额窦区域内翻性乳头状瘤的手术治疗

目的 探讨额窦内翻性乳头状瘤的治疗方法.方法 介绍1999-2006年采用内镜+开放进路(眼眉内飞鸟状切口)手术治疗的6例额窦内翻性乳头状瘤的临床资料,结合国内外文献,探讨额窦内翻性乳头状瘤的起源部位、临床表现、影像学检查、肿瘤的分期与分类、手术方法、放射治疗、预后等相关问题.结果 6例额窦内翻性乳头状瘤患者手术后随访时间2～8年,中位随访时间2.5年.除1例患者因肿瘤复发和恶变,拒绝治疗死亡外,其余5例肿瘤均未复发.3例接受了手术后放疗,其中1例在放疗3年后恶变为中分化鳞癌,1例3年后出现了上颌骨放射性骨髓炎.结论 对于原发或侵犯额窦的内翻性乳头状瘤,可以选择内镜+鼻外联合进路手术.由于肿瘤侵犯额窦最外侧、最上部以及前壁是当前内镜下手术的死角,单纯在内镜下不可能将肿瘤切除干净,开放性切口还是有必要的.为了避免复发,手术中应在直视下力求将肿瘤切除干净,手术后放疗应慎重.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病

目的 探讨经鼻内镜联合额窦前壁开窗双径路治疗额窦疾病的手术指征.方法 回顾性分析24例经鼻内镜联合额窦前壁开窗双径路手术治疗额窦疾病的临床资料,其中额窦后壁粉碎性骨折并脑脊液漏16例、额窦骨瘤5例、额窦内翻性乳头状瘤2例、额窦内翻性乳头状瘤癌变1例.结果 16例额窦脑脊液漏均一次修补成功,5例额窦骨瘤、2例内翻性乳头状瘤和1例内翻性乳头状瘤癌变者均一次手术切除,术后完全恢复,无术中、术后并发症发生.手术后额窦脑脊液漏患者随访3～132个月;额窦骨瘤患者随访8～38个月;额窦内翻性乳头状瘤及癌变患者随访7～42个月,中位随访时间36个月,病变均元复发,额窦引流通畅,额部无影响容貌的缺陷.结论病变主体位于额窦后壁、有复发倾向或恶性病变,以及病变范围或手术部位的外侧界限超越眶纸板平面是经鼻内镜联合额窦前壁开窗双径路的手术指征.     

Surgery of the anterior skull base for head and neck tumors

A total of seven patients with head and neck tumors underwent a surgery of the anterior skull base in combination with an extracranial approach. Two patients had squamous cell carcinoma of the frontal sinus; one, undifferentiated carcinoma of the ethmoid sinus; two, squamous cell carcinoma of the ethmoid sinus; one, olfactory neuroblastoma; and one, recurrent squamous cell carcinoma of the nasopharynx. Two patients, one with frontal sinus carcinoma and one with undifferentiated carcinoma, developed recurrence. The former was treated with a salvage operation and the latter, with radiotherapy and chemotherapy. Six patients are alive disease free (4, 5, 6, 8, 27 and 73 months) whereas the other is alive with disease (8 months). One patient developed partial necrosis of the reconstructed bony skull base and another developed enophthalmus and temporary diplopia postoperatively. No serious complications, however, were noted in any cases.     

Acinic cell carcinoma of maxillary sinus

Acinic cell carcinoma is a tumor that occurs most commonly in the parotid glands. We have experienced a rare case of acinic cell carcinoma of the left maxillary sinus. The patient was a 71-year-old female. She noticed her left nasal congestion and epiphora from left eye in April 1994. She had a history of left maxillary sinus surgery in February, 1972. Antrotomy was performed and histopathological examination of specimen from the maxillary sinus proved acinic cell carcinoma. The tumor was considered to be the recurrence 22 years after initial surgery, because it coincided with the surgical specimen of previous surgery. Radical resection of maxilla was performed for complete resection of tumor with palate reconstruction by left scapula and latissimus dorsi myocutaneus flap. No recurrence is observed for more than 4 years after surgery. Although this tumor is of low grade malignancy, complete resection with adequate surgical margin is advisable due to high incidence of this tumor to recur after long periods of time.     

