舌癌cNO患者哨位淋巴结检测方法的比较

目的：探索舌癌哨位淋巴结（sentinel node，SN）检测的理想方法，比较术前核素扫描＋术中亚甲蓝示踪法和术中γ探头检测法的应用价值。方法：分别采用术前核素扫描＋术中亚甲蓝示踪法（A组）和术中γ探头检测法（B组），对临床NO（clinically NO，cNO）舌癌患者各20例进行SN检测，以颈清扫标本常规病理检查及随访中淋巴结复发与否为评价颈部淋巴结转移状况的金标准，比较2种方法检测SN的有效性；采用SPSS12．0软件包进行χ^2检验。结果：A组SN检出率为100％（20／20），隐匿性淋巴结转移的发生率为25％（5／20），SN活检评价颈淋巴结转移状况的准确率为95％（19／20），假阴性1例，阴性预测值均为94％（15／16）。B组SN检出率为95％（19／20），隐匿性颈淋巴结转移率为15％（3／20），SN活检评价颈淋巴结转移状况的准确率和阴性预测值均为84％（16／19），假阴性3例，假阴性率为16％（3／19）。2组SN检出率、阴性预测值无统计学差异，P〉0．05。结论：舌癌SN检测方法中，术中γ探头检测法并不优于术前核素扫描＋术中亚甲蓝示踪法，后者简便易行，有较高的实用价值。     

舌癌前哨淋巴结活检的临床研究

目的　探索前哨淋巴结 (sentinelnode ,SN)活检能否准确评价舌癌颈淋巴结转移状况及其适应范围。方法　使用术前核素扫描法和术中亚甲蓝示踪法对临床N0 (cN0 )舌癌 2 0例和临床N (cN )舌癌 5例进行SN示踪 ,对比SN和颈清扫标本石蜡切片病理结果。结果　全组 2 5例检出SN 2 4例 ,检出率为 96 % ,共 5 3个 ,平均每例 2 2个 ;cN0 组 2 0例全部检出SN并准确评价颈淋巴结转移状况 ;cN 组 5例中检出SN 4例 ,4例中cN 颈部 5侧 ,其中有 4侧检出SN ,2侧为假阴性 ,cN0颈部 3侧中 2侧检出SN ,均为SN pN 。结论　核素扫描法和生物染料法结合能有效地对舌癌进行SN示踪 ;SN活检能准确地评价cN0 舌癌颈部淋巴结转移状况 ;能否用于评价cN 病例的cN0 侧颈部淋巴结转移状况需进一步研究。     

临床NO舌鳞癌哨位淋巴结微转移检测及其意义

目的:以CK19 mRNA为标志物,采用RT-PCR法检测临床NO舌鳞癌哨位淋巴结(sentinel node.SN)的微转移状况,从基因水平探讨择区颈清扫的必要性.方法:采用1γ头示踪法对21例临床NO舌鳞癌患者进行SN示踪,采用RT-PCR法检测CK19基凼在SN中的表达,并与颈部慢性炎症淋巴结和舌鳞癌转移淋巴结各10枚的CK19基因表达进行对比.采用SPSS10.0软件包进行χ2:检验.结果:21例临床NO舌鳞癌中,20例SN示踪成功,共取得SN 53枚,每例1～4枚,平均2.65枚.RT-PCR法检测CK19基因表达诊断颈部淋巴结转移的敏感度为90%.特异度为80%,SN示踪成功的20例中,常规病理检查发现淋巴结转移2例,隐匿性转移率为10%;51枚常规病理阴性的SN中,CKl9-mRNA阳性表达ll枚(来自7例患者),微转移发牛率为21.57%,隐匿性转移率为35%,2种方法评价舌鳞癌隐匿性颈淋巴结转移率有显著性差异,P=0.013.结论:由于微转移的存在,以SN常规病理分析来决定颈清扫术式并不可靠,择区颈清扫仍然是临床NO舌鳞癌颈部治疗的首选方法.     

