腮腺肿瘤的治疗经验及远期疗效观察

目的手术治疗腮腺肿瘤的多种方法及其远期疗效评定。方法回顾性分析我科自1997～2004年所收治的腮腺肿瘤手术患者病历资料86例,男性53例,女性33例,年龄23～84岁,中间年龄57岁。所有患者都作腮腺浅叶切除术或浅叶扩大切除术或腮腺全切除术,必要时作颈清扫术。常规术中快速冰冻和术后病理检查。术后面神经功能评定。恶性肿瘤患者辅助性根治放疗(50 Gy～70 Gy)。有效随访期36～120个月不等。结果86例腮腺肿瘤患者中良性肿瘤73例(85%),恶性肿瘤13例(15%)。8例腮腺深叶肿瘤中5例为恶性肿瘤。随访中良性肿瘤1例局部复发,局部控制率为98.6%(72/73);恶性肿瘤3年生存率为69.2% (9/13),3年原发灶局部控制率为84.6%(11/13),术后颈淋巴结转移率为23.1%(3/13)。术中快速冰冻与术后常规病理符合率为86%,腮腺良性肿瘤的面神经完好保存率为97.3%(71/73),恶性肿瘤面神经完好保存率为69.2%(9/13),总体面神经完好保存率为93%。结论腮腺浅叶切除术是常规基本术式,根据肿瘤具体情况可改变为腮腺浅叶扩大切除术或全腮腺切除术。术中应尽可能保存面神经主干及各分支,特别是颞面干。快速冰冻是腮腺手术中的有效诊断方法。腮腺深叶肿瘤恶变率高。     

腮腺肿瘤手术57例临床体会

目的探讨腮腺肿瘤手术方式、手术范围与治疗效果的关系。方法对1997～2003年间面神经解剖行腮腺肿瘤切除术57例(腮腺浅叶切除术51例，全腮腺切除术6例，1例行功能性颈淋巴结清扫术，术后加放疗4例)的临床随访资料进行分析。结果腮腺浅叶切除术51例中，并发暂时性面瘫5例，持续性面瘫1例，全腮腺切除6例中，并发暂时性面瘫2例，持续性面瘫2例，无腮腺瘘及Frey综合征，随访6月～7年无复发。结论腮腺良性肿瘤应施行解剖面神经的腮腺浅叶及肿瘤切除，恶性肿瘤在面神经尚未累及时行保留面神经的腮腺广泛切除，术后辅以放疗，可以减少肿瘤复发和面瘫等并发症的发生。     

儿童头颈部淋巴管畸形的外科治疗

目的 探讨儿童头颈部淋巴管畸形的外科治疗方法和疗效.方法 回顾性总结北京大学第一医院自1998年1月至2008年12月住院治疗的11例儿童短径大于4 cm的头颈部淋巴管畸形.11例儿童头颈部淋巴管畸形均行增强CT或MRI扫描检查,治疗均采用外科手术治疗,其中行肿物及腮腺浅叶切除4例,肿物及腮腺全切除2例,颈清扫术式切除肿物2例,颈清扫术式联合开胸术切除肿物1例,颌下肿物切除术2例.术中采用假包膜外剥离法及顺行解剖面神经主干法,肿物与面神经粘连紧密的2例行肿物剔除术.其中6例行外周面神经解剖,2例行面神经下颌缘支解剖.结果 11例儿童头颈部肿物均彻底切除,无器官功能异常,无明显外形变化,治愈率为100%.3例在行面神经下颌缘支解剖和肿物切除时牵拉下颌缘支出现轻度面瘫(下颌缘支力弱),1例颈部广泛肿物行颈清扫术后出现Homer综合征,均在神经营养治疗后术后1～3个月内恢复.1例1岁患儿行颈清扫术式联合开胸术切除肿物的术中输血150 ml.所有病例随访6～121个月,随访中位数32个月,未见肿物复发.结论 采用面神经解剖及(或)颈部解剖、肿物假包膜外剥离法等手术可以根治儿童头颈部大型淋巴管畸形,是保留功能、防止畸形的有效方法.     

