口咽癌的外科治疗

目的：探讨口咽癌扩大切除一期再建的手术方法,观察并发症及术后语言,吞咽功能恢复情况。方法：３０例口咽癌中软腭癌２例,扁桃体癌３例,咽侧壁癌１６例,舌根癌９例;Ⅲ,Ⅳ期患者６３．３％（１９／３０）,颈淋巴结转移５３．３％（１６／３０）,２２例用下颌骨切开外旋或切除切支入路进行了肿块根治性切除,同期行颌下清扫术１例,肩胛舌骨肌上清扫术３例,根治性颈清扫术２６例。咽部缺损用带蒂胸大肌皮瓣整复１７例,胸倘     

口咽癌治疗研究进展

过去几十年,人乳头状瘤病毒在口咽癌中的致病作用逐渐被揭示,口咽癌的治疗模式也发生了巨大变化.随着放射技术的不断发展以及为满足器官功能保护的需要,放化疗成为口咽癌的重要治疗方式之一.此外,免疫治疗、微创外科技术也取得显著成果,但目前针对人乳头状瘤病毒相关口咽癌的治疗尚处于研究阶段.现结合国内外报道就口咽癌诊疗的相关研究进展做一综述.     

舌根癌的外科治疗

恰当地选择舌根癌外科手术进路，修复肿瘤切除后的缺损，对提高生存率、恢复并保存患者的语言、吞咽等功能是十分必要的。1987～1994年，对23例舌根鳞状细胞癌采取了经咽侧和经下颌骨切开的手术进路，用颈阔肌瓣一期修复舌根咽侧缺损。术后2、3、5年生存情况分别为20／23、13／16、4／7。语言及吞咽功能恢复良好，部分病人因术后放疗致口腔干燥而影响吞咽。根据肿瘤大小、侵袭范围选择手术进路才能充分显露肿物，便于彻底切除，又可避免不必要的损伤。颈阔肌瓣尽管修复面积有限，用于修复部分舌根、咽侧缺损，具有切取方便、距受区近、质地软、成活率高、并发症少等优点。     

口咽癌手术治疗的临床效果观察

我科于1996年1月～2003年12月对18例晚期口咽癌施行根治或扩大切除术,并对13例行一期修复,取得较好的疗效,现将结果报道如下。1资料与方法1.1临床资料。18例中,男12例,女6例,年龄49～72岁,中位年龄56岁。其中舌根癌9例,软腭癌5例,扁桃体癌4例。癌     

2002年AJCC咽癌分期方案

2002年AJCCⅡ因癌(包括舌根、软腭和悬雍垂)新分期方案将口咽和喉咽癌T4病变分为T4a(可手术切除)和T4b(不能手术切除)，因此Ⅳ期分为ⅣA期、ⅣB期和ⅣC期。     

下咽癌外科治疗41例分析

本文回顾41例下咽癌病人的外科治疗效果，5年生存率为37.5％（12／32），其中咽胃吻合术病例5年生存率为35．7％（5／14）。无手术死亡病例。产生各种并发症者为41．4％（17／41）。全部病人均恢复吞咽功能，部分病人保留了喉功能。本文就下咽癌的综合治疗、咽胃吻合术及下咽癌手术中喉功能的保护等问题进行讨论。     

下颌骨外旋径路切除晚期口咽癌的临床研究--附6例报告

目的探讨晚期口咽癌的手术入路和口咽缺损的一期修复。方法采用下颌骨外旋径路切除晚期口咽癌6例，其中口咽侧壁癌5例，舌根癌1例；口咽缺损均采用胸大肌肌皮瓣修复。结果全部病例随访2～7年，4例存活3～7年以上，2例分别于术后1，3年死于局部复发。1例咽瘘，3例短期食物返流入鼻腔。全部病例半年内吞咽、言语功能基本恢复。结论下颌骨外旋径路切除晚期口咽癌，具有视野开阔、直视下完整大块切除肿瘤、且便于修复缺损；胸大肌肌皮瓣修复口咽侧壁、舌根及软腭缺损效果良好。     

