鼻腔副鼻窦癌鼻窦镜下手术加术后放疗

鼻腔副鼻窦癌是头颈部较常见恶性肿瘤,早期患者手术切除 术后放疗预后颇佳.随着内窥镜技术的发展,某些鼻腔副鼻窦肿瘤亦可选择内窥镜下手术切除.本文着重分析鼻腔副鼻窦癌,鼻窦镜下手术切除加术后放疗的局部控制率、术后放疗的意义、适应证的选择.     

复发性鼻腔鼻窦内翻性乳头状瘤治疗分析

目的 探讨复发性鼻腔鼻窦内翻性乳头状瘤治疗。方法 对26例鼻腔鼻窦内翻性乳头状瘤术后复发病人，行鼻外进路加经鼻内窥镜手术切除，术后平阳霉素术腔贴敷方法治疗。结果 26例病人，术后随访－3年，痊愈24例，复发2例，治愈率92．3％。结论 采用鼻外进路加鼻内窥镜手术的方法和药物的综合疗法，对复发性鼻腔鼻窦内翻性乳状瘤治疗有重要意义。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中，22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术，4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9～60个月。1例术后30个月复发，其它25例未见复发，全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变，而对广泛病变则应采用鼻内镜联合鼻侧切开术，术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的 研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法 对25例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术，术中配合使用电动吸切器切除肿瘤，术后随访12～60个月。结果 全部25例均在鼻内窥镜下一次完整切除肿瘤。25例中2例分别于术后12个月和16个月内复发，其余23例在随访期内未见复发。结论 使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效，对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

复发性鼻腔鼻窦内翻性乳头状瘤治疗分析

目的　探讨复发性鼻腔鼻窦内翻性乳头状瘤治疗。方法　对 2 6例鼻腔鼻窦内翻性乳头状瘤术后复发病人 ,行鼻外进路加经鼻内窥镜手术切除 ,术后平阳霉素术腔贴敷方法治疗。结果　 2 6例病人 ,术后随访 1～ 3年 ,痊愈 2 4例 ,复发 2例 ,治愈率 92 3%。结论　采用鼻外进路加鼻内窥镜手术的方法和药物的综合疗法 ,对复发性鼻腔鼻窦内翻性乳头状瘤治疗有重要意义     

中山医科大学肿瘤防治中心利用鼻内镜手术鉴别副鼻窦疾患

为鉴别鼻咽癌原发肿瘤有否侵犯鼻窦，放疗后有无残存肿瘤、肿瘤复发及副鼻窦非癌病变，直接关系到治疗靶区的确定和设野，关系到是否需要再行放疗或手术、化疗。而鼻窦部位深而隐蔽，活检受到限制。近年主要采用CT等检查诊断，但不能确定病变性质，影响了临床诊断的准确性及治疗方法的选择，延误了治疗时机。中山医科大学肿瘤防治中心黄晓明博士从国外引进先进的鼻内镜技术，在临床上对放疗后鼻窦部位有阳性CT征像的患者，进行了鼻内镜手术，能尽快确诊，及时制定治疗措施。此手术径路便捷，损伤少，能直视下取材，制定原发灶有否侵及副具…     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中,22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术,4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9~60个月。1例术后30个月复发,其它25例未见复发,全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变,而对广泛病变则应采用鼻内镜联合鼻侧切开术,术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的　研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法　对 2 5例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术 ,术中配合使用电动吸切器切除肿瘤 ,术后随访 12～ 60个月。结果　全部 2 5例均在鼻内窥镜下一次完整切除肿瘤 ,2 5例中 2例分别于术后 12个月和 16个月内复发 ,其余 2 3例在随访期内未见复发。结论　使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效 ,对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