cN0声门上型喉癌颈淋巴结隐匿性转移规律及处理

目的:探讨cN0声门上型喉癌患者颈部淋巴结隐匿性转移规律并选择合理的颈清扫区域。方法:139例cN0声门上型喉癌患者在行喉切除术同时行颈淋巴结清扫术,其中行改良性颈清扫57例,肩胛舌骨肌上淋巴结清扫30例,颈Ⅱ、Ⅲ区淋巴结清扫52例。将所获淋巴结按颈部分区逐一行组织病理学检查,观察其转移规律及临床疗效。结果:139例cN0声门上型喉癌患者中,同期行单侧颈清扫113例,同期行双侧颈清扫26例。139例(165侧)颈清扫标本经病理学检查,颈淋巴结阳性36例(25.9%),首次病理学检查颈淋巴结阴性者在随访中发现未手术侧淋巴结转移6例,总颈淋巴结隐匿性转移率为30.2%(42/139),单侧隐匿性转移率为26.6%(37/139),双侧隐匿性转移率为3.6%(5/139)。165侧颈清扫标本共获得淋巴结3 594枚,平均每侧21.8枚,共获病理阳性淋巴结83枚,其中位于Ⅰ区1枚(1.2%),Ⅱ区65枚(78.3%),Ⅲ区16枚(19.3%),Ⅳ区1枚(1.2%),Ⅴ区0枚。颈部复发率为5.0%(7/139),pN0与pN+的颈部复发率分别为0和16.7%(7/42),差异有统计学意义(P<0.05),总5年生存率为76.3%(106/139)。结论:颈Ⅱ、Ⅲ区是cN0声门上型喉癌颈部淋巴结隐匿性转移的主要区域,择区性(Ⅱ、Ⅲ区)颈淋巴结清扫术治疗cN0声门上型喉癌是合适的。     

244例腮腺癌治疗评估

本文总结我科从１９６４年１月到１９９１年６月诊治２４４例腮腺癌患者的治疗经验。男性１４７例,女性９７例,３０～６０岁占６２．３％。首发癌１９２例,其中临床Ⅰ、Ⅱ期占５１．６％,Ⅲ、Ⅳ期占４８．４％;复发癌５２例。全组均采用外科手术治疗,其中１０１例术后加用放疗,面神经被肿瘤累及切除８２例（３３．６％）。行颈清扫术或腮腺旁淋巴结切除术１８２例,全组颈淋巴结转移率为３２．４％。５、１０年生存率分别为７５％和５９．４％,死亡１１１例,死于局部复发占５５％。作者认为手术是治疗腮腺癌的主要手段,对临床晚期、病理分化差、手术姑息患者应加用术后放疗,以提高局部控制率;面神经被肿瘤累及应予切除;对颈部淋巴结肿大可疑有转移病例应行治疗性颈清术,对病理分化差患者应行选择性颈清术。病理类型、临床分期、是否复发癌及首次治疗是否彻底是影响预后的主要因素。     

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 2 2 8例甲状腺乳头状癌患者手术治疗结果进行分析。 2 2 8例患者中肿瘤位于单侧叶者 16 2例 ,狭部 18例 ,双叶 34例 ,侵犯甲状软骨及气管 14例。颈淋巴 c N0 14 8例 ,c N+ 80例。术后均随访 5年以上。结果 :c N+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 / 4 1)和 87.2 % (34/ 39)。腺内型 c N0 伴被膜侵犯者行选择性颈清扫 2 1例 ,随诊观察 2 0例 ,其 5年生存率分别为 90 .5 % (19/ 2 1)和 90 .0 % (18/ 2 0 ) ;腺内型 c N0 不伴被膜侵犯者均未行颈清扫 ,其 5年生存率为 99.0 % (99/ 10 0 ) ,5年内发生颈淋巴结转移率为 1.0 % (1/ 10 0 ) ;腺外型 c N0 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 .4 7% (4/ 16 2 )。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/ 2 0 )。侵犯甲状软骨板及气管者 ,行喉全切除 ,其 5年生存为 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 c N0 者主张随访观察 ,发现淋巴     

