VEGF-C在甲状腺髓样癌和甲状腺滤泡状癌中的表达差异

目的 :研究甲状腺髓样癌和甲状腺滤泡状癌中血管内皮生长因子 C(VEGF- C)的表达差异 ,探讨 VEGF- C与甲状腺髓样癌淋巴道转移的关系。方法 :对 4 9例甲状腺髓样癌 (MTC) (其中 36例伴颈淋巴结转移 ) ;2 1例甲状腺滤泡状癌 (FTC) ;2 1例正常甲状腺组织 (NT)用免疫组化 ABC法进行 VEGF- C蛋白检测。结果 :VEGF- C在正常甲状腺组织中无表达 ,在甲状腺髓样癌和甲状腺滤泡状癌中有表达。但 VEGF- C在甲状腺髓样癌原发灶中的表达高于甲状腺滤泡状癌 ,差异有统计学意义。结论 :VEGF- C在甲状腺髓样癌中高表达可能与该病的高区域淋巴结转移有关。     

喉部分切除术中喉功能修复术式的选择

目的 :探讨在治疗不同期喉癌喉部分切除术中不同的喉功能修复术式的疗效。方法 :对 30例 T2 ,部分 T3 声门型喉癌喉部分切除术后分别以胸骨舌骨肌 ,甲状软骨膜 ,颈前皮肤 ,Tucker's术修复喉功能。结果 :全部喉功能恢复占 83.3% (2 5/ 30 ) ,部分喉功能恢复 10 0 .0 %。结论 :对不同期喉癌喉部分切除后的功能修复术应采用不同的修复方法。病变范围越小 ,术后全部喉功能恢复率越高。喉部分切除时应作喉探查 ,以便彻底切除喉肿瘤的同时 ,选取最佳方案修复喉功能     

甲状腺乳头状癌术式探讨

目的：回顾分析甲状腺乳头状癌治疗效果，探讨外科治疗最佳方案。方法：对我院1984－1996年收治的228例甲状腺乳头状癌患者手术治疗结果进行分析。228例患者中肿瘤位于单侧叶者162例，狭部18例，双叶34例，侵犯甲状软骨及气管14例。颈淋巴cN0148例，cN^ 80例，术后均随访5年以上。结果：cN^ 者行功能性（41例）和根治性颈清扫（39例）的5年生存率分别为87．8％（36／41）和87．2％（34／39）。。腺内型cN0伴被膜侵犯者行选择性颈清扫21例，随诊观察20例，其5年生存率分别为90．5％（19／21）和90．0％（18／20），腺内型cN0不伴被膜侵犯者均未行颈清扫，其5年生存率为99．0％（99／100），5年内发生颈淋巴结转移率为1．0％（1／100）；腺外型cN0行颈清扫4例，5年内发生对侧转移为1／4，3例未行颈清扫者5年内发生颈淋巴转移为2／3。腺叶切除术后对侧复发率为2．47％（4／162）。行全甲状腺切除的5年生存率为85．7％（12／14），被膜内全甲状腺切除的5年生存率为85．0％（17／20）。侵犯甲状软骨板及气管者，行喉全切除，其5年生存率为3／5，保留喉功能的5年生存为6／9。结论：对甲状腺乳头状癌提倡功能性颈清扫；腺内型cN0者主张随访观察，发现淋巴转移再生颈清扫；腺外型cN0病人主张同期颈清扫。原发灶位于单侧行腺叶及峡部切除，位于峡部及左，右叶各1／3切除，位于双侧行被膜内全甲状腺切除，侵犯甲状软骨板及气管者尽可能保留喉功能。     

会厌下移一期重建声门治疗声门癌

本文报道用会厌下移一期重建声门术（Ｔｕｃｋｅｒ术）治疗双声带受侵犯的声门癌３１例，结果证明此手术不仅能彻底切除肿瘤，而且能有效的保存喉的发声、呼吸和吞咽保护功能，３年生存率８１．５％（２２／２７），降低了致残率及复发率，改善了患者的生存质量，故认为该术式是治疗双声带受侵的声门癌的一种较理想术式，值得推广使用。     

甲状腺乳头状腺癌颈淋巴结清扫术

我院在１９５２～１９９７年共治疗甲状腺癌２０９７例，其中乳头状腺癌１７３２例１９５４～１９９２年间乳头状腺癌１２１９例，男３１７，女９０２例，男女之比为１：２．８５．年龄最小６岁，最大８０岁，中位年龄３７．６８岁，Ｓ＝１２．７２，行颈淋巴结清除术９１３例（７１例行双颈清除术），共９８４例次。通过对９１３例（９８４例次）颈淋巴结清除术的分析及随访。预防性组淋巴结阳性率为６６．３２％，治疗性组为９３．９８％，预防性组１０年以上无瘤生存率远高于治疗性组。治疗性组５年、１０年无瘤生存率功能性组优于传统性组（Ｐ＜０．０１），预防性组１０、１５、２０年无瘤生存率功能性组优于传统性组（Ｐ＜０．００５），说明功能性颈淋巴结清除术即保留功能又不降低生存率，是一种值得提倡的治疗方法。另外通过１０９例死亡原因回顾，死于复发和转移６２例（５６．８８％），术后１０年内死亡者占８３．８７％（５２／６２），术后１０年以上复发机会明显减少。转移瘤多以肺转移为主，占７１．４％。     

