副腮腺肿瘤临床分析

目的　探讨副腮腺肿瘤的临床、影像、病理特点及治疗效果。方法　收集并分析我院经治的8例副腮腺肿瘤病例资料。结果　多形性腺瘤5例,基底细胞腺瘤、多 形性腺瘤恶变（高分化非特异性腺癌）、高分化鳞状细胞癌各1例。良性肿瘤病例的CT表现为肿块呈椭圆形、边界清楚、密度均匀;恶性肿瘤病例的CT表现为肿块形状不规则、境界不清、密度欠均匀。8例患者均行手术治疗,入路分别选择：1例面颊部直接切口,2例口内入路,5例标准腮腺肿瘤切除入路,鳞状细胞癌病例同时行选择性颈清扫术。2例恶性肿瘤患者术后辅以放疗。所有患者治疗后随访1～5年,无复发及转移。结论　副腮腺肿瘤CT表现具有一定的特征性,彻底切除是首选治疗,入路宜选用标准腮腺切除切口,恶性肿瘤术后辅以放疗,短期疗效较好。     

良性腮腺肿瘤摘除术

1964至1989年,作者观察腮腺肿大289例,其中腮腺良性肿瘤184例。治疗:98例腮腺混合瘤及67例腮腺Warthin氏瘤行肿瘤剥除术;15例腮腺混合瘤及4例Warthin氏瘤行腮腺全切除。结果:随访发现腮腺全切除19例中6例复发,计腮腺混合瘤5例,Warthin氏瘤1例。14例发生Frey氏综合征;肿瘤剥除术后无复发。本组仅1例肿瘤为多中心性。作者认为,大多数腮腺良性肿瘤宜行单纯肿瘤剥除术,并发症少,复发率不比腮腺全切除者高。下列情况则宜行腮腺全切除:①肿瘤直径超过4～5 cm;     

颅内三叉神经鞘瘤的CT及MRI诊断

目的分析颅内三叉神经鞘瘤的CT和MRI表现。方法搜集36例经手术和病理证实的颅内三叉神经鞘瘤的CT和MRI资料,探讨颅内三叉神经鞘瘤分型、诊断要点及有关鉴别诊断。结果颅内三叉神经鞘瘤分三型：颅后窝型（8例）、颅中窝型（4例）及骑跨型（24例）。病灶信号混杂,易囊变（12例）,增强后可见不均匀强化;CT能看到岩尖骨质吸收或破坏（17例）。结论CT和MRI的联合应用对三叉神经鞘瘤的定位、定性诊断具有较高的准确性,对临床治疗及手术方式的选择具有指导作用。     

鼻部多形性腺瘤的CT表现

目的探讨鼻部多形性腺瘤的CT表现，提高诊断准确性。方法回顾性分析4例经手术病理证实的鼻部多形性腺瘤患者CT表现并复习相关文献。其中男1例，女3例，年龄23～60岁，中位年龄47.5岁；全部患者均行鼻窦CT平扫，其中1例平扫后行增强扫描。结果4例鼻部多形性腺病患者中，1例位于鼻根部，3例位于鼻中隔前部，肿瘤大小为1～3 cm，病变形状1例呈椭圆形，3例呈类圆形，边界均清楚。CT平扫时病灶密度与邻近肌肉组织密度相等，密度不均匀，其中3例病变内部可见裂隙样低密度区，1例病变周围骨质呈轻微压迫性骨质吸收，其病灶内部可见斑点状钙化，增强扫描病灶未见明显强化。结论鼻部多形性腺瘤的CT表现有一定的特征性，有助于临床早期诊断及治疗方案的制定。     

腮腺良性肿瘤引起的面瘫

面瘫是腮腺恶性肿瘤及其病变进展的重要表现,腮腺良性肿瘤引起面瘫罕见。我们现报道由腮腺多形性腺瘤和Warthin瘤引起的面瘫,并对面瘫发生的临床特征和机理进行分析。     

三叉神经瘤影像学诊断的价值

三叉神经瘤14例,12例做CT检查,2例做MRI检查,14例术后均经病理检查证实.12例CT扫描呈混杂密度6例,均匀高密度5例,等密度1例,注射造影剂后多呈不均匀强化,肿瘤周围均无脑水肿.2例MRI图像T1加权像呈低信号,T2加权像呈高信号.X线平片示11例有岩骨、颅底骨吸收破坏.临床常伴有听神经、面神经等受累.CT和MRI是诊断三叉神经瘤的有效检查方法.三叉神经瘤应与脑膜瘤、胶质瘤及听神经瘤等相鉴别.     