喉声门上型低分化鳞状细胞癌57例临床观察

目的探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后.方法回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期Ⅰ期4例,Ⅱ期5例,Ⅲ期18例,Ⅳ期30例).单纯手术25例,单纯放射治疗9例,术前放射治疗加手术14例,手术加术后放射治疗7例,术前化学治疗加手术2例.喉全切除23例,喉部分切除25例;同期颈清扫3l例(单侧17例,双侧14例),上颈清扫12例.结果5年生存率47.4%(27/57),颈部转移率63.2%(36/57),双颈转移率24.6%(14/57),远处转移率21.1%(12/57),局部复发率10.5%(6/57),颈部复发率28.1%(16/57),喉部分切除的局部复发率12.0%(3/25).生存率随分期下降,T1+T2与T3+T4和N0+N1与N2+N3的生存率差异分别有显著性(x2=4.942,P=0.026;x2=4.306,P=0.038).单纯手术与手术结合放射治疗的生存率差异无显著性,N2和N3患者的手术结合放射治疗相对优于单纯手术.结论喉声门上型低分化鳞癌患者以晚期病变为主,易较早发生淋巴结转移,颈部转移和远处转移率较高,治疗仍以手术为主,喉部分切除术是可行的,T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗.     

甲状腺癌再次手术的探讨

目的 探讨甲状腺癌再手术的必要性和方式.方法 总结1991年1月～2006年1月检查甲状腺癌局部切除术后再次手术治疗的126例患者临床资料.第1次对原发灶只进行单纯肿瘤切除或腺叶部分切除者,再手术时切除残叶及峡部,或加对侧叶部分或近全切除;颈淋巴结转移者,行经典性或改良性颈清扫术.结果 术后病理检查残叶有癌残留52例,无癌残留74例,癌残留率41.3%,术后病理检查证实淋巴结转移癌67例,颈淋巴结转移率72.8%.喉返神经损伤发生率3.2%.5年、10年累积生存率分别为93.2%、82.4%.结论 由于误诊等原因致甲状腺癌术后残留率高,积极合理的再手术是必要的.     

分化型甲状腺癌外科治疗的术式选择

目的 :探讨分化型甲状腺癌外科治疗术式的选择。方法 :对 6 6例分化型甲状腺癌病例行患侧腺叶、峡部加对侧次全切除术 49例 ,患侧腺叶及峡部切除术 7例 ,一侧腺叶次全切除及对侧部分切除术 6例 ,全甲状腺切除术 4例。行患侧功能性颈清扫术加对侧功能性颈清扫术 43例 ,双侧功能性颈清扫术 1例及患侧传统性颈清扫术 10例 ,患侧传统性颈清扫术 5例。结果 :3年生存率 96 % (2 5 /2 6 ) ,5年生存率 94% (17/18) ,1例死于白血病 ,1例失访。 4例行全甲状腺切除术的病例术后均出现甲状腺功能减退 ,其中 2例出现甲状旁腺功能减退(5 0 % ) ,其他病例均未发生甲状腺功能和甲状旁腺功能减退。无一例发生喉返神经麻痹。结论 :对分化型甲状腺癌 ,主张行患侧腺叶切除加对侧次全切除或大部切除 ;如术前发现颈淋巴结肿大 ,应同时行患侧淋巴结清扫术。而N0 患者 ,除了对高危组 (男 >41岁 ,女 >5 1岁 )患者腺体外乳头状瘤或明显侵犯包膜的滤泡型腺癌者应行功能性颈清扫术 ,其他随访容易的N0 患者可以不必常规行颈清扫术 ,并提倡长期密切随访。     