口腔黏膜恶性黑色素瘤颈淋巴结转移区域特点初探

目的:通过分析口腔黏膜原发性黑色素瘤颈淋巴清扫术后标本中淋巴结转移情况,探索口腔黏膜恶性黑色素瘤的颈淋巴结转移特点,为颈清术式的选择及标本的规范处理提供指导。方法:收集整理1999-08—2009-07我院口腔病理科的原发性口腔黏膜恶性黑色素瘤的病例资料,用HE和免疫组化染色重新判定颈淋巴结转移的情况。结果:在获得的56个病例中,发生转移的共50例,86%的颈淋巴结转移多发于Ⅰ～Ⅲ区(43/50例),在Ⅰ～Ⅲ区的标本中淋巴结转移阳性率为21.1%(215/1017枚),Ⅳ区和Ⅴ区为4.57%(18/394枚);19例术前临床诊断无转移者(cN0)中有13例术后病理发现存在颈淋巴结转移,假阴性率达68.5%。结论:口腔黏膜恶性黑色素瘤的cN0患者应接受选择性颈淋巴结清扫,术式宜选择功能性肩胛舌骨上清扫术;应重视颈清术后标本淋巴结的分区送检,尤其Ⅴ区的送检。     

cN0舌癌患者颈淋巴结转移的区域分析

目的探讨cN0舌癌患者颈淋巴结转移的区域分布情况,为cN0舌癌患者颈淋巴清扫的术式选择提供参考。方法取61例cN0舌癌患者根治性颈淋巴清扫术后标本,收集各平面区域的淋巴结进行病理切片,分析其淋巴结转移情况及各区域的分布。结果 20例患者发现淋巴结转移,转移率32.8%,811颗淋巴结中62颗证实有转移,占7.6%。其中平面Ⅰ为11.0%（26/237）,平面Ⅱ为8.2%（20/243）,平面Ⅲ为6.0%（13/218）,平面Ⅳ为3.5%（3/85）,平面Ⅴ无淋巴结转移。结论 cN0舌癌患者仍有较高的颈淋巴结转移率,转移淋巴结主要分布于平面Ⅰ、Ⅱ和Ⅲ,少部分转移至平面Ⅳ,选用肩胛舌骨上颈淋巴清扫术最好扩展至平面Ⅳ。     

纳米碳混悬液示踪早期舌鳞癌前哨淋巴结的临床研究

目的 评估纳米碳混悬液示踪cT1-2N0舌鳞癌前哨淋巴结的效果,进一步探究其在口腔癌前哨淋巴结活检中的应用价值. 方法 58例cT1-2N0的舌鳞癌患者被纳入本次前瞻性研究. 其中试验组30例患者术前于癌周注射纳米碳混悬液,对照组28例患者术前癌周注射亚甲蓝. 所有受试者均接受选择性颈淋巴清扫术. 结果 试验组较对照组术野清晰,染色淋巴结与周围组织界限清楚. 试验组中,纳米碳混悬液对前哨淋巴结的检出率、敏感度、准确率和假阴性率分别为96. 7%(29/30)、87. 5%(7/8)、93. 3%(28/30)和12. 5%(1/8);对照组中亚甲蓝对前哨淋巴结的检出率、敏感度、准确率和假阴性率分别为92. 8%(26/28)、66. 7%(4/6)、85. 7%(24/28)和33. 3%(2/6),2组差异均无统计学意义(P>0. 05). 结论 纳米碳混悬液有助于前哨淋巴结的检出,注射纳米碳混悬液可作为舌鳞癌前哨淋巴结活检的重要辅助手段.     

蓝染法定位CN0舌癌前哨淋巴结的价值

目的：探讨蓝染法在CN0期舌鳞癌前哨淋巴结定位的应用价值。方法：对32例CN0舌鳞癌病例术中应用蓝染法定位前哨淋巴结,采用先翻开颈部皮瓣后再在病灶边缘注射亚甲蓝的方法,观察颈部淋巴结蓝染情况,计数发现淋巴结蓝染的时间及蓝染淋巴结数目,切取蓝染淋巴结送冰冻病理检查,然后完成颈清扫术,观察前哨淋巴结病检结果与术后颈部淋巴结常规病理检查结果的相关性,计算前哨淋巴结对CN0舌癌患者颈部淋巴结转移的预测价值。结果：32例中31例成功定位前哨淋巴结,定位成功率96．88％,从注射染料到出现淋巴结蓝染平均25min,每例平均定位前哨淋巴结1．9个,8例前哨淋巴结病理检查阳性,与术后常规病理检查对照未发现假阴性病例,前哨淋巴结对CN0舌癌颈淋巴结转移的阳性及阴性预测价值均为100％。结论：蓝染法定位CN0期舌鳞癌前哨淋巴结有较高的临床应用价值。     

