99m锝-右旋糖酐颈淋巴显像对喉癌和下咽癌颈淋巴结转移的诊断价值

目的：探讨乳突区皮下注射^99m锝-右旋糖酐（^99mTc-DX105）单光子发射计算机断层扫描（SPECT）颈淋巴显像对喉癌和下咽癌颈淋巴结转移的诊断价值。方法：对30例喉癌和下咽癌患者术前经双侧乳突区皮下注射^99mTc-DX105 SPECT颈淋巴显像与颈廓清标本病理检查进行对比研究。结果：30例患者53侧颈部SPECT，显像阳性24侧，其中3侧为假阳性；阴性29侧，其中1侧为假阴性。53侧SPECT颈淋巴显像的敏感性、特异性及准确率分别为95．5％（21／22）、90．3％（28／31）和92．5％（49／53）。8侧隐匿性转移淋巴结中SPECT显像检出7侧，检出率为87．5％（7／8）。结论：乳突区皮下注射^99mTc-DX105 SPECT颈淋巴显像对指导喉癌和下咽癌的临床分期及颈淋巴结清扫，具有一定的临床意义。     

喉癌、下咽癌组织中环氧化酶-2的表达与临床意义

目的研究喉癌、下咽癌中环氧化酶-2(COX-2)的表达与肿瘤临床病理参数及肿瘤预后的关系.方法应用免疫组化法检测喉癌、下咽癌组织及声带息肉组织中COX-1和COX-2的表达,并分析癌组织中COX的表达强度与肿瘤对应的各项病理参数及与预后的关系.结果喉癌、下咽癌组COX-2阳性表达率为67.5%(27/40),声带息肉组COX-2阳性表达率为0(0/30),COX-2的阳性表达与肿瘤的临床分期、病理分级及预后有关,与淋巴结转移关系不明显.结论COX-2在喉癌、下咽癌组织中表达增高,并与肿瘤的恶性度相关,表明COX-2可能在喉癌、下咽癌的发生发展中起重要的作用.     

颈部淋巴结阴性下咽癌患者的预后及远期生存分析[论著]

目的　研究分析淋巴结病理阴性（pN0）下咽鳞状细胞癌患者的生存和预后影响因素。方法　回顾性分析2001年1月~2014年12月在复旦大学附属眼耳鼻喉科医院行下咽切除术的53例下咽鳞状细胞癌患者资料,所有患者经术前评估均无颈部淋巴结转移,均行颈清扫术并且病理证实无颈部淋巴结转移。收集患者临床病理资料,随访其生存情况并分析预后影响因素。结果　梨状窝癌37例,环后区癌7例,咽后壁癌9例。T1级2例,T2级21例,T3级21例,T4级9例。5年无病生存率、疾病特异性生存率、总生存率分别为61.1%、63.6%、42.4%。多因素分析显示食管侵犯是影响复发率、疾病特异性生存率、总生存率的独立危险因素。结论  食管侵犯是颈部淋巴结阴性下咽鳞状细胞癌患者的重要预后影响因素,对于食管发生侵犯的患者术后应密切随访。     

双源CT诊断非金属可疑食管异物的队列研究

目的通过分析双源CT诊断非金属食管异物的敏感性和特异性,评价双源CT对非金属可疑食管异物的诊断意义。方法应用前瞻性队列研究,选取2015年1月1日～2016年12月31日符合纳入标准的患者153例双源CT和正侧位平片对照。结果93例双源CT阳性示食管异物,其中57例平片阳性;内镜检查证实并取出92例,内镜检查阴性1例。本组病例中双源CT敏感性100%（92/92）,特异性98.4%（60/61）,阴性预测值100%（60/60）。结论双源CT检查非金属食管异物敏感性、特异性、阴性预测值高,能明确异物类型及异物位置。双源CT可作为非金属食管异物的常规检查,及时诊断,避免不必要的食管内镜检查。     

正电子发射计算机断层和CT融合显像诊断颈淋巴结转移癌

目的探讨18F-脱氧葡萄糖(18-Fluorine Fluorodeoxyglucose,FDG)正电子发射计算机断层显像(Positron Emission Tomography,PET)-CT融合显像在颈淋巴结转移癌中的诊断价值。方法17例颈部肿块病人,CT或MRI发现可疑病变28处,其中鼻咽癌放射治疗后6例,肺癌治疗后3例,甲状腺癌手术后3例,下咽癌放疗后1例,不明原发灶4例,行全身或颈部PET-CT检查,其结果与临床病理报告对照。结果17例患者,共28处PET-CT显像阳性20例,阴性8例;对照病理结果,假阳性1例,假阴性1例,18F-FDGPET-CT诊断颈淋巴结转移癌的灵敏度、特异性、准确度分别为95.0%,87.5%,92.9%。结论18F-FDGPET-CT结合PET提供肿瘤代谢图像,CT提供解剖图像,在颈淋巴结转移癌的诊断及监测复发方面具有较大的临床价值。     

