人工智能技术在喉癌诊疗领域中的应用

喉癌是头颈部最常见的恶性肿瘤之一，而喉部是人体发声、通气的重要器官，提高喉癌的诊疗水平可显著改善喉癌患者的预后和生活质量。近年，随着科技的发展和各种大型数据库的建立，人工智能技术在喉癌各诊疗领域的研究不断深入，并在辅助图像识别、病理成像诊断、机器人辅助手术、多因素预后预测等方面取得了一定成果。本文就人工智能技术在喉癌的早期筛查、诊断、治疗和预后预测等领域中的研究进展进行综述，探讨目前人工智能技术在喉癌诊疗中的应用局限与不足，并展望其未来的发展方向。     

Current aspects of endolaryngeal and endotracheal microsurgery in children

Achievements of today's laryngeal and tracheal surgery came for the most part from novel optic techniques and anesthesia. All the operations were performed with application of the microscope or endoscopic devices. Gas exchange was provided differently: using volume, injection and high frequency artificial ventilation of the lungs. An individual approach to gas exchange technique in respiratory obstruction allowed to avoid emergency tracheotomy. A laryngeal mask was used in children for air delivery in fibrotracheobronchoscopy. Removal of tumors, dissection of laryngeal scars, trachea and bronchi were made by means of ultrasound and laser equipment. Interventions are considered for each condition.     

肿瘤异常蛋白在喉癌临床诊断中的价值研究

目的 对喉癌患者和健康者进行肿瘤异常蛋白检测,分析肿瘤异常蛋白在喉癌诊疗中的价值.方法 选取耳鼻咽喉头颈外科2017年9月至2019年9月经病理科确诊的95例喉癌病人为实验组,同期选取95例健康者为对照组,对所有研究对象进行外周血肿瘤异常蛋白检测,探究其在喉癌患者临床诊断中的应用价值.结果 喉癌患者中肿瘤异常蛋白阳性率为83.16％,高于健康人群(15.79％),差异具有统计学意义(P＜0.001).有淋巴结转移、Ⅲ+Ⅳ期喉癌患者外周血TAP阳性表达率较高,差异具有统计学意义(P＜0.05).不同性别、不同年龄喉癌患者的外周血清肿瘤异常蛋白表达水平比较,差异无统计学意义(P＞0.05).结论 在喉癌患者外周血中肿瘤异常蛋白表达具有较高的灵敏性,肿瘤异常蛋白对喉癌的临床诊断有较高的应用价值.     

Anesthesia considerations during management of airway stenosis: A systematic review

ObjectiveTo determine the efficacy of ventilatory techniques by evaluating prevalence of technique failure and intraoperative hypoxia during endoscopic management of airway stenosis.Data sourcesA systematic review was conducted using PubMed and Embase for anesthesia techniques in endoscopic management of airway stenosis.Review methodsThe primary outcome measured was reports of partial and complete technique failure. The secondary outcome measured was intraoperative hypoxia.ResultsWe identified 7704 abstracts with 17 meeting criteria for analysis. The reported partial and complete ventilatory technique failures were: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % laryngeal mask airway, 0 % nonocclusive balloon dilator, 4.76 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, and 30.24 % jet ventilation. The reported rate of intraoperative hypoxia was: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, 2.18 % jet ventilation, 3.57 % laryngeal mask airway, and 5 % nonocclusive balloon dilator.ConclusionEvone Flow-Controlled Ventilation with Tritube endotracheal tube had the lowest risk of technique failure and intraoperative hypoxia. Nonocclusive balloon dilator and laryngeal mask airway were also favorable techniques for ventilation. Jet ventilation showed a lower rate of intraoperative hypoxia, but a higher rate of failure. Newer techniques, such as Evone Flow-Controlled Ventilation with Tritube, nonocclusive balloon dilator and spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, may offer promise compared to older techniques like jet ventilation; however, larger studies with more uniform data are needed to determine their efficacy.     

Tracheostomy: a must or elective procedure in laryngeal resection for cancer?

The paper outlines 15-year experience in anesthesia perfection in laryngeal resections with polymeric endoprosthesis (tube endoprosthesis EG 1-4, TU 42-2-467-85) made in 115 patients with laryngeal cancer stage III; presents the analysis of complications in the above resection depending on the time of postoperative and decanulation and anesthesiological procedure. The authors propose methods of shortening the time to decanulation and even to avoid tracheostomy in transcutaneous jet high-frequency artificial lung ventilation.     