下颌裂开切除晚期口咽癌4例报告

我科自 1 996年 1月始对 4例晚期口咽癌患者采用下颌裂开途径肿瘤切除术 ,取得较好效果 ,报告如下。1　资料与方法1 .1　临床资料本组 4例Ｔ4口咽癌患者 ,均为男性 ;年龄 45～63岁 ,平均 5 7岁。按ＵＩＣＣ 1 987年标准 ,Ｔ4Ｎ1 Ｍ0 2例 ,Ｔ4Ｎ2 Ｍ0 和Ｔ4Ｎ3Ｍ0 各 1例。肿瘤均源于口咽侧壁。累及舌根部 3例 ,口底部 1例。 1例肿瘤侵及广泛 ,累及右侧梨状窝、右侧室带和声带、杓会厌襞、甲状腺右叶 ,以及右侧鼻咽侧壁与咽旁隙。ＣＴ显示肿瘤约 1 0 .5ｃｍ× 4.5ｃｍ× 4.8ｃｍ ,上缘自鼻咽部 ,咽隐窝消失 ,下至梨状窝、喉及食管上口 ,同侧…     

Surgical versus non-surgical management of early stage oropharyngeal squamous cell carcinoma

National guidelines state that early-stage oropharyngeal carcinoma can be treated by either primary surgery or radiotherapy. There is a paucity of evidence comparing surgery versus non-surgical therapy within the same population. With the shift in head and neck cancer treatment towards primary chemoradiation, the aim of this observational cohort study was to help define whether surgery still has a role for early-stage oropharyngeal disease, using a national prospective audit of all new head and neck cancers recruited between 1999 and 2001 in Scotland. Patients with T1-2 N0 M0 tumours were identified. Patients were divided into those treated surgically (±adjuvant radiotherapy) or non-surgically. Five-year outcome data were calculated. Forty-two patients were treated surgically (13 received adjuvant radiotherapy) and 32 patients treated non-surgically. Disease-specific 5-year survival was 69 and 60%, respectively (p?=?0.22). Locoregional failure occurred in seven of the surgical group and five of the non-surgical group. The success of chemoradiotherapy and the evidence for its use as adjuvant therapy may dissuade clinicians from considering surgical intervention. This study demonstrates the outcomes of surgical and non-surgical therapy within the same population. Where clear margins can be achieved, and in the absence of negative prognostic neck pathology, surgery remains a good option; allowing radiotherapy to be preserved for locoregional failures or second primary tumours. Although there are limitations to this study, it does demonstrate the benefit of prospective population data collection.     

环后癌的手术治疗

目的 探讨环后癌手术治疗的相关技术方法。方法对21例环后癌患者进行手术治疗，其中T3NOM0 5例，T3N1M0 1例，13N2M0 2例，T4NOM0 7例，T4N1M0 4例，T4N2M0 1例。T4N3M0 1例。在彻底切除肿瘤的前提下，保留可利用的正常组织进行咽喉功能重建。共行保留喉功能手术10例，不保留喉功能手术11例，同时行单侧颈清扫术8例，双侧颈清扫术3例，术后行辅助放疗。结果随访时间60～276个月，平均96个月。全组患者3年生存率61．9％(13／21)，5年生存率52．4％(11／21)。随访期间死于颈淋巴结转移4例，肿瘤局部复发3例，心肺功能衰竭1例，原因不明2例。喉功能保留病例仅恢复了发音和吞咽保护功能。术后出现咽瘘5例，下咽狭窄3例，严重误吸1例。结论在彻底切除肿瘤的前提下谨慎选择环后癌手术方法，利用保留下来的正常喉组织进行喉功能重建，从而恢复喉的部分功能是可行的。患者可获得较好的生存率和生存质量。     

鼻咽癌手术治疗进展

常期以来鼻咽癌以放射治疗为主 ,如放疗失败再放疗 ,则其五年生存率很低 ,且患者生存质量也差 ;近年来兴起的手术治疗或放疗后的挽救性手术治疗 ,可在一定程度上提高病人的生存率 ,改善病人生存质量。本文就鼻咽癌手术治疗有关资料进行综述 ,以供同道参考     

The use of intensity-modulated radiation therapy in the treatment of oropharyngeal carcinoma