腮腺良性肿瘤切除附143例报告

目的 分析腮腺良性肿瘤的外科治疗.方法 回顾分析1995年8月～2009年12月143例行腮腺良性肿瘤手术资料,其中腮腺浅叶肿瘤115例,深叶肿瘤28例.病理诊断Warthin瘤69例(占48.28%),混合瘤63例(占44.06% ).其中有5例为双侧.行腮腺浅叶区域切除术73例,腮腺浅叶切除术42例,腮腺部分浅叶切...     

鼻窦骨化纤维瘤CT诊断

目的探讨鼻窦骨化纤维瘤的CT诊断。方法回顾性分析8例鼻窦骨化纤维瘤患者的临床资料及CT表现,对比CT表现及术后病理诊断。结果鼻窦骨化纤维瘤的CT表现为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。8例均诊断为鼻窦骨化纤维瘤,与术后病理相符。结论鼻窦内圆形或类圆形高密度影,密度均匀或不均匀,部分区域内见低密度影,表面为厚薄不均的骨壳,界限清楚,为骨化纤维瘤的CT表现特点。     

颅底脊索瘤的CT诊断

目的探讨颅底脊索瘤的CT诊断及临床应用价值。方法回顾性分析15例经手术、病理证实确诊为颅底脊索瘤的CT表现。结果15例颅底脊索瘤中经手术和CT扫描证实,发生于斜坡5例,发生于鞍区及鞍旁7例,发生于鼻咽部1例,发生于蝶窦2例。病灶有钙化11例,颅底骨质破坏12例。结论CT扫描能够显示颅底脊索瘤部位、大小及侵犯范围,有助于确定手术方案及对术后进行评估。     

60例咽旁隙肿块的CT及MRI影像学特征分析

目的探讨咽旁隙肿块的CT及MRI表现,了解其影像学特征。方法回顾性分析2014年6月~2016年6月收治的60例咽旁隙肿块患者的CT及MRI影像学特征,观察肿块的位置、形态、与周围组织关系、密度、信号高低等情况。结果在60例咽旁隙肿块患者中,神经鞘瘤36例、涎腺混合瘤15例、颈动脉体瘤5例、鼻咽癌颅底咽旁隙转移4例。神经鞘瘤表现为包膜完整、边界光滑、呈椭圆形或圆形的肿块,与腮腺深叶间分界清楚,涎腺混合瘤为包膜完整的圆形肿块,与腮腺深叶间没有脂肪间隙,茎突、二腹肌、腭帆张肌等周围组织均出现移位。颈动脉体瘤表现为形态规则的软组织肿块,CT平扫呈等密度、增强后明显强化;MRI扫描,T1W1呈等或稍高于肌肉信号,T2W1呈不均性的高信号,并可见流空血管影像。鼻咽癌颅底咽旁隙转移的MRI显示,T1W1呈低密度信号的椭圆形肿块,增强后高信号内可见坏死囊变区。结论正确地认识咽旁隙肿块的CT及MRI影像学特征,有助于提高其临床诊断率,为咽旁隙肿块的治疗提供一定的依据。     

腮腺多发沃辛瘤临床回顾性分析

目的分析腮腺多发沃辛瘤的临床特点并探讨其诊疗方法。方法对收治的26例腮腺多发沃辛瘤患者的临床资料进行回顾性研究,对影响复发的因素采用Fisher’s确切概率法进行分析,进而讨论该病适宜的治疗方式。结果 26例腮腺多发沃辛瘤患者男女患病比率为2.25∶1,发病年龄45～81岁。细针穿刺细胞学检查(fine needle aspiration cytology,FNAC)诊断准确率为84.4%。其中2例保守治疗,1例放弃手术,余23例患者计29侧腮腺接受手术治疗。5例患者计6侧腮腺术后复发。分析患者年龄、性别、吸烟史、症状持续时间、肿瘤数目、直径、位置、伴发其他肿瘤、手术方式、手术并发症和术后吸烟情况对肿瘤复发的影响,手术方式是影响肿瘤复发的独立危险因素。结论腮腺多发沃辛瘤发病具有自身特点,细针穿刺细胞学检查是该病的常规检查,手术切除是主要的治疗方式。     