109例下咽后壁癌患者的治疗分析

目的探讨影响下咽后壁癌患者预后的相关因素,为下咽后壁癌的治疗提供新的思路。方法收集2009年1月—2017年12月手术治疗的109例下咽后壁鳞状细胞癌患者，按照性别、是否保留喉功能、T分期、N分期、临床分期、肿瘤分化程度、手术方法及治疗方式分别分组，分析不同分组之间生存率的差别。结果下咽后壁癌患者的1、3、5年生存率分别为75%、52%、38%。下咽后壁癌N分期以及临床分期越早，生存率越高。结论只要选取了合适的手术入路保证肿瘤完整切除，可以保留患者的喉功能，并且对咽功能进行修复，从而提高患者的术后生活质量。     

正电子发射断层摄影术在头颈部恶性肿瘤诊断中的应用

目的 :探讨18F FDG正电子发射断层摄影术 (PET)在头颈部恶性肿瘤诊断中的价值。方法 :回顾性分析应用18F FDGPET检查的 75例头颈部肿瘤患者 (鼻咽癌 36例 ,食管癌 18例 ,甲状腺癌 13例 ,喉癌 6例 ,下咽癌 2例 )的临床资料 ,其18F FDGPET显像结果与病理结果进行比较 ,部分与CT、MRI比较。结果 :18F FDGPET显像结果与病理结果相符率极高 ,鼻咽癌的灵敏度为 91.30 % ,特异度为 76 .92 % ,准确率为 86 .11% ;食管癌的灵敏度为 10 0 .0 0 % ,特异度为 83.33% ,准确率为 94 .4 4 % ;甲状腺癌、喉癌和下咽癌的灵敏度、特异度及准确率均为 10 0 %。结论 :18F FDGPET在头颈部恶性肿瘤的诊断中具有明显的优势。     

喉癌下咽癌患者一级亲属染色体对致突变物的敏感性观察

为探讨遗传因素与喉癌下咽癌的关系，检测了几组不同人群淋巴细胞染色体对致突变物诱发畸变的敏感性，结果：喉癌组、下咽癌组及对照组每细胞染色单体断裂率（ｂ／ｃ值）分别为０．６１±０．２７，０．６６±０．３１和０．２８±０．１２。喉癌和下咽癌的一级亲属组（亲属组）的ｂ／ｃ值为０．４５±０．２６。把健康一级亲属的喉癌、下咽癌患者从喉癌组和下咽癌组中抽出另列为患者组，其ｂ／ｃ值为０．５９±０．２９。亲属组与患者组比较ｂ／ｃ值差别无显著性（Ｐ＞０．０５），但明显高于健康对照组（Ｐ＜０．００１），明显低于喉癌组和下咽癌组（Ｐ＜０．０１）。结果显示喉癌和下咽癌患者及其健康一级亲属对致突变物敏感性均高于健康人，因此喉癌下咽癌患者的一级亲属应列为患癌高风险人群，注意预防癌肿的发生。     

叶绿素染色在喉癌下咽癌颈淋巴结清扫术中的应用

目的 :探讨喉癌、下咽癌的颈淋巴结转移方式。方法 :对 5 0例喉癌、下咽癌患者于颈清扫术前 ,在喉及下咽粘膜下注射叶绿素使颈淋巴结系统染色 ,指导施行颈清扫术并收集淋巴结 ,进行连续切片观察。结果 :颈淋巴结被染成深绿色 ,与周围组织颜色对比明显 ,便于颈部手术和采集淋巴结 ;经病理检查证实 ,颈淋巴结总的转移率为 4 8% ,Ⅰ、Ⅴ区转移时均伴有其它区域的转移 ,Ⅱ、Ⅲ区转移率高于Ⅰ、Ⅳ、Ⅴ区 (P <0 .0 1) ;临床诊断颈淋巴结阴性 (cN0 )的患者淋巴结转移率为 2 3.5 % ,转移区域均在Ⅱ、Ⅲ区。结论 :临床诊断颈淋巴结阳性 (cN+ )喉癌、下咽癌患者的颈清扫手术 ,首先要保证清扫II、III区淋巴结 ,术中所见决定选择性颈清扫术式 ,对cN0 的下咽癌或声门上癌可行单侧或双侧颈深上、中淋巴结清扫术。叶绿素染色清晰 ,安全无毒 ,便于手术 ,可以在颈清扫术中常规应用     