Epstein-Barr virus antibodies in blood serum of patients with laryngeal cancer

Association of Epstein-Barr virus with cancers of upper respiratory tract has been recently reported. The aim of our study was to determine the prevalence of serum IgG and IgM antibodies against Epstein-Barr virus capsid antigen (EBVCA) and nuclear antigen (EBNA) in patients with laryngeal cancer. Serum samples from 28 patients with laryngeal cancer were evaluated for presence of IgG and IgM EBVCA and EBNA antibodies using ELISA assay. Serum from 18 healthy age and sex-matched individuals served as control. Patients with laryngeal cancer and healthy subjects were negative for anti-EBV-VCA IgM antibodies (< 20 IU). Serum samples were positive for IgG EBNA in 85.7% of patients with laryngeal cancer and in 72.2% of control group. 89.3% of patients with cancer and 88.8% of healthy individuals were positive for IgG VCA antibodies. The mean level of IgG EBNA (107.8 +/- 71.4) and IgG VCA (124.8 +/- 54.7) antibodies in patients with laryngeal cancer was higher than in control group. The differences were not significant. Patients with N0 neck had significantly higher IgG VCA and EBNA antibodies levels than patients with N1-N3 neck. The results may suggest a role of Epstein-Barr virus in laryngeal cancer pathogenesis.     

Hyperfrequency of pulmonary cancer in a population of 415 patients treated for laryngeal cancer

Four hundred fifteen patients with laryngeal cancer were treated mainly by primary irradiation from 1965 to 1983, at the Radium Centre of Odense. By December 31, 1983, a total of 32 patients had developed pulmonary cancer. The Danish Cancer Registry calculated the expected number of pulmonary cancer in a population of the same composition from the same period of time and the same geographical locale. A statistically significant hyperfrequency of pulmonary cancer among males was found, most pronounced among supraglottic cases: 6.73. Furthermore, a cumulative estimation of the risk of developing pulmonary cancer as a function of follow-up revealed a risk of 26% during the first 14 years of follow-up. The only effective way to solve the problem is to stop smoking.     

Preglottic low-frequency Venturi jet ventilation in laryngoscopic microsurgery in adults. The influence of inspiratory time and frequency of ventilation

The influence of inspiratory time and frequency of jet ventilation was investigated in an experimental model of a jet ventilator and a set of artificial lungs. The optimal ventilatory settings, when used in the clinical context, result in safe, adequate ventilation, as was proved by Astrup and intratracheal pressure measurements in 15 patients.     

The use of forced ventilation during microlaryngoscopy with laser CO<Subscript>2</Subscript>

CO(2) laser is currently used in the treatment of laryngeal lesions. The technique leads to vaporisation of the tissues on which it is focused, resulting in the production of smoke that remains in the laryngoscope and in the area of the exposed larynx. The fumes can only be partially removed with an aspiration tube. As a result, the vision of the operative field becomes obscured, thus making it difficult to perform surgery. We present a method to resolve this problem consisting in forced ventilation of the air present in the laryngoscope and the exposed larynx. Simultaneous use of the forced ventilation air and the aspiration tube permits a more efficient withdrawal of fumes from the operative field and a better view of the larynx for the surgeon. Since 1986, we have performed 200 CO(2) laser cordectomies in patients with early stage glottic cancer without any kind of complication.     

Evaluation of cytochrome concentration in peripheral blood lymphocytes of patients with laryngeal cancer

The aim of the study was evaluation of cytochrome concentration in the peripheral blood lymphocytes of patients with laryngeal cancer. The study was conducted in a group of 62 patients presenting different clinical advancement of the disease. The study material consisted of the studied population's peripheral blood from which T lymphocytes were isolated and incubated with monoclonal antibodies. To evaluate antigens’ expression, a FACS Galibur flow cytometre was used; the evaluated cells were labeled with fluorochrome-conjugated monoclonal antibodies. Next, mononuclear cells were rinsed with cold PBS and suspended in the lysis buffer. In the obtained cell lysate the c cytochrome concentration was determined with the use of an immunoenzymatic test, HumanCytochrome cELISA Kit (BenderMed Systems, Austria). Obtained results were compared with the measurements taken in 20 healthy individuals who constituted the control group. On the basis of conducted study it was found that the level of c cytochrome concentration was significantly increased in the T CD3+ lymphocytes in the peripheral blood of patients with stage IV of laryngeal cancer. A positive correlatio was also found between the cytochrome level in lymphocytes and the advancing stage of the disease. Our own observation give grounds to conjecture that together with the progress of laryngeal cancer the energetic potential of lymphocytes increases and so does the readiness of the lymphatic cells to undergo the redox processes, therefore the amount of c cytochrome in the cells increases.     