早期局限性舌癌的隐匿性颈淋巴结转移

由于舌的淋巴供应十分丰富,因此舌癌颈淋巴结转移常见,晚期舌癌的颈淋巴结转移率为20％～50％。目前对于直径小于4cm的早期舌癌(临床No)是否需常规行预防性颈淋巴清扫术仍有不同意见。作者对28例Ⅰ、Ⅱ期舌鳞状细胞癌(SCC)病例进行回顾分析,所有患者均为初诊,经口腔入路手术切除舌部癌肿,颈部不作处理而予严密随访。结果在随诊期间,13例患者发生同侧颈淋巴结转移(3例原发灶复发伴颈淋巴结转移),1例仅局部复发,淋巴结隐匿转移率为42％(10/24)。无淋巴结转移的患者中,无一例死于原发癌,对淋巴结转移患者仅挽救性颈清扫术,成功率30％。因此作     

前哨淋巴结活检术诊断口腔鳞癌淋巴结隐匿性转移的研究进展

前哨淋巴结活检术是诊断cN_0口腔鳞癌患者颈淋巴结隐匿性转移的新手段,采用蓝色染料定位法、核素示踪法定位前哨淋巴结,对其进行病理学检查,可较精确地预测区域性淋巴结转移。该技术成功率达到 95％～100％,敏感度达到80％,阴性预测率达到100％,这对医生决定是否对患者进行选择性颈清扫术具有重要意义。     

前哨淋巴结活检在口腔鳞状细胞癌治疗中的临床意义

目的 探讨前哨淋巴结活检（sentinel lymph node biopsy，SLNB）在口腔鳞状细胞癌临床应用中的可行性、准确性。方法 对31例口腔鳞状细胞癌患者术前使用核素扫描法行前哨淋巴结（sentinellymphnode，SLN）示踪，体表定位；术中γ-探测仪进一步识别SLN行前哨淋巴结活检，同时行颈淋巴清扫；术后对SLN和颈淋巴清扫的病理检查结果进行分析。结果 SLNB对全组病例颈部淋巴结转移状况评价的准确率为96．8％。灵敏度为92，3％，假阴性率为7．7％。结论 SLNB是口腔鳞状细胞癌治疗中的一项新技术，能高灵敏度的反映颈淋巴结状态，具有临床可实用性。     

柠檬精油对牙周致病菌抑制作用及其安全性初步研究

目的:探讨柠檬精油对牙周致病菌的体外抗菌活性及对细胞增殖的影响。方法:采用微量液体稀释法测定柠檬精油对Pg、Fn、Aa、Pi的最小抑菌浓度(minimal inhibitory concentration,MIC)及最小杀菌浓度(minimum bactericidal concentration,MBC);以较低浓度的MIC为标准稀释LEO作为实验组,采用MTT法测定柠檬精油对HUVECs的毒性作用,明确抑菌浓度下LEO的安全性。结果:柠檬精油对牙周主要致病菌均有抑菌作用,Pg、Fn、Aa、Pi的MIC分别是9.0 g/L、4.5 g/L、4.5 g/L、9.0 g/L,Aa、Fn的 MBC是9.0 g/L,Pg、Pi的MBC未测得。1/2MIC、1/20MIC浓度的LEO能够抑制人脐静脉内皮细胞的生长,而低于1/200MIC浓度的LEO则对人脐静脉内皮细胞的生长没有影响,其中1/200MIC浓度的LEO作用明显优于0.02%的CHX。结论:体外环境中,柠檬精油对牙周致病菌Pg、Fn、Aa、Pi具有抗菌活性,低浓度应用对机体相对安全。     

Computer-assisted planning for maxillofacial prosthodontic rehabilitation

Computerized tomography (CT) planning and the use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects.     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