Demographics of benign parotid tumours: Warthin’s tumour versus other benign salivary tumours

Conclusion: Some variation from the ‘classical’ clinical picture for Warthin’s tumours is evident in these patients. A predilection for the parotid tail and a propensity for multiplicity has been confirmed. Objectives: This study sought to analyse demographic and clinical features of a Warthin’s patient population. Methods: Retrospective review of patients presenting with a benign parotid tumour. The group of Warthin’s tumours was compared with the group of patients with other benign parotid tumours. Results: Of 170 primary parotid tumours, 41 (24%) were Warthin’s tumour. Mean age of Warthins patients was significantly older (60 years vs 48 years, p?=?0.001) and male gender more prevalent (61% vs 33%, p?=?0.015) than in other benign tumours. Most (86%) Warthin’s tumours were found in the parotid tail, compared with 61% of other benign tumours (p?=?0.002). There was no significant ethnic predilection for Warthin’s tumours. Bilaterality (30%) and multiplicity (27%) were common. Significance of gender differences disappeared with logistic regression analysis.     

Two-Phase Helical Computed Tomography Study of Salivary Gland Warthin Tumors: A Radiologic Findings and Surgical Applications

Objectives

The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings.

Methods

We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates.

Results

Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05).

Conclusion

Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy.     

原发性腮腺鳞状细胞癌的诊治

目的探讨原发性腮腺鳞状细胞癌（简称鳞癌）的临床特点、治疗和预后因素。方法回顾性分析中国医学科学院肿瘤医院头颈外科1990年1月～2008年8月24例原发性腮腺鳞癌,总结其临床资料、病理结果、生存情况和预后因素。结果Kaplan-Meier法计算全组5年生存率达35.9%,手术肉眼切净肿瘤的患者（n=18）5年生存率达47.9%。初治（n=15）和复发挽救（n=9）患者的5年生产率分别为44.2%和22.2%（P=0.132）,治疗失败的原因主要是局部区域复发。多因素分析提示二次治疗和肿瘤肉眼残存是预后不良的因素。结论原发性腮腺鳞癌恶性程度较高,首次治疗是关键,切除的肿瘤可获得较好的效果,肿瘤肉眼残存或二次治疗的患者预后较差。     

Surgical treatment strategy in Warthin tumor of the parotid gland

IntroductionWarthin tumors are the second most common benign tumors of the parotid gland. We examined the clinical features of Warthin tumors in our hospital, and analyzed the consistency within the literatures.ObjectiveThe aim of this study is to analyze the clinical features of Warthin tumors in our 10-year experience of 118 Warthin tumors undergoing surgery at a single institute.MethodsFrom December 2006 to December 2016, 110 patients who underwent surgical treatment for Warthin tumors were identified based on their medical records.ResultsA total of 118 parotid gland operations were performed in 110 patients. Almost 90% of Warthin tumors were found in males, and average patient age was 66.1 ± 6.1 years. The prevalence of smoking history was 89.1% (98/110). Eight patients (7.3%) had bilateral Warthin tumors. Seventy-seven lesions (65.3%) were located in the parotid tail portion, followed by 34 lesions in the superficial lobe (28.8%) and 7 lesions in the deep lobe (5.9%).ConclusionWe determined the appropriate extent of surgery depending on the fine needle aspiration cytology and tumor location by computed tomography scans. Partial facial dysfunction after the operation was detected in 12 cases, and facial nerve function recovered within 3 months. Only one patient experienced a recurrence, and was disease free after the re-operation. We suggest that our treatment algorithm, depending on the location of tumors and the result of fine needle aspiration cytology, can be useful to determine the appropriate extent of surgery for Warthin tumors.     