6例孤立性蝶窦肿瘤的诊断与手术治疗

目的：研究孤立性蝶窦肿瘤的诊断和治疗。方法：6例孤立性蝶窦肿瘤,全部病人均有头痛症状,其中5例有眼-神经症状,所有病人均经CT证实为孤立性蝶窦占位性病变,并在鼻内窥镜下取病检。其中良性2例,包括乳头腺瘤1例,内翻性乳头状瘤1例。恶性肿瘤4例,包括蝶窦低分化鳞癌2例,腺样囊性癌1例,内翻性乳头状瘤恶变1例。1例乳头状腺瘤行鼻内窥镜下蝶窦开放术,其余5例经鼻外筛窦径路手术。结果：2例良性肿瘤中,1例乳头状瘤治愈随访40月,1例内翻性乳头状瘤手术后随访15月症状改善。4例恶性肿瘤中3例术后放疗观察18-28月无复发。1例失访。结论：鼻内窥镜、影像学检查对本病的诊断起重要作用,并对手术有指导意义。良性肿瘤以鼻内窥镜手术为主。恶性肿瘤以手术加放疗治疗,鼻外筛窦径路是治疗此类恶性肿瘤的优选术式。     

鼻腔—鼻窦肿瘤的内窥镜诊断、治疗与随访

鼻内窥镜手术在临床应用于慢性鼻窦炎或(和)鼻息肉的治疗取得了良好的效果并已广泛开展。随着鼻内窥镜外科技术的发展,其应用范围不断扩大,已延伸到鼻腔、鼻窦肿瘤的诊断、治疗与随访[1]。我科自1996年起在这方面开展了一些临床工作。现将资料进行回顾,以探讨鼻内窥镜在鼻腔一鼻窦肿瘤的诊断、治疗、随访方面的应用价值。     

Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.     

CT Scan Study of Influence of Septal Angle Deviation on Lateral Nasal Wall in Patients of Chronic Rhinosinusitis

The nasal septum is an important physiological and support structure of the nose. The nasal septal deviation causes alteration in air flow, mucociliary clearance and effects structures of the lateral nasal wall causing various nasal symptoms and other sinonasal disease. A systematic analysis was performed to measure the angle of septal deviation on CT scan PNS coronal section and to evaluate the influence of increasing septal angle deviation on the severity of lateral nasal wall abnormalities. A total of 61 patients with clinical evidence of chronic rhinosinusitis refractory to medical therapy for minimum three months were included in this study. After preliminary anterior & posterior rhinoscopic examination, all patients were evaluated with nasal endoscopy & CT scan PNS coronal view. There was statistically significant increase in hypertrophy of the middle turbinates and prominence of bulla ethmoidalis with OMC impingement on the side opposite to the direction of septal deviation. No apparent statistically significant difference between ipsilateral and contra lateral side OMC disease and anterior sinus mucosal disease in relation to direction of septal deviation in various groups was seen. We concluded that there is a strong association of increasing angles of septal deviation with corresponding patterns of disease in ostiomeatal complex. The result of the present study reemphasized the fact that, obstruction at ostiomeatal complex and anterior ethmoids secondary to septal deviation is the key factor for causation of chronic sinusitis.     

鼻腔原发性恶性黑色素瘤25例临床病理分析

目的观察鼻腔原发性恶性黑色素瘤的形态特点，以帮助临床诊断和治疗。方法对1975年-2006年间诊治的鼻腔原发性恶性黑色素瘤25例的临床资料进行回顾性分析。结果25例中，肿瘤多位于鼻腔外侧壁和鼻中隔，中鼻道10例，鼻中隔6例，中鼻甲4例，下鼻甲3例，鼻底1例，另1例病变范围广无法判断其来源。肿瘤呈黑色或紫褐色21例，呈结节状或菜花状；淡红色表面光滑如息肉状4例；肿瘤触之易出血。结论鼻腔原发性恶性黑色素瘤临床少见，易误诊，应与鼻腔癌、血管瘤、鼻息肉相鉴别；对鼻腔发现的黑色或紫褐色肿物，触之易出血者可作该病的临床诊断，活检应谨慎，以免促进肿瘤转移。     

Carcinomas of the nasal cavity.