人喉癌下咽癌组织中转化生长因子β1基因的检测

目的 :检测喉癌下咽癌组织中转化生长因子 β1(TGF β1)mRNA的表达 ,探讨其在喉癌、下咽癌发生发展中的可能作用。方法 :取 2 0例喉癌、下咽癌患者术后新鲜组织标本 ,用半定量的逆转录 聚合酶链反应 (RT PCR)方法检测TGF β1的mRNA表达。结果 :检测 2 0例标本 ,其中 17例TGF β1表达阳性 ,且Ⅲ～Ⅳ期表达较Ⅰ～Ⅱ期强。结论 :TGF β1在喉癌、下咽癌中的表达可能是导致喉癌、下咽癌患者免疫功能低下 ,促进肿瘤生长的原因之一     

General and rhinosinusitis-related quality of life in patients with Wegener's granulomatosis

OBJECTIVES: The objectives of this cross-sectional study were to outline the pattern of sinonasal morbidity and determine its effects on the quality of life (QOL) of patients with Wegener's granulomatosis (WG). METHODS: The authors conducted a survey of 199 patients with WG, including two validated (QOL) instruments to assess general (SF-36) and rhinosinusitis-specific quality of life (Sinonasal Outcome Test [SNOT-22]). RESULTS: Patients with WG who have sinonasal involvement reported significantly lower general QOL scores than their unaffected counterparts (P = .000006-0.04) for all SF-36 subsets except for emotional role. WG-related sinonasal morbidity was comparable to the high levels previously demonstrated in the general rhinosinusitis population. A total of 38.2% of all patients with WG reported a nasal symptom as their most troublesome from a list of nasal and constitutional symptoms. Twenty-three percent of all patients with WG rated nasal crusting and 17% rated epistaxis as one of their top three most troublesome symptoms even in the setting of multisystem disease. The inclusion of crusting, bleeding, and nasal deformity in the SNOT scoring significantly increased average scores of patients with WG (P = .024, paired t test). CONCLUSIONS: Sinonasal involvement impacts significantly on the general QOL of patients with WG and is at least as significant as that of the general rhinosinusitis population. Nasal symptoms that are of particular relevance to this patient group include nasal crusting and epistaxis.     

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital.MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system.ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020).ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.     

A pilot study of the SNOT 22 score in adults with no sinonasal disease

Objective: To determine the SNOT 22 score in a normal population. Study design: Analysis of SNOT 22 scores participants with no sinonasal disease. Setting: Bath, UK. Participants: 116 participants from a local hospital and tennis club. Results: Results were obtained from 54 men and 62 women with a mean age of 40 (range 19–75). SNOT score ranged from 0–50 with a mean score of 9.3 (95% confidence interval range of 7.5–11.1). The modal score was 0 and the median score 7 (95% confidence interval range of 5–8). Conclusion: Due to the scewed nature of the data, the median score (7) is taken as the normal SNOT 22 score. We recommend that in an clincial situation a SNOT 22 score of 7 be used a a guide for “normal”, and that care should be taken when suggesting treatment on patients with a score below this level.     