64例下咽癌病人临床疗效的回顾分析

目的 :探讨下咽癌外科切除与修复手术的治疗效果。方法 :分析 1989年 1月～ 1995年 9月 6 4例下咽癌切除患者的手术方法、并发症、生存率等 ,其中保留喉功能的下咽癌切除患者 2 6例 ,未保留喉功能的下咽癌切除患者 38例。结果 :6 4例下咽癌患者手术后全部恢复了吞咽功能 ,并发症发生率 40 .6 % (2 6 / 6 4) ,以咽瘘最常见。2 6例保留喉功能的下咽癌切除术后拔管率 5 3.8% (14/ 2 6 ) ,3年和 5年生存率分别为 6 5 .4% (17/ 2 6 )和 5 0 % (13/ 2 6 )。38例喉全切除下咽癌患者 3年和 5年生存率分别为 5 2 .6 % (2 0 / 38)和 44 .7% (17/ 38)。保留喉功能和未保留喉功能两者 3、5年生存率比较没有显著差异 (P >0 .0 5 )。结论 :保留喉功能下咽癌手术适用于 T1 、T2 期的肿瘤及经过仔细选择部分 T3期肿瘤患者 ,不影响患者的长期生存率 ,同时可有效的提高患者的生存质量     

甲状腺癌再次手术62例临床分析

目的：总结甲状腺癌再手术的原因及探讨甲状腺癌再手术方式。方法：临床资料回顾性分析,结合文献进行讨论。结果：同期手术治疗甲状腺癌患者共１３３例,其中６２例属再次手术治疗（占４６．６％）,男性１５例,女性４７例。再手术原因包括：①原发癌灶残留;②甲状腺癌联合根治术后复发或淋巴结转移;③对侧甲状腺及对侧颈淋巴结出现病灶;④甲状腺隐性癌并颈淋巴结转移。再手术方式包括：①对原发灶行单纯肿瘤切除或腺叶次全切除者,切除残叶及峡部,或加对侧叶次全切;②对颈部淋巴结转移者,行颈淋巴结清扫术;③对隐性癌并颈淋巴结转移者,行甲状腺癌联合根治术;④对侧甲状腺及对侧颈淋巴结转移者,作对侧甲状腺癌根治术。再手术组５年生存率８４．８％,８年生存率８０％。结论：对局限于一侧甲状腺叶的甲状腺癌,首次手术至少行患侧甲状腺叶及峡部切除,避免单纯肿瘤摘除术;联合根治术后复发或颈淋巴结转移患者,手术仍为主要治疗手段;应重视甲状腺隐性癌的诊断及处理。     

蝶窦区病变外科手术径路之探讨——附50例报告

目的:探讨切除蝶窦区病变的良好手术径路。方法:根据病变种类的不同,分别采用:①用鼻内镜经单侧鼻腔入路治疗双侧蝶窦病变;②腭部粘膜“Ｔ”形瓣翻揭＋硬腭开窗入路;③扩大的鼻侧切开＋鼻锥翻揭入路;④颅面联合径路;⑤骨折外移鼻中甲行鼻中隔蝶窦入路。结果:本组５０例,术中视野较为开阔、清晰。因减少了手术盲目性,本组未出现医源性并发症。蝶窦区良性病变３７例中,术后随访３年未见复发;蝶窦区恶性肿瘤１３例中经随访,３年存活率为６１．５%(８/１３),５年存活率为４６．２%(６/１３)。结论:为了减少手术并发症,根据蝶窦的不同病变而采取不同的手术径路是合理的。     

游离腹直肌肌皮瓣移植颅面部巨大缺损一期整复术

目的 :探讨修复巨大颅面缺损的手术方法。方法 :采用显微血管外科技术 ,对 4例颅面部晚期癌肿切除术后形成的巨大缺损施行游离腹直肌肌皮瓣移植一期整复术。其中右侧上颌窦巨大恶性血管外皮瘤侵犯颜面眼眶及颅底 1例 ,左上颌骨癌侵犯面颊及鼻背 1例 ,左上颌骨纤维肉瘤侵犯眼眶及侧颅底 1例 ,左上颌骨癌上颌骨切除术后放疗面颊部软组织大面积坏死 1例。结果 :4例游离腹直肌肌皮瓣均以腹壁下动脉为血管蒂 ,皮瓣的皮岛最小 6× 9cm,最大 12× 15cm,切取腹直肌的大小依照待修复区充填缺损所需组织量的多少而定。根据所修复的部位受区血管有所不同。术后皮瓣全部成活 ,局部整形效果满意。结论 :游离腹直肌肌皮瓣移植是修复巨大颅面缺损的一种可靠和理想的手术方法     