喉杓会厌襞癌的临床分析

目的 分析喉杓会厌襞癌的临床特征、治疗方式及预后因素.方法 回顾性分析30例原发于声门上区喉杓会厌襞癌患者的临床资料,分析不同T、N分级,不同治疗方式的喉杓会厌襞癌患者3年无瘤生存率.结果 30例中15例有颈淋巴结转移,颈淋巴结转移率为50%,3年无瘤生存率为46.7%(14/30).T2、T3、T4级生存率分别为77.8%(719)、35.3%(6/17)、25.0%(1/4),T2级与T3 T4级患者生存率有显著性差异;NO患者3年无瘤生存率为66.7%(10/15),N 患者为26.7%(4/15),两者有显著性差异.喉全切除术、喉近全切除术及喉部分切除术患者3年无瘤生存率分别为28.6%(2/7)、25.0%(2/8)、66.7%(10/15);单纯手术治疗与综合治疗的生存率分别为57.1%(4/7)、43.5%(10/23).结论喉杓会厌襞癌不易早期诊断,颈淋巴结转移率高,预后差.T分级与颈淋巴结是影响喉杓会厌襞癌的预后因素.根据肿瘤局部浸润范围,部分患者可以行喉部分切除术,NO患者手术时应同时行同侧颈淋巴结清扫术.     

The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review

PurposeDetermine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.Materials & methodsRetrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.Results75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.ConclusionParotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.     

分化型甲状腺癌Ⅵ区与Ⅱ-Ⅴ区淋巴转移的关系及预后

目的探讨分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ）区颈淋巴转移的特点，为临床选择正确术式提供依据。方法回顾性分析1984年3月至2000年12月，99例甲状腺癌患者在辽宁省肿瘤医院头颈外科进行初次手术，同期行颈清扫术，进行病理检查，术后随访，并对结果进行统计分析。结果99例分化型甲状腺癌中，乳头状甲状腺癌61例（双侧乳头状甲状腺癌1例），乳头滤泡混合型13例，滤泡状甲状腺癌25例。根据2002年UICCTNM分期：Ⅰ期60例，Ⅱ期1例，Ⅲ期5例，Ⅳ期33例。一侧腺叶及峡部切除80例，一侧腺叶及对侧大部或次全切除15例，全甲状腺切除术4例。全部患者同期颈清扫术104侧（双颈清扫5例），其中经典性清扫66例（68侧），改良性清扫33例（36侧）。术后病理检查淋巴结阳性83例（86侧），其中3例双侧淋巴结阳性，颈淋巴转移率为83．8％（83／99）。VI区阳性率37．5％（39／104），颈侧区（Ⅱ-Ⅴ区）阳性率76．9％（80／104），VI区和颈侧区淋巴结阳性率比较，差异有统计学意义（配对X^2检验，X^2=33．01，P〈0．01）。统计分析表明颈侧区淋巴转移和Ⅵ区淋巴转移无相关性（独立X。检验，X^2=2．08，Pearson列联系数C=0．14，P〉0．05）。10年、15年生存率分别为88．3％和84．5％。结论分化型甲状腺癌Ⅵ区与颈侧区（Ⅱ-Ⅴ区）淋巴转移率不同。不能仅从Ⅵ区转移判断颈侧区是否有转移。发生Ⅵ区淋巴转移的患者不比颈侧区（Ⅱ-Ⅴ区）淋巴转移的预后差，经过正确的外科治疗，预后较好。     

Strategy of neck dissection in parotid cancer

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.     

声门上型喉癌颈淋巴隐匿性转移及其处理

目的 探讨声门上型喉癌颈淋巴隐匿性转移规律及其处理方法。方法 选择术前未行放疗、化疗的声门上喉鳞状细胞癌，临床N0M0病例，共30例，男19例，女11例；年龄40～72岁，平均54．8岁；按UICC(1997年)标准分期1、28例，1318例，T44例。行主病变侧肩胛舌骨肌上颈清扫术(supraomohyoid neck dissecton，SOHND)，将获得淋巴结逐一行病理组织学检查，观察其转移规律及临床治疗效果。结果 首次颈清扫术30例中有6例颈淋巴结转移癌阳性，在2～3年随访中有3例发生对侧颈淋巴结转移，计有9例颈淋巴转移，隐匿性转移率同侧为20％(6／30)，对侧为10％(3／30)。颈清扫术共获淋巴结527个，平均每侧17．6个。获转移阳性淋巴结10个，其中Ⅱ区9个，Ⅲ区1个，Ⅰ区无癌转移。喉及主病变侧颈部均无复发，2年无瘤生存率86．7％(26／30)。结论 声门上型喉癌颈淋巴结隐匿性转移率达30％，采用Ⅱ、Ⅲ区的择区性颈清扫术处理其颈淋巴结(Ⅰ区可不必作为常规清扫区域)是切实可行的。     

