶,囊壁强化,鼻窦腔扩大,骨壁变薄或骨壁呈吸收性破坏缺损为特征;鼻窦骨瘤4例,CT表现致密性骨块;软骨瘤1例,CT表现富钙化的球形软组织肿块。鼻窦鳞状细胞癌、上颌骨黏液表皮样癌和胚胎性横纹肌肉瘤分别为9例、1例和2例,CT主要表现为边界不清欠均质肿块,骨壁虫蚀样破坏为特征。40例良、恶性肿瘤不同程度侵入眼眶;侵入颅内11例。结论：CT既能确切显示鼻窦良、恶性肿瘤的特征,又能清晰显示肿瘤的累及范围,做到确切定性及准确定位。     

CT对累及眼部的鼻窦病变诊断价值

目的 :探讨累及眼部的鼻窦常见良、恶性病变的CT诊断价值。方法 :经CT扫描及病理证实的鼻窦肿瘤 4 0例 ,均以眼部症状首诊 ,全部行眼眶及鼻窦平扫 ,平扫加增强扫描 2 7例 ,轴位加冠状扫描11例。结果 :鼻窦黏液囊肿 2 3例 ,CT主要表现为边界清晰的囊性病灶 ,囊壁强化 ,鼻窦腔扩大 ,骨壁变薄或骨壁呈吸收性破坏缺损为特征 ;鼻窦骨瘤 4例 ,CT表现致密性骨块 ;软骨瘤 1例 ,CT表现富钙化的球形软组织肿块。鼻窦鳞状细胞癌、上颌骨黏液表皮样癌和胚胎性横纹肌肉瘤分别为 9例、1例和 2例 ,CT主要表现为边界不清欠均质肿块 ,骨壁虫蚀样破坏为特征。 4 0例良、恶性肿瘤不同程度侵入眼眶 ;侵入颅内 11例。结论 :CT既能确切显示鼻窦良、恶性肿瘤的特征 ,又能清晰显示肿瘤的累及范围 ,做到确切定性及准确定位。     

Intensity-modulated radiation therapy for malignancies of the nasal cavity and paranasal sinuses

PURPOSE: To report the clinical outcome of patients treated with intensity-modulated radiation therapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS: Between 1998 and 2004, 36 patients with malignancies of the sinonasal region were treated with IMRT. Thirty-two patients (89%) were treated in the postoperative setting after gross total resection. Treatment plans were designed to provide a dose of 70 Gy to 95% or more of the gross tumor volume (GTV) and 60 Gy to 95% or more of the clinical tumor volume (CTV) while sparing neighboring critical structures including the optic chiasm, optic nerves, eyes, and brainstem. The primary sites were: 13 ethmoid sinus, 10 maxillary sinus, 7 nasal cavity, and 6 other. Histology was: 12 squamous cell, 7 esthesioneuroblastoma, 5 adenoid cystic, 5 undifferentiated, 5 adenocarcinoma, and 2 other. Median follow-up was 51 months among surviving patients (range, 9-82 months). RESULTS: The 2-year and 5-year estimates of local control were 62% and 58%, respectively. One patient developed isolated distant metastasis, and none developed isolated regional failure. The 5-year rates of disease-free and overall survival were 55% and 45%, respectively. The incidence of ocular toxicity was minimal with no patients reporting decreased vision. Late complications included xerophthalmia (1 patient), lacrimal stenosis (1 patient), and cataract (1 patient). CONCLUSION: Although IMRT for malignancies of the sinonasal region does not appear to lead to significant improvements in disease control, the low incidence of complications is encouraging.     

Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy

PURPOSE: To evaluate the long-term clinical outcome and toxicity of conventional and three-dimensional conformal radiotherapy for malignancies of the nasal cavity and paranasal sinuses. METHODS AND MATERIALS: Between January 1976 and February 2003, 127 patients with histologically proven cancer of the paranasal sinuses (n = 119) or nasal cavity (n = 8) were treated with preoperative (n = 61), postoperative (n = 51), or primary (n = 15) radiotherapy, using conventional (n = 74) or three-dimensional conformal (n = 53) techniques. No elective neck irradiation of the cervical lymph nodes was performed in N0 patients. RESULTS: Median follow-up was 5.6 years (range, 3-307 months) for all patients, and 7.3 years (range, 47-307 months) for patients still alive at the close-out date. The actuarial 5-year local control, overall survival, and disease-free survival rates were 53%, 54%, and 37%, respectively. Only 6 (5%) of all 127 patients and 4 (3%) of 122 originally N0 patients developed a regional failure in the neck. Distant metastasis occurred in 20% of patients. Both primary tumor extent and lymph node involvement were the most important prognostic factors, together with squamous cell carcinoma histology. CONCLUSION: Local failure remains the dominant cause of poor outcome for patients with sinonasal cancer, despite aggressive local treatment with combined surgery and radiotherapy in operable patients. Distant metastasis and certainly regional relapse were much less common sites of failure. Overall survival remains poor, suggesting the need for more efficacious local and possibly systemic therapy.     