舌体癌的手术治疗方法探讨

目的 :回顾性总结我科 1988年至 1995年间舌体鳞癌手术治疗经验 ,探讨舌体鳞癌手术治疗方法相关问题。材料与方法 :入选病例为 1988年 5月～ 1995年 6月我科住院初治舌体鳞状细胞癌共 185例。男 10 2例 ,女 83例 ,年龄 2 8～ 88岁。临床分期 : ～ 期 72例 , ～ 期 113例。所有病例均行原发灶手术切除 +颈淋巴清扫术。原发灶手术切除术后缺损及下颌骨体部处理根据不同情况采用不同术式。c N0 14 8例行选择性颈淋巴清扫术。c N1～ 337例行治疗性根治性颈淋巴清扫术。结果 :185例中 177例获 5年随访 ,随访率 95 .6 8%。 185例舌体鳞癌 5年生存率为 72 .4 3%。已死亡 4 3例中 ,因肿瘤局部复发 30例 ,淋巴转移 7例 ,远处转移 5例 ,其它 1例。舌体缺损修复 :未修复者 4 2例 ,用前臂皮瓣修复 117例 ,胸大肌皮瓣修复 2 6例。下颌骨体部处理 :未切除者 92例 ,方块切除 75例 ,下颌骨体部部分切除 18例。 185例颈淋巴转移率为 2 9.19% ,c N0 者颈淋巴 p N+转移机率为 19.5 9%。结论 :舌体鳞癌行下颌骨体部切除者适用于癌肿已侵犯口底颌舌沟舌侧粘骨膜者。舌体鳞癌舌体缺损小于 1/ 3时可不修复 ,大于 1/ 2者可应用前臂皮瓣 ,大于 2 / 3者行胸大肌肌皮瓣修复。c N0 选择性颈清扫术 :T1 者颈部严密观察 ,T2 行肩胛舌     

Recurrence pattern after conservative surgery for papillary thyroid carcinoma

Objective

Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma.

Methods

We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk.

Results

The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p < 0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (≥4 cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis.

Conclusion

Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence.     

Transoral videolaryngoscopic surgery for papillary carcinoma arising in lingual thyroid

Carcinoma arising in lingual thyroid is an extremely rare entity accounting for only 1% of all reported ectopic thyroids. Here, we report a case of carcinoma arising in lingual thyroid, which has been successfully managed by transoral resection and bilateral neck dissections.A lingual mass 4-cm in diameter with calcification was incidentally detected by computed tomography at medical check-up. No thyroid tissue was observed in normal position. Ultrasound examination showed bilateral multiple lymphadenopathies. Fine needle aspiration biopsy from lymph node in his right neck was diagnosed as Class III and thyroglobulin level of the specimen was 459 ng/ml. Due to the difficulty in performing FNA of the lingual masses, right neck dissection was performed in advance for diagnostic purpose. Pathological examination showed existence of large and small follicular thyroid tissues in several lymph nodes, suggesting lymph node metastasis from thyroid carcinoma. Two months after the initial surgery, video-assisted transoral resection of lingual thyroid with simultaneous left neck dissection was performed. Postoperative course was uneventful. Papillary carcinoma was found in the lingual thyroid and thyroid tissues were also found in left cervical lymph nodes.Video-assisted transoral resection was useful for the treatment of thyroid cancer arising in lingual thyroid.     

Clinical study on papillary thyroid carcinoma presenting with lymph node metastasi