Carcinosarcoma of the parotid gland: report of a case with immunohistochemical findings

OBJECTIVES: Carcinosarcoma (true malignant mixed tumor) of the parotid gland is an extremely uncommon tumor composed of both carcinomatous and sarcomatous components. An understanding of this manifestation is crucial to guide management and treatment of this disease. METHODS: A patient who presented with facial nerve weakness and a painful mass of the parotid gland underwent fine needle aspiration, laboratory testing, and computed tomography of the neck that demonstrated a large parotid malignancy. The patient underwent surgical treatment followed by radiotherapy. Histologic and immunohistochemical examination of the specimen was performed. RESULTS: This report of a slow-growing parotid mass with otalgia and facial nerve weakness was treated with radical parotidectomy, supraomohyoid neck dissection, and cable graft repair of the excised facial nerve, which was completely encircled by tumor. Postoperative radiotherapy was administered. Histologic and immunohistochemical evaluation demonstrated carcinosarcoma. CONCLUSIONS: Carcinosarcoma is an unusual tumor of the parotid gland. Treatment generally involves surgery with subsequent radiotherapy. Long-term close follow-up is recommended, for this tumor has a high propensity for both local and regional recurrence and metastasis.     

Clinical analysis of cervical metastatis from an unknown primary carcinoma

From 1997 to 2004, 19 cases-18 men and 1 woman-with cervical lymph node metastasis from an unknown primary carcinoma were retrospectively investigated regarding the clinical observation and the treatment outcome. With respect to the histopathological types, 16 cases had squamous cell carcinoma, 2 cases had adenocarcinoma and 1 case had ductal carcinoma. As for the region of lymph node metastasis with maximum size, metastasis located in the upper deep cervical region arrounted for 84%. The presence of primary lesions was comfirmed in 11 cases (3 tonsil, 1 nasopharynx, 1 base of tongue, 2 hypopharynx, 1 esophagus, 1 larynx, 1 gallduct, 1 mammary gland) after the treatment of their metastatic leisions. Tonsillectomy and Blind biopsy were effective for 5 patients. Seventeen patients were treated with neck dissection. Eleven patients with neck dissection underwent radiotherapy. The overall 3-year survival rate as determined by the Kaplan-Meier method was 62%. The 3-year survival rate of the 17 cases whose metastatic leisions were treated with radical neck dissection was 66%. The 3-year survival rate of cases with known primary sites and cases with unknown primary sites after treatment were 55% and 83%, respectively. Radiotherapy with radical neck dissection was thought more effective than radical neck dissection for local and neck control.     

Primary squamous cell carcinoma of the parotid gland

PURPOSE: To investigate the clinical behavior and treatment outcome of patients with primary squamous cell carcinoma (SCC) of the parotid gland. PATIENTS AND METHODS: Twelve cases of primary SCC originating in the parotid gland were retrospectively reviewed. The majority of patients had a locally advanced disease. Eight cases underwent a combination of radical surgery and postoperative radiotherapy, whereas the remaining four cases were treated with radiotherapy alone. Patterns of treatment failure, survival rate, and prognostic factors for these patients were investigated. RESULTS: The predominant pattern of failure was local failure, either alone or in combination with other failures. Two patients who were treated with radiation alone had persistent disease after completion of treatment, whereas 4 of 8 patients who received combined modality treatment and 2 of 4 patients who were treated with radiation alone subsequently developed local recurrences in the primary site or surgical bed. The local failure rate and regional failure rate were 58% and 25%, respectively. Most locoregional recurrences developed within 1 year after initial treatment. Only 2 patients had distant metastasis. The prognosis appeared to be relatively poor for those patients, compared with those with SCC in other head and neck sites. The overall 5-year actuarial survival rate and the disease-free survival rate were 31% and 33%, respectively. Although advanced stage, facial nerve palsy, and regional lymph node metastasis all portended an unfavorable prognosis, only patient age and treatment modality were found to be statistically significant poor prognostic factors. CONCLUSIONS: Primary SCC of the parotid gland is an uncommon tumor with a highly malignant potential. Our results indicate that a combination of radical surgery and postoperative radiotherapy is the treatment of choice for achieving better locoregional control rates and improved cure rates in the treatment of these patients.     