Between 1969 and 1985, 45 patients with carcinomas of the nasal cavity proper received curative treatment. Thirty patients had squamous cell carcinoma, one had undifferentiated carcinoma, 9 had adenocarcinoma, and 5 had adenoid cystic carcinoma. Eighteen patients were treated with definitive radiotherapy (interstitial brachytherapy in 5 and external beam therapy in 13 patients), and 27 received surgery and radiotherapy. The median length of follow-up was 11 years (range: 2.8-16.8 years). Thirty-six patients had no evidence of disease at the last follow-up visit. All 14 patients with carcinoma of the nasal septum had the disease controlled. Nine of 31 patients with lesions of the lateral wall and floor died of the disease, 5 of uncontrolled local disease, 2 of distant metastases, and 2 of both. The disease-specific survival rates at 5 and 10 years were 83 and 80%, respectively, and the corresponding overall survival rates were 75 and 60%, respectively. Blindness occurred in 4 patients, 2 due to orbital exenteration and 2 to radiation injury to the cornea and optic pathway. Other infrequent side effects were bone necrosis, dental decay, nasal stenosis, and septal perforation. This study indicated that the prognosis of patients with nasal cavity carcinoma was better than that of patients with maxillary sinus cancer treated during the same era. In addition, the study showed that carcinomas of the nasal septum were smaller than those of lateral wall and floor at diagnosis, so that excellent control could be achieved by definitive radiotherapy; when accessible, interstitial brachytherapy might be the treatment of choice in such patients.     

Extranodal Natural Killer/T-Cell Lymphoma of the Nasal Type with Skin Metastases

Extranodal natural killer/T-cell lymphoma (ENKL) of the nasal type is a rare, clinically aggressive disease. ENKL of the nasal type is often localized in the upper aerodigestive tract, including the nasal cavity, nasopharynx, paranasal sinuses, tonsils, hypopharynx and larynx, and usually presents as stage I/II. Extranasal involvement can occur, and a common site of extranasal involvement or metastatic disease includes the skin. Identifying skin metastases is important for the appropriate staging and treatment. We report a case of ENKL of the nasal type that presented with localized disease and subsequent skin lesions that were consistent with skin metastases.Key Words: Extranodal natural killer/T-cell lymphoma, Nasal type, Skin metastases     

鼻中隔基底细胞腺瘤恶变1例报告及文献复习

目的:描述1例来源于鼻中隔的基底细胞腺瘤的病情经过,并对鼻部区域原发性基底细胞腺瘤/癌的相关文献进行复习.方法:对本例患者的临床特征,影像学以及病理学改变进行分析.总结了既往所报道的2例鼻腔原性基底细胞腺瘤以及所有文献所报道的原发于鼻部区域的基底细胞腺癌的临床与病理特征.结果:原发于鼻部区域的基底细胞腺瘤/癌(BCA/BCAC)较为罕见,两者的主要症状为鼻阻塞与鼻出血,平均病程为3.6月.13例BCAC的颈淋巴结转移率为15.4％,远低于头颈部其它区域的BCAC.术后复发率为50％,病死率为25％.电镜下BCAC与BCA在组织学上有很多相似之处,但BCAC的细胞具有异型性,核分裂象较多见,生长呈侵袭性,可能浸润周围血管或神经.BCAC需和实性腺样囊性癌、涎腺导管癌和基底样鳞状细胞癌相鉴别.结论:BCAC多数生存时间较长,生物学行为符合低度恶性肿瘤,其易复发但侵袭力不强.鼻腔的基底细胞腺瘤可能具有恶变倾向,密切随访极为必要.     