累及声门旁间隙的梨状窝癌喉功能保存手术

目的：探讨累及声门旁间隙的梨状窝癌喉功能保存手术的可行性和治疗效果。方法：回顾性分析14例累及声门旁间隙梨状窝癌患者的临床资料。手术切除病变组织后行喉成形,同时行双侧选择性颈清扫术。术后3例患者未接受放化疗,其余11例均行放化疗。术后随访6个月~5年,平均3年6个月。结果：12例患者切口一期愈合,2例咽瘘经换药后痊愈。患者均有术后吞咽呛咳,最迟术后2个月拔胃管经口进食。11例术后放化疗者中10例随访3年未见复发,1例复发未治疗后死亡。3例未接受放化疗者中,2例在6个月内复发,行放化疗后1例未见复发,1例失访;1例术后8个月复发,行全喉切除术,术后放化疗,首次术后1年6个月死亡。3年生存率为78.6%;患侧声带6例有轻微动度,8例无明显声带解剖标志。结论：选择适当病例,对累及声门旁间隙的梨状窝癌患者行喉功能保存手术,可取得较好的临床效果,使患者有更好的生存质量。     

Results of orbital preservation for advanced malignant maxillary sinus tumors

OBJECTIVE: The purpose of the study was to examine the oncological and functional outcomes of multimodality therapy for patients with advanced malignant maxillary sinus tumors that invaded the orbit. STUDY DESIGN: Retrospective study. METHODS: The medical records of 26 patients with orbital invasion were retrospectively analyzed. The patient group consisted of 16 men and 10 women, with a median age of 58 years. The mean follow-up period was 73 months. The most common disease was squamous cell carcinoma. Seven patients had nodal disease. All patients underwent simultaneous combined therapy consisting of conservative surgery through a sublabial incision, radiotherapy, and regional chemotherapy. Patients with nodal disease were treated with either irradiation or selective neck dissection. RESULTS: The 5- and 10-year overall survival rates were 68% and 51%, respectively. The 5- and 10-year local control rates were 66% and 51%, respectively. Overall survival rates and local control rates were significantly worse in patients with disease other than squamous cell carcinoma. Local control rates were significantly worse in patients with orbital apex disease than in patients without orbital apex disease. All 26 patients, despite orbital involvement, retained their orbital contents. Nineteen of these patients demonstrated adequate ocular function. CONCLUSIONS: Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy is an effective method for local control and preservation of ocular function. However, performing orbital conservation procedure in patients with disease other than squamous cell carcinoma and with orbital apex disease must be considered carefully.     

Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences.

PURPOSE: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has been subject of much debate. The purpose of this study is to evaluate the results of endoscopic sinus surgery in the treatment of paranasal sinus inverted papilloma. PATIENTS AND METHODS: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. RESULTS: A close follow-up of all patients was maintained. Seventy-seven per cent (10/13) of the patients had no recurrence after the initial endoscopic procedure. Three patients had recurrences of their tumor within 11 months after surgery, which means a rate of 23% (3/13). In 2 patients, the recurrences were treated endoscopically. In one patient, recurrence and malignant transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient underwent radical maxillectomy and postoperative radiotherapy. None of the patients died of inverted papilloma. CONCLUSION: Endoscopic sinus surgery is a viable treatment alternative for paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. When the disease is more extensive, it should be approached by radical surgery, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mid-facial degloving.     