甲状腺癌的诊断及再次手术治疗的意义

目的分析甲状腺癌再次手术的原因及探讨甲状腺癌的诊断，选择合适的甲状腺癌再次手术方式，了解甲状腺癌再手术患者的生存情况。方法总结1992至2000年10月因原发癌灶残留或甲状腺微小癌原发灶未切除到本院行再次手术治疗的128例患者的临床资料。再手术方式包括：①第一次对原发灶只进行单纯肿瘤剜除或腺叶部分切除者，再手术时切除残叶及峡部，或加对侧叶部分或近全切除；颈淋巴转移者，行经典性或改良性颈清扫术；②对甲状腺微小性癌进行患侧腺叶及峡部切除及改良或择区性颈清扫术。对1999至2004年78例我院首诊的表现为单纯甲状腺结节性肿物、临床检查为可疑甲状腺癌患者，术前行细针抽吸细胞学检查（fine needle aspiration，FNA）、术中淋巴结冰冻切片检查（frozen section，FS）、FNA＋FS分别为10例、55例和13例，将检查结果与术后病理结果对照。结果病理检查证实冉次手术的甲状腺癌患者残癌率68．8％（88／128），并发症发生率23．4％（30／128），其中喉返神经损伤率2．3％（3／128），暂时性低钙血症发生率19．5％（25／128）。术后随访，复发5例，颈淋巴转移3例；再手术患者5年、10年生存率分别为92．0％（101／110）、86．9％（17／20）。78例甲状腺肿物术前行FNA、术中FS及FNA＋FS诊断准确率分别为90．0％、87．3％和92．3％。结论由于误诊与不规范手术致甲状腺癌术后残癌率较高，积极合理的再手术是必要的。再次手术增加了手术并发症，提高术前诊断准确率和规范的首次手术治疗是减少手术并发症的根本。     

Conjunctival melanoma with metastasis to the parotid gland in a 10 year-old boy: A case report and literature review

Conjunctival melanoma is a rare invasive neoplasm, usually seen in middle-aged and elderly persons. Its incidence in the adult population seems to be on the rise but it remains extremely rare in children with only few reported cases. Conjunctival melanoma metastasizing to the parotid has been reported in few cases in adults; whereas in the pediatric population only two cases of conjunctival melanoma metastasis have been reported from which only one is to the parotid gland. Methods: A case report of conjunctival melanoma and secondary metastasis to the ipsilateral parotid gland in 10 year-old boy and literature review. Case report: A 10 year-old boy, previously healthy, presented to the ophthalmology service for left conjunctival nevus that was surgically excised after a rapid increase in size. The histopathologic diagnosis came out as melanoma. He presented 1 month after excision with left preauricular node. MRI study showed a parotid lymph node with a necrotic center that was also positive on PET scan. Fine needle aspiration cytology revealed metastatic melanoma. Following a complete negative workup for other metastatic disease, the patient underwent left total parotidectomy with facial nerve preservation and ipsilateral neck dissection. Plaque brachytherapy was given for local control of the conjunctival lesion. Post operatively he received systemic chemotherapy with interferon-α2b and left neck radiotherapy with no evidence of recurrence or metastasis after almost 1 year post-diagnosis. Conclusion: Malignant melanomas of the conjunctiva are extremely rare in children and even more rare to present with metastasis. We hereby present the second case of conjunctival melanoma metastatic to the parotid in a pediatric patient.