Psychometric validity of the 22‐item Sinonasal Outcome Test

Objectives: We set out to determine the psychometric validation of a disease‐specific health related quality of life instrument for use in chronic rhinosinusitis, the 22 item Sinonasal Outcome Test (SNOT‐22), a modification of a pre‐existing instrument, the SNOT‐20. Design, setting and participants: The National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis was a prospective cohort study collecting data on 3128 adult patients undergoing sinonasal surgery in 87 NHS hospitals in England and Wales. Data were collected preoperatively and at 3 months after surgery, and analysed to determine validity of the SNOT‐22. Test–retest reliability was assessed in a separate cohort of patients in a single centre. Main outcome measures: The SNOT‐22, a derivative of the SNOT‐20 was the main outcome measure. Patients were also asked to report whether they felt better, the same or worse following surgery. To evaluate the SNOT‐22, the internal consistency, responsiveness, known group differences and validity were analysed. Results: Preoperative SNOT‐22 scores were completed by 2803 patients. 3‐month postoperative SNOT‐22 scores were available for 2284 patients of all patients who completed a preoperative form (81.5% response rate). The Cronbach’s alpha scores for the SNOT‐22 were 0.91 indicating high internal consistency. The test–retest reliability coefficient was 0.93, indicating high reliability of repeated measures. The SNOT‐22 was able to discriminate between patients known to suffer with chronic rhinosinusitis and a group of healthy controls (P < 0.0001, t = 85.3). It was also able to identify statistically significant differences in sub‐groups of patients with chronic rhinosinusitis. There was a statistically significant (P < 0.0001, t = 39.94) decrease in patient reported SNOT‐22 scores at 3 months. At 3 months the overall effect size in all patients was 0.81, which is considered large. We found the minimally important difference that is the smallest change in SNOT‐22 score that can be detected by a patient, to be 8.9 points. Conclusions: We have found the SNOT‐22 to be valid and easy to use. It can be used to facilitate routine clinical practice to highlight the impact of chronic rhinosinusitis on the patient’s quality of life, and may also be used to measure the outcome of surgical intervention. The minimally important difference allows us to interpret scores in a clinical context, and may help to improve patient selection for surgery.     

汉化版SNOT-22评价慢性鼻-鼻窦炎患者生存质量的初步研究

目的 探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者的健康相关生存质量(quality of life,QOL)状况.方法 采用中文版医学结局研究简表36项(medical outcome study shortform 36-items,MOS SF-36)和汉化版鼻腔鼻窦结局测试22条(sinonasal outcome test-22,SNOT-22),对2006年12月至2007年3月住院接受鼻内镜手术的64例CRS患者和20名健康志愿者进行QOL调查,并对汉化版SNOT-22量表进行考核.结果 汉化版SNOT-22量表的可行性、信度、效度和反应度等性质均通过考核(P值均＜0.01),其中影响健康最重要的5个问题依次是:鼻塞、流清鼻涕、嗅觉或味觉减退、头晕和鼻涕倒流.CRS患者术前鼻窦CT Lund-MacKay评分(10.19±6.37)与汉化版SNOT-22量表评分(33.77±14.90)的相关系数为0.233,表明二者之间有一定正相关性,但相关性不高.结论 汉化版SNOT-22量表能有效评价CRS患者的QOL.CRS患者术前鼻窦CT Lund-Mackay评分与汉化版SNOT-22量表评分有一定正相关性.     

Impact of depression on disease-specific symptoms and quality of life in patients with chronic rhinosinusitis

BACKGROUND: Depression is associated with increased symptom burden in the setting of chronic medical conditions. Studies investigating the influence of depression on the symptoms of chronic rhinosinusitis (CRS) are lacking. The purpose of this project was to establish the prevalence of depression in patients with CRS and to explore the impact of this disorder on disease-specific symptoms and general quality of life (QOL) in the preoperative and postoperative setting. METHODS: We reviewed the records of 320 consecutive patients presenting with sinonasal symptoms to our specialty sinus clinic. Patients with CRS were evaluated by nasal endoscopy, CT imaging, and validated questionnaires including the Chronic Sinusitis Survey and SF-8 Health Survey, a QOL measurement. Findings in CRS patients with depression were compared with a matched-control group of CRS patients without depression before and after endoscopic sinus surgery. RESULTS: Overall, 26% of patients presenting with sinonasal symptoms had a diagnosis of depression. After evaluation including CT imaging, 33% of the initial population was diagnosed with CRS. The prevalence of depression in these CRS patients was 25%. Disease-specific symptoms were similar between groups; however, depressed CRS patients reported significantly worse pain and energy level and difficulty with daily activities (p < 0.050) when compared with a control group of CRS patients without depression. Postoperatively, nondepressed patients showed a marked improvement in disease-specific as well as general QOL scores (p < 0.050), whereas depressed patients did not. CONCLUSION: CRS patients with and without depression have similarly poor disease-specific symptoms. However, depressed CRS patients have poorer disease-specific and overall QOL outcomes after sinus surgery.     

Improvement of sinonasal mucociliary function by endoscopic sinus surgery in patients with chronic rhinosinusitis

Objectives

Mucociliary clearance is an important defense mechanism for upper and lower airway. Chronic rhinosinusitis has been frequently associated with mucociliary dysfunction. Endoscopic sinus surgery (ESS) is recommended for treatment-resistant sinusitis in order to improve mucociliary function. The present study investigated the effect of ESS on the saccharin time (mucociliary clearance time) in relation to symptom profile assessed by the Sino-nasal Outcome Test (SNOT)-22, and disease severity based on the Lund-Kennedy endoscopic scores and Lund-Mackay computed tomographic (CT) scores.