不同治疗方案对原发于鼻咽部非霍奇金淋巴瘤疗效分析

目的探讨以鼻咽部为首发部位的非霍奇金淋巴瘤的临床特征、治疗方法和预后。方法回顾性分析北京协和医院1994～2007年12月期间收治的66例首发于鼻咽部非霍奇金淋巴瘤患者,比较其临床特点,探讨其治疗方式及预后。结果首发于鼻咽部的淋巴瘤66例,男40例,女26例,81％首发于鼻腔或鼻窦,以鼻塞、流涕为主要临床表现,主要治疗分单放疗、单化疗、先放后化、先化后放4种,有效率分别为100％（3／3）、40％、60％、87％,生存期分别为43个月、8个月、10个月、42个月（P〉0．05）。病理类型、国际预后指数、分期可能对患者的生存产生影响。结论首发于鼻咽部非霍奇金淋巴瘤在临床表现上有特殊的表现,治疗应以综合治疗为主。对T细胞和NK／T细胞来源、分期晚、局部侵犯或中高危患者应采取更加积极的治疗手段。     

鼻T／NK细胞淋巴瘤诊断分析

目的提高对鼻T/NK细胞淋巴瘤的认识,减少误诊误治.方法对10例本病患者临床资料进行回顾性分析.结果中位年龄49.5岁,男女比例4∶1.7例病检之前曾被临床误诊为慢性鼻炎、鼻窦炎、鼻疖、鼻息肉及咽喉炎,误诊率达70.0%(7/10).首次病检诊断鼻T/NK细胞淋巴瘤4例,首次或前2次病检未确诊6例,病理假阴性率达60.0%(6/10).全部病例经免疫组织化学检查证实鼻T/NK细胞淋巴瘤.误诊主要原因为:①对本病认识不足,病检不及时;②取材不当致假阴性病理结果.结论本病多发于40岁以上男性,临床表现复杂、无特异性,且病理形态多样,易误诊及延误治疗.重复病检并结合免疫组化检查是诊断与鉴别诊断的重要手段.     

Atypical Presentations of Rhinosporidiosis: A Clinical Dilemma?

Rhinosporidiosis is a chronic inflammatory disease common in India and Sri Lanka. Its manifestations are mostly nasal, though extranasal ones in head and neck region are not rare. Occasionally these presentations lead to diagnostic dilemma. Here we present some cases with its associated confusions if any. In this study thirty five patients were included. Extranasal manifestations were noted in nine cases. Two patients attended with laryngopharyngeal and one with lacrimal sac presentation–subsequent nasal endoscopic examination revealed presence of nasal masses, too. Other six cases presented with polypoidal mass hanging from nasopharynx into oropharynx. One of them was confused with nasopharyngeal angiofibroma. Two laryngopharyngeal masses were removed successfully with rigid laryngoscope followed by cauterisation of the base. The solitary lacrimal sac mass was excised by external approach combined with nasal endoscope guided excision of nasal mass. The other six cases with nasopharyngeal attachment were subjected to nasal endoscope guided removal. In all these cases, the base of the lesions was cauterised. The experience about the various manifestations and diagnostic problems is discussed here.     

鼻NK／T细胞淋巴瘤相关噬血细胞综合征

 【摘要】　目的　探讨鼻NK／T细胞淋巴瘤并发噬血细胞综合征（HPS）的临床特征、治疗方法及预后。方法　对3例鼻NK／T细胞淋巴瘤并发HPS患者的临床资料进行回顾性分析。结果　3例鼻NK／T细胞淋巴瘤患者符合HPS诊断标准,初诊时具有多项淋巴瘤相关不良预后因素,1例以HPS为首发症状,2例发生HPS时处于疾病进展期,骨髓检查均发现淋巴瘤细胞浸润。并发HPS后患者病情进展迅速,最明显症状是发热、血象进行性下降、纤维蛋白原降低、血清铁蛋白升高及骨髓中出现噬血现象。给予以HLH-2004为基础的方案联合化疗后,HPS均有不同程度改善,但由于原发病无法控制,HPS很快复发,患者并发肝功能异常、凝血异常或弥散性血管内凝血,最终死亡。结论　鼻NK／T细胞淋巴瘤并发HPS时预后差,常发生在淋巴瘤进展期或终末阶段。以HLH-2004为基础的方案联合化疗有望逆转病情,延缓疾病进展,为原发病治疗创造机会。