Oropharyngeal dysphagia in amyotrophic lateral sclerosis alters quality of life

Dysphagia is one of the most important complications encountered in amyotrophic lateral sclerosis (ALS). Our aim was to determine whether oropharyngeal dysphagia impacted the quality of life (QoL) of patients with ALS. Thirty consecutive patients were recruited (31–82 years, 18 men). Swallowing function was evaluated using a standardised videofluoroscopic barium swallow. All the patients completed a specific questionnaire on quality of life in dysphagia (SWAL‐QoL) immediately after the videofluoroscopy. The results of dysphagia outcome severity scale separated 14 patients with oropharyngeal dysphagia and 16 with normal swallowing function. There was no difference in the average age, weight and body mass index of the two groups (dysphagic patients: 68 ± 11 kg versus non‐dysphagic patients: 69 ± 14 kg). Most of the dysphagic patients had a bulbar affection based on their Norris scores which determine the importance of cranial nerves illness (20 ± 8), significantly lower than those of the non‐dysphagic patients (35 ± 5) (P < 0·0001). There was no difference in the neurological peripheral symptoms evaluated by Amyotrophic Lateral Sclerosis Functional Rating Scale scores (dysphagic patients: 26 ± 7 versus non‐dysphagic patients: 27 ± 8) (ns). The swallowing quality of life questionnaire revealed that the dysphagic patients had significant burden (P < 0·001). They were affected by the necessity to applied a food selection (P < 0·01), by the increase in eating duration (P < 0·05) and described a decrease in eating desire (P < 0·05). They complained of fear regarding the risk of dysphagia (P < 0·05). They also described difficulties with oral communication (P < 0·001). All of those complained about dysphagia which impacted directly mental health (P < 0·05) and social life (P < 0·05). In conclusion, oropharyngeal dysphagia is a common symptom accompanying ALS, which alters the patient's QoL, especially social health.     

Interventional neuroradiologic procedures in the head and neck

Interventional radiology and interventional neuroradiology are evolving specialties which can aid the head and neck surgeons in the clinical management of patients with complex vascular lesions.     

Functional palatomaxillary reconstruction using free tissue transfer

The use of bone containing vascularized flaps has become the gold standard in the reconstruction of composite, post ablative palato-maxillary defects.     

小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡的疗效及免疫改变

目的:探讨小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡(顽固性RAU)的临床疗效及对免疫指标调节的作用。方法:选择37例顽固性RAU的患者,小剂量短疗程口服泼尼松治疗1个月,前20 d 10 mg/d,之后5 d减量为7.5 mg/d,最后5 d减量为5 mg/d,治疗前后检查血常规、肝肾功能、外周血体液和细胞相关免疫指标,观察治疗1个月、停药2个月后临床疗效及不良反应,治疗1个月后免疫指标改变。结果:小剂量短疗程口服泼尼松治疗顽固性RAU的治疗1个月后总有效率为100%,停药2个月后总有效率为91.4%,治疗1个月后外周血免疫球蛋白及补体(IgG、IgA、IgM、IgE和C4)水平降低(P<0.05),免疫细胞(B、T淋巴细胞及NK细胞)比例未出现明显差异。结论:采用小剂量短疗程泼尼松治疗顽固性RAU有较好的疗效,可延长溃疡发作间歇期,降低溃疡发作的数目、面积及疼痛程度,未见不良反应的发生。调节体液免疫可能是泼尼松治疗顽固性RAU的途径之一。     

Researches on optimizing treatment of Chinese cleft lip and/or palate

We all know that the development of the sequential therapy ameliorates the clefts treatment. Modes and methods of the sequential therapy differ among different countries and places because of the differences of economy, medical system and sanitary status.     

Osteotomy versus unicompartmental arthroplasty: an algorithm for anteromedial knee osteoarthritis

Knee arthritis occupies a significant proportion of the musculoskeletal burden in the UK. Total knee arthroplasty currently comprises the mainstay of treatment. There has been a shift towards treating isolated unicompartmental osteoarthritis with bone-preserving surgical techniques, in the form of realignment osteotomy or unicompartmental arthroplasty. There are significant data regarding the survivorship of unicompartmental knee arthroplasty from the National Joint Registry data. Similar registry data are not available for osteotomy surgery yet, but the evidence suggests that unicompartmental knee arthroplasty has greater survivorship. Osteotomies can, however, deliver higher functional return. For both techniques to succeed, it is imperative that rigorous surgical decision-making, with regards to patient selection, should be followed. This paper discusses the basis for these principles and their importance in delivering optimal care. Often, these two surgical techniques are promoted as being mutually exclusive; this paper argues that, in fact, they are part of a complementary algorithm that can deliver the best outcome to the appropriately selected patient.