Facial pain following sinonasal surgery or facial trauma

The case notes of 22 patients who reported facial pain after sinonasal surgery or trauma out of a cohort of 973 patients seen in a rhinology clinic were reviewed retrospectively. This group included 10 patients who had undergone endoscopic sinus surgery and four who had suffered facial fractures. None of the patients reported any facial pain before surgery or trauma. In only one case was there any evidence, clinically, endoscopically, or radiologically, of any paranasal sinus disease and when this resolved with nasal medical treatment the pain remained. The treatment of these patients' facial pain centred on the use of neurological medical treatment. One third of the patients responded to low-dose amitriptyline, a further third showed some response to other pharmacological agents including carbamazepine, and the remaining third showed no response. These cases illustrate the characteristics and management of facial pain after sinonasal surgery and highlight the importance of medical neurological treatment in the absence of any objective evidence of sinus disease.     

慢性鼻窦炎合并哮喘患者CT Lund Mackay评分与VAS评分相关性分析

目的探讨慢性鼻窦炎合并哮喘患者术前CT Lund Mackay评分与术前及术后1年主观症状VAS评分的相关性。方法回顾性分析19例慢性鼻窦炎合并哮喘患者术前CT Lund Mackay评分和主观症状VAS评分及术后1年主观症状VAS评分,采用线性回归分析及配对t检验进行统计学分析。结果患者术前CT Lund Mackay评分中筛窦、窦口鼻道复合体、上颌窦评分较高,蝶窦最低。患者术前鼻塞、流涕VAS评分较高,头痛及嗅觉减退VAS评分较低。术后1年鼻塞、流涕VAS评分变化较大,头痛次之,嗅觉减退VAS评分变化相对较小（P＜0.05）。术前VAS评分（总分）及术后1年VAS评分（总分）与患者术前CT Lund Mackay评分呈正相关（r=0.465,P=0.045;r=0.522,P=0.022）。结论鼻塞、流涕是术前慢性鼻窦炎合并哮喘患者的主要鼻部症状,术后鼻塞、流涕、头痛、嗅觉减退均有改善,其中鼻塞、流涕改善最明显。术前VAS评分（总分）及术后1年VAS评分（总分）与术前患者CT Lund Mackay评分相关性良好。对于慢性鼻窦炎合并哮喘患者术前进行鼻窦CT客观评估,对于手术效果评估具有重要意义。     

Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis

PURPOSE: To assess objective and quality of life (QOL) outcomes before and after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) and to determine preoperative factors that predict surgical outcome in these patients. METHODS: One hundred nineteen adult patients with CRS and a mean follow-up of 1.4 +/- 0.35 years were evaluated prospectively including the following patient factors: prior sinus surgery, polyps, asthma, acetylsalicylic acid intolerance (ASA), smoking, allergy, depression, and sex. Computed tomography (CT), endoscopy, and QOL assessment was performed. Predictive value of patient factors was determined based on change in endoscopy and QOL scores after ESS. RESULTS: Objective outcomes: preoperative CT scores were significantly worse in patients with polyps, asthma, and ASA, whereas CT score was unaffected by prior sinus surgery, smoking, allergy, depression, and sex. Patients with CRS demonstrated significant improvement on nasal endoscopy after ESS, but preoperative, postoperative, and change in scores were affected by certain patient factors. Endoscopy scores were significantly worse in patients with prior sinus surgery, polyps, asthma, and ASA, but these patients also experienced the greatest improvement in endoscopy scores. Smokers and patients with depression had the least change in endoscopy scores. QOL outcomes: patients with CRS experienced improvement in QOL after ESS. Pre- and postoperative QOL was positively affected by polyps and adversely affected by ASA, depression, and female sex, but these groups still experienced significant improvement in QOL scores. Pre- and postoperative QOL was unaffected by prior sinus surgery, asthma, smoking, and allergies, and all of these groups experienced significant improvement in QOL scores. Factors predictive of outcome: ASA and depression were predictive of worse outcome. Preoperative CT scores approached significance as being predictive of outcome. CONCLUSION: Surgical management of CRS was associated with significant improvement on objective and QOL measures; however, specific patient factors, in particular ASA and depression, predict poorer outcome. Preoperative CT may be a predictor of endoscopic and QOL outcome and deserves further study.