经鼻内镜手术治疗鼻腔鼻窦骨源性良性肿瘤——附14例报告

目的探讨经鼻内镜手术治疗鼻腔鼻窦骨源性肿瘤的可行性及手术技巧。方法回顾性分析1998年6月-2012年5月经鼻内镜手术治疗的14例鼻腔鼻窦骨源性肿瘤的临床资料。所有患者均于术前行鼻窦高分辨CT（HRCT）检查,确定肿瘤的位置和侵犯范围。手术均在全身麻醉下进行,经鼻内镜手术11例,鼻内镜辅助鼻外径路手术3例。其中行肿瘤彻底切除9例,部分切除5例。结果所有患者术后平均随访5年7个月。2例侵及眶内及前颅窝的骨化纤维瘤患者分别于术后2个月和8个月复发,接受第2次手术后1例病变基本控制,目前仍在随访中,另1例去外院接受了第3次鼻颅脑联合手术再复发,仍在观察中;1例骨母细胞瘤患者采用经鼻经额联合径路内镜手术,但侵入前颅窝相当于鸡冠处的肿瘤仍有残留,术后2年患者因左侧眶内及颅内肿物复发去外院行开颅手术后失访;其余患者随访至今未见复发。所有病例均未发生其他严重并发症。结论鼻腔鼻窦骨源性肿瘤局限于鼻腔鼻窦者经鼻内镜手术可彻底切除;但当肿瘤破坏颅底突入颅腔或肿瘤侵及颈内动脉、视神经等重要结构时,单纯内镜下肿瘤不易彻底切除,需多学科的联合手术或其他辅助治疗。     

High risk for bilateral Warthin tumor in heavy smokers--review of 185 cases

CONCLUSIONS: We identified smoking as a significant risk factor for multilocular Warthin tumor development. Therefore, we recommend taking history of smoking into account when making the decisions for surgical strategy. OBJECTIVES: Warthin tumor is a common benign neoplasm of the parotid gland. Risk factors for multilocular development have not been defined. PATIENTS AND METHODS: A total of 185 consecutive patients treated for Warthin tumor were included. Charts were reviewed for symptoms, risk factors, and diagnostic and surgical procedures. Patients were followed for facial function and recurrence. Risk factors were evaluated. RESULTS: Overall, in 203 parotid operations, a lateral parotidectomy (77%) was performed in most cases; 94% were primary surgery and 6% were revision surgery. In 89% of patients swelling was the only symptom. Bilateral Warthin tumor was seen in 17% of patients. Of these cases synchronous and metachronous bilateral tumors were observed in 61% and 39%, respectively. The median time period for second contralateral tumor development was 7 years. Postoperative transient facial dysfunction was observed in 31%, which recovered within 3 months in all cases. Evaluation of risk factors revealed that 89% of the subjects were smokers and 66% were heavy smokers. The risk for bilateral Warthin tumors correlated significantly with the amount of nicotine intake (p=0.003).     

功能性手术在治疗腮腺尾叶良性肿瘤中的临床应用

目的通过与传统术式比较,探讨功能性手术在腮腺尾叶良性肿瘤治疗中的临床应用。方法 72例腮腺尾叶良性肿瘤患者随机分为两组,传统术式组（38例）保留面神经,行肿瘤及腮腺浅叶切除术;功能性术式组（34例）行C形切口,保留面神经及耳大神经,行肿瘤及腮腺浅叶部分切除术,酌情行胸锁乳突肌瓣整复。所有患者术后随访0.5-5年,观察两组术后并发症发生率及肿瘤复发情况。结果两组患者肿瘤复发、涎漏、口干差异无统计学意义（P均〉0.05）,但两组术后暂时性面瘫、Frey综合征、耳廓区麻木感、面部凹陷畸形发生率差异具有统计学意义（P均〈0.05）。结论功能性腮腺切除术治疗腮腺尾叶良性肿瘤,术后并发症少,优于传统术式。     

早期分化型甲状腺癌的手术治疗

目的探讨早期分化型甲状腺癌的手术方式及行中央区颈廓清术的必要性。方法回顾性分析诊治的46例早期分化型甲状腺癌患者,根据肿瘤在甲状腺中所处的位置及病理类型确定手术方式,其中行甲状腺侧叶次全切除术2例,腺叶切除术6例,腺叶+峡部全切除术8例,甲状腺次全切除术28例,甲状腺全切除术2例;同期行VI区颈廓清术44例,并采用统计学方法分析患者性别、年龄、体重指数、肿瘤分期与颈部淋巴结转移之间的规律。结果 46例患者术后随访3~5年,均未发现复发及淋巴结转移。性别、体重与颈部淋巴结转移无关(P均>0.05),年龄、肿瘤分期、肿瘤病理类型分别与颈部VI区淋巴结转移相关(χ2=10.125,P<0.05;χ2=6.597,P<0.05;χ2=13.455,P<0.01)。结论早期分化型甲状腺癌的淋巴结转移与患者年龄、肿瘤分期及其病理类型相关,根据肿瘤的大小、在甲状腺中的位置及病理类型明确手术方式。