PURPOSE OF REVIEW: The management of oropharyngeal cancers continues to evolve. Due to the functional consequences of surgery, organ preservation strategies with radiation combined with chemotherapy have been developed. Newer strategies to diminish the acute and late toxicities and improve the functional outcome of organ preservation strategies are being developed. Intensity-modulated radiation therapy is a relatively new, advanced form of radiation therapy that is being studied in an effort to improve local control rates and minimize the late effects of treatment. RECENT FINDINGS: Several recent studies have further supported the role for radiation therapy and chemotherapy as part of organ preservation strategies for cancers of the oropharynx. With the intensification of treatment, however, toxicities and functional impairment occur and have not been well documented in the past. Several recent studies report on the toxicities of traditional treatment methods. In addition, data show that intensity-modulated radiation therapy may be superior in terms of limiting toxicity compared with standard radiation therapy techniques. The integration of intensity-modulated radiation therapy with chemotherapeutic and radioprotective agents to further improve the therapeutic window for radiation therapy is being actively pursued. SUMMARY: This paper reviews recent advances in radiotherapy for oropharynx cancer and the use of intensity-modulated radiation therapy.     

Surgical treatment of medullary carcinoma of the thyroid

Medullary thyroid carcinoma, comprising approximately 7% of thyroid carcinoma, produces calcitonin, which can be monitored by immunoassay for diagnosis, at preclinical stages, and for persistent disease and its extent. It presents as sporadic and hereditary forms. The latter consists of the multiple endocrine neoplasia (MEN)-2A syndrome, which includes pheochromocytomas and hyperparathyroidism in some families, and the MEN-2B syndrome, which consistently includes mucosal neuromas and somatic features. The carcinoma, especially the MEN-2B variety, is more aggressive than well-differentiated thyroid carcinoma. After the presence and management of a possible pheochromocytoma is resolved, treatment is by total thyroidectomy, the MEN-2 syndromes always indicating bilateral involvement. Gross evidence of medullary thyroid carcinoma is associated with metastases to regional lymph nodes, justifying removal of lymph nodes in the central neck, anterior superior mediastinum, and lateral neck. At operation, attention is given to preservation of parathyroid glands but also to removal of hyperplastic parathyroid glands; subtotal parathyroidectomy usually is needed if clinical hyperparathyroidism is evident. Diagnosis at the preclinical stage, C-cell hyperplasia, permits total thyroidectomy. Lateral cervical lymph node dissection is determined by biopsy of midjugular lymph nodes. In this situation, serum calcitonin levels are usually normal after operation, indicating cure. However, for palpable medullary thyroid carcinoma, serum calcitonin levels are often elevated after appropriate neck surgery. In this event, scanning techniques are used to monitor patients, and reoperation is performed if localization of medullary thyroid carcinoma is achieved. The mediastinum is particularly observed for recurrence. Reoperation is justified for recurrence in the neck and mediastinum. Early diagnosis and monitoring permits long-term survival. In the future it is anticipated that diagnostic genetic techniques will provide definitive and early diagnosis in the hereditary form, permitting earlier treatment with assurance of cure.     

颅面复发肿瘤外科治疗

目的经放射治疗、化学治疗或手术后复发的颅面晚期恶性肿瘤往往因病变范围广泛,累及颅脑和神经、血管等重要结构,手术切除困难,或又因对放射治疗或化学治疗不敏感而使患者得不到有效治疗,为了改善这类患者的生存质量,预防致死性并发症,延长其生命而行手术治疗.方法根据6例这类病例的病变部位、范围和性质行非定型手术切除,并酌情进行颅底和脑膜重建和修复,包括使用前额带蒂肌皮瓣、颅骨骨板和阔筋膜等.结果6例这类患者其病变均侵犯眼、脑膜、脑组织、海绵窦、颅底或其它重要神经血管等结构,1例术后半年因颈内动脉破裂大出血死亡,5例存活1年以上,其中3例分别存活4、5和12年.结论对这类晚期复发肿瘤采用非定型手术(nondefinedoperation)切除,只要方法得当是可以延长患者生命,为颅面晚期复发肿瘤的治疗取得初步有益经验.     

Adenosquamous carcinoma of the lateral oropharyngeal wall

Adenosquamous carcinoma of the head and neck is a rare and aggressive tumor, with fewer than 100 cases reported in the world literature to date. We report a case of adenosquamous carcinoma of the oral pharynx arising as a second primary malignancy in a patient being treated for primary gastric MALT (mucosa-associated lymphoid tissue) lymphoma. We also review the literature to assess current treatment and long-term prognosis of this rare tumor.