Papillary thyroid carcinoma (PTC) may metastasize to cervical lymph nodes. It is, however, uncommon for a palpable neck node alone to lead to the diagnosis of this disease when it is not apparent at presentation. Standard treatment for such cases has not yet been established. We retrospectively analyzed clinical courses in 8 patients with thyroid papillary carcinoma presenting with palpable lymph node metastasis at Hokkaido University Hospital between 1990 and 2003. Three had high thyrogloblin in cervical cystic lesions, leading to the diagnosis of PTC with lymph node metastasis. In 4, PTC was diagnosed by pathological examination of cervical lymph nodes initially diagnosed as lateral cervical cysts. Preoperative examination did not indicate PTC within the gland in any case. All 8 were alive at the last visit after follow-up from 23 to 150 months (mean: 78 months). Total thyroidectomy was done on 4 and thyroid lobectomy on 3. Pathological examination of resected thyroid glands confirmed multifocal papillary carcinoma from 4 mm to 15 mm in diameter. Six underwent unilateral neck dissection and 1 chose bilateral dissection. The other patient received no additional surgery on either the thyroid or neck after the single enlarged lymph node initially diagnosed as a lateral cervical cyst was resected. Postoperative radioiodine treatment was done in 2 undergoing total thyroidectomy. Recurrence in the cervical area were observed in 1 whose neck dissection was insufficient. Based on these observations, we concluded that patients who undergo thyroid lobectomy and adequate neck dissection may enjoy longer survival than those treated with total thyroidectomy without sacrificing thyroid and parathyroid function. We therefore propose a prospective study on the effectiveness of thyroid lobectomy with neck dissection including positive nodes in patients with occult PTC presenting with lymph node metastasis.     

前哨淋巴结探查在甲状腺乳头状癌外科手术中的应用

目的：探讨甲状腺乳头状癌前哨淋巴结（SLN）的检测及其对颈淋巴结转移的预测价值。方法：用术中在肿瘤周围注射亚甲蓝的方法对25例甲状腺乳头状癌患者进行SLN的临床研究,术中取蓝染淋巴结及颈清淋巴结做常规苏木精-伊红染色病理检查,并将两者进行对照,观察SLN转移对颈淋巴结转移的预测作用。结果：25例患者中22例成功地显示了SLN,成功率为88％,显示的SLN中有19例病理阳性,其中13例颈淋巴结清扫术证实有非SLN的颈淋巴结转移,5例未发现有非SLN的其他淋巴结转移,1例因自身因素未行颈淋巴结清扫术。结论：SLN检测对预测甲状腺乳头状癌淋巴结转移有重要价值。     

Early death from papillary thyroid carcinoma

Purpose

The natural history of papillary thyroid carcinoma (PTC) is characterized by a slow growth rate and an excellent prognosis at 20 and 30 years. However, there is a small subset of patients with poorer outcome.

Methods

Twenty patients who died of PTC within 10 years of diagnosis were studied to identify prognostic indicators and biological markers of early death. Findings were statistically compared with a previous review of all patients with PTC treated in the same institute and studies in the literature.

Results

The study group included 6 men and 14 women with a mean age of 65 years at diagnosis. Average tumor size was 3.6 cm; 16 patients had extracapsular extension. All tumor samples studied histologically stained poorly for p53, Ki67, and CD34. Regional metastases were present in half the patients, and distal metastases in all. All patients had an advanced disease stage (Tumor, Node, Metastases classification), and only 4 had a low score on the Metastases, Age, Completeness of resection, local Invasion, tumor Size risk stratification. Analysis of the findings against data in the literature for the whole population of patients with PTC, who had a considerably better survival (<8% mortality within 8-15 years vs 100% within 10 years in our sample), yielded significant differences for rates of extrathyroidal extension (P = .0001), regional metastases (P = .016), and distant metastases (P = .0001).

Conclusion

Extrathyroid extension, late regional metastases, and distant metastases may be risk factors for early death from PTC.     

Cystic papillary carcinoma of thyroid gland — A rare case

A case of cystic papillary carcinoma of thyroid gland is reported, which depicts typical ultrasonographic features that help in diagnosing a rare case with diagnostic certainty.     

甲状腺乳头状癌的基因重排分析

目的研究中国人甲状腺肿瘤的RET／PTC和H4-PTEN基因重排的规律及其与临床病理的联系。方法运用RT-PCR和测序的方法，检测了139例患者的甲状腺肿瘤组织中RET／PTC-1、RET／PTC-2、RET／PTC-3、ELKS—RET以及H4-PTEN（H4／PTEN和PTEN／H4）的重排方式。结果在126例甲状腺乳头状癌中，共发现12例RET／PTC-1重排、6例RET／PTC-3重排、6例次H4／PTEN重排和7例次PTEN／H4重排，其中有3例同时检出了两种以上重排，总的重排阳性率为21、4％（27／126）。H4-PTEN重排阳性的病例在三次重复实验中，不能得到相同的结果。重排阳性的病例具有发病年龄较轻（P=0．02）和淋巴转移概率较高的特点（P=0．02），RET重排阳性的患者颈侧区的淋巴转移的概率较高（P〈0．01）。PTEN／H4重排也存在于甲状腺髓样癌（2／5）。结论H4-PTEN重排可以与RET／PTC重排同时发生。甲状腺乳头状癌是一种具有高度重排易感性的肿瘤。重排阳性的甲状腺乳头状癌具有发病年龄较轻和淋巴转移概率较高的特点。