Prognostic significance of epidermal growth factor receptor in squamous cell carcinoma of the maxillary sinus

Summary The expression of epidermal growth factor receptor (EGFR) was determined immunohistochemically in two groups of maxillary sinus squamous cell carcinomas, one with recurrences at the primary site after combination therapy with radiotherapy, chemotherapy and/or surgery and one without local recurrences. Using a four-graded scale (-,+,++,+++), 9 of the 10 recurrent carcinomas had a staining intensity and proportion of stained cells of ++ or more. A comparable staining intensity was found in 9 of the 18 non-recurrent carcinomas. This difference is statistically significant (Fisher's exact probability test, P < 0.05). These results indicate that an increased expression of EGFR may influence the recurrence rate of squamous cell carcinoma of the maxillary sinus after combined therapy.     

跨锁骨和胸骨肿瘤的外科治疗12例分析

目的 探讨跨锁骨和胸骨肿瘤的外科治疗方法。方法 回顾性分析和总结12例超越颈胸解剖分界线的颈根部和胸腔纵隔肿瘤行颈胸联合进路手术治疗的相关问题。结果 本组良性肿瘤7例，经手术治疗后随访1—8年均健在。恶性肿瘤5例，其中4例为术前各种检查未发现原发灶的颈根部转移鳞状细胞癌，行手术和常规放疗后，1例于术后16个月死于原位复发和腋下转移，1例术后失访，另2例分别于术后4年2个月和2年3个月时随访观察无复发。1例颈根部和纵隔甲状腺乳头癌行手术和放疗后3年4个月健在。结论 通过对12例跨锁骨和胸骨肿瘤颈胸联合进路手术治疗方式和结果分析，提高对传统颈根部肿物手术治疗的认识。     

鼻腔鼻窦神经内分泌癌11例诊疗分析

目的 探讨鼻腔鼻窦神经内分泌癌的诊疗方法及预后.方法 回顾性分析浙江省肿瘤医院1998-2010年收治的11例鼻腔鼻窦神经内分泌癌患者的临床资料.其中小细胞神经内分泌癌10例,非典型类癌1例.参照Kadish分期本组患者A期2例,B期6例,C期3例.治疗方法采取单纯手术1例,单纯放疗1例,单纯化疗1例,放疗+化疗2例,以手术为主的综合治疗(手术结合术后放化疗)6例.结果 全部患者随访2个月至12年,综合治疗的6例中1例3年后死亡,1例4年后死亡,1例无瘤生存12年,另2例无瘤生存8年,1例仍在治疗随访中.其他治疗方案的5例中4例1年内死亡,1例1年半后死亡.结论 本病治疗并无统一方案,以手术为主的综合性治疗是较合适的治疗方案.神经内分泌癌易复发,预后较差,早期的准确诊断和综合治疗是提高本病生存率的关键.     

小涎腺肿瘤的外科治疗

目的:分析和探讨小涎腺肿瘤的临床特征和诊疗要点。方法:对我院1997～2004年收治的54例小涎腺肿瘤患者的临床特征和治疗效果作回顾性分析。结果:54例患者中失访16例,在随访到的38例患者中,因肿瘤复发死亡4例,其中2例鼻腔腺样囊性癌分别于术后2年和3年死于肿瘤复发,1例喉肌上皮癌术后3年死于肿瘤复发,1例鼻窦黏液表皮样癌术后1年5个月死于肿瘤复发;2例鼻窦腺样囊性癌术后复发,再次手术后无瘤生存;1例鼻腔腺样囊性癌术后11个月复发,行伽玛刀治疗及中药治疗带瘤生存;其余患者均无瘤生存。结论:小涎腺肿瘤分布广泛,病理类型繁多,本组病例以恶性肿瘤多见,占81.4%。不同部位的肿瘤和不同病理类型的肿瘤临床表现和治疗方案各不相同。对良性肿瘤多采用肿瘤摘除术。而对恶性肿瘤治疗,手术结合放疗是主要的治疗方案。成功的关键是完整地切除肿瘤和有足够的切缘。