52例原发鼻腔鼻窦黏膜恶性黑色素瘤疗效分析

目的：分析原发鼻腔鼻窦恶性黑色素瘤疗效及放疗在其治疗中作用。方法回顾分析2001—2014年间我院收治原发鼻腔鼻窦恶性黑色素瘤52例临床资料,其中单纯手术18例,手术联合放疗31例（手术＋术后放疗24例、术前放疗＋手术7例）,单纯放疗3例。使用倾向配比评分法对手术联合放疗组与单纯手术组配对分析。中位随访时间59个月。全组5年LC、DMFS、DFS、OS分别为49％、48％、22％、45％。配对后手术联合放疗5年LC 明显高于单纯手术（88％∶43％,P＝0．028）,但5年DMFS相近（67％∶57％,P＝0．955）、DFS相近（58％∶24％,P＝0．131）、5年OS也相近（67％∶67％, P＝0．727）。术前放疗＋手术组、手术＋术后放疗组手术切缘阴性率分别为100％和50％（ P＝0．004）。结论手术联合放疗可提高原发鼻腔鼻窦恶性黑色素瘤LC率,术前放疗增加手术切缘阴性率。     

Cancer of the nasal cavity and paranasal sinuses

Sinonasal malignancies continue to have poor survival rates. Disease-related mortality is usually the result of disease recurrence and progression at the primary site despite aggressive therapy. Complete surgical excision with postoperative radiation therapy remains the standard of care for resectable lesions. Improved reconstructive techniques have increased our ability to aggressively clear locally advanced disease in this anatomically challenging region, while reducing associated functional and cosmetic morbidity. Intensive multimodality treatment regimens coupled with newer medical technology may ultimately improve the long-prevailing poor prognosis of these tumors.     

Sarcoma of the nasal cavity and paranasal sinuses

The management of sarcoma of the nasalcavity and paranasal sinuses is a challenging problem because of natural behaviour and evasive diagnosis of the tumour and the anatomic location. Sarcoma is a malignant tumour of mesenchymal or mesodermal origin, and is therefore of lymphoid, fibrous, bony or cartilaginous origin. The incidence of sarcoma in cancers of the nose and paranasal sinuses is 5% (Lewis, 1969). The present paper surveys 11 cases of sarcoma of soft part, bony and cartilaginous origin, treated in our hospital during 1978–84.     

Cancer of the nasal cavity and paranasal sinuses

Sinonasal malignancies continue to have poor survival rates. Disease-related mortality is usually the result of disease recurrence and progression at the primary site despite aggressive therapy. Complete surgical excision with postoperative radiation therapy remains the standard of care for resectable lesions. Improved reconstructive techniques have increased our ability to aggressively clear locally advanced disease in this anatomically challenging region, while reducing associated functional and cosmetic morbidity. Intensive multimodality treatment regimens coupled with newer medical technology may ultimately improve the long-prevailing poor prognosis of these tumors.     

104例鼻腔鼻窦腺样囊性癌临床分析

背景与目的：腺样囊性癌是一种来自于涎腺组织的少见肿瘤,占所有头颈部恶性肿瘤的1%~2%。鼻腔鼻窦腺样囊性癌的发病率较低,且生长缓慢,较少淋巴转移,但是容易侵犯临近组织和沿着神经浸润生长,后期有较高的复发率和远处转移率,往往预后不佳。该研究总结鼻腔鼻窦腺样囊性癌的临床及病理特点,并对其预后和影响因素进行分析。方法：该研究为一项单中心、回顾性的研究,分析了104例2000年9月—2012年11月间在复旦大学附属眼耳鼻喉科医院接受过放疗的鼻腔鼻窦腺样囊性癌患者,中位随访时间5.1年。使用Kaplan-Meier、log-rank检验和COX比例风险模型进行生存相关的数据分析。结果：患者平均年龄(54.5±11.5)岁,男女各占50%。鼻腔为最常见的原发部位(63.5%),其次为上颌窦(29.8%),临床分期以Ⅲ~Ⅳ期为主(76.0%),手术切缘阳性者为56.7%,出现神经浸润者为34.6%。术后放疗的患者占67.3%,术前放疗占27.9%,仅4.8%的患者采用了单纯放疗,其中29.8%的患者在手术和放疗基础上联合了化疗。采用CRT放疗者为81.7%,采用IMRT放疗者为18.3%。最终18例出现复发,28例出现远处转移,肺部为最常见的转移部位,神经浸润是影响复发或转移的独立危险因素(P=0.0002)。患者的5年和10年总生存率(overall survival,OS)分别为77.0%(95%CI：68.7%~85.3%)和67.8%(95%CI：57.8%~77.9%);5年和10年的无瘤生存率(disease-free survival, DFS)分别为57.8%(95%CI：48.0%~67.7%)和56.4%(95%CI：46.3%~66.4%)。复发或远处转移是显著影响OS的危险因素(未校正HR=60.1,95%CI：8.15~443.1,P<0.0001),神经浸润阳性是显著影响DFS的危险因素(未校正HR=2.99,95%CI：1.642~5.445,P=0.0002)。原发部位、临床分期、手术切缘是否阳性及放疗方式对预后无明显影响。结论：神经浸润、复发或远处转移可能是影响鼻腔鼻窦腺样囊性癌预后的重要因素。