自体软骨在外伤性歪鼻合并鼻通气障碍患者鼻整形术中的应用探讨

目的探讨自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中的使用方法和效果。方法回顾性分析2017年1月至2019年4月,在陆军军医大学大坪医院耳鼻咽喉头颈外科收治的30例鼻外伤患者的病例资料,其中男21例,女9例,年龄21~50岁,平均34.9岁,病程6 d至14年。全部患者均伴有不同程度的歪鼻畸形及鼻通气障碍,分为轻、中、重三类,其中轻度8例,中度11例,重度11例,均同期行开放性鼻整形术及鼻中隔偏曲矫正术。对于轻、中度歪鼻畸形及鼻通气障碍,采用耳软骨修饰鼻尖及加强鼻中隔软骨支撑、修饰鼻背凹陷畸形。对于重度歪鼻畸形及鼻通气障碍,将肋软骨雕刻成"Y"字型整体支架或者片状肋软骨构成2+1或4+1支架,将肋软骨支架与鼻中隔软骨尾端贯穿缝合固定,重塑加固鼻中隔支撑架及鼻小柱,避免鼻背塌陷。术前、术后测量鼻外观偏离值,并分别进行鼻外观视觉评分量表(VAS)、鼻腔通气VAS评分。采用Stata 15统计软件对术前与术后的测量数据行配对资料的t检验,VAS评分行卡方检验。结果30例患者中,3例术后出现鼻中隔血肿,经清理后正常恢复。术后随访2个月至2年,所有患者均无鼻中隔穿孔、鼻梁塌陷等并发症发生。术后治愈率为60.0%(18/30),所有患者术后歪鼻程度下降Ⅰ级,有效率为100%(30/30)。患者术后测量鼻外观偏离值低于术前,差异有统计学意义[(2.40±1.58)mm比(6.85±2.43)mm,t=8.42,P<0.001]。术后鼻外观VAS评分高于术前,差异有统计学意义[(6.60±1.16)分比(1.93±1.31)分,t=-14.59,P<0.001]。患者术后鼻腔通气VAS评分高于术前,差异有统计学意义[(6.53±1.04)分比(1.97±1.07)分,t=-16.78,P<0.001]。结论自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中使用疗效好,同期行开放性鼻整形术及鼻中隔偏曲矫正手术,可缩短治疗时间,及时改善患者鼻外观及鼻通气功能。     

喉癌患者手术前后凝血状态的动态观察

目的 :探讨喉癌患者手术前后的凝血状态。方法 :测定 46例喉癌患者行全喉切除术前 1天及术后第1、10天的凝血系统 8项参数 ,观察其测值的变化 ;并以 82例健康人为对照组 ,进行比较。结果 :患者术前即存在抗凝活性明显降低 ,并伴有纤溶活性增强 ,手术创伤使上述异常进一步加重。随着癌肿的切除和手术创伤的恢复 ,患者抗凝及纤溶系统逐渐恢复至正常水平。结论 :喉癌患者存在一定程度的凝血障碍 ,而手术能进一步加重其障碍程度 ,故临床上应高度重视对患者的抗凝及纤溶系统的监测 ,以防血栓及出血性疾病的发生。     

喉癌组织内微血管密度的测定及其临床意义

目的 :探讨喉癌组织内微血管的形成情况及其临床意义。方法 :采用第 因子相关抗原免疫组化法定量观察 38例喉癌组织内微血管的形态和分布并计算微血管密度 (MVD)。结果 :1喉癌组织内血管形态不规则 ,血管分布具有异质性 ,在癌巢实质内存在几无血管的“空白区”。 2癌组织中的 MVD显著高于癌周正常组织 (P <0 .0 1)。 3颈部淋巴结转移组喉癌组织 MVD高于非转移组 (P <0 .0 1) ; 、 期喉癌组织 MVD高于 、 期 (P <0 .0 1)。 4声门上型喉癌组织 MVD与声门型相比较差异无显著性意义 (P >0 .0 5 )。 5喉癌组织内 MVD在高分化、中分化、低分化三组中分别为 (2 4.70± 6 .36 )、(2 8.6 4± 11.5 4)、(2 9.0 7± 7.84)个 / HPF。其差异无显著性意义。结论 :1喉癌组织内存在血管增生现象 ,增生血管主要位于肿瘤间质 ,分布具有异质性。 2喉癌组织内MVD与喉癌分型及组织学分级无明显关系。 3肿瘤血管的形成有利于肿瘤的侵袭转移 ,喉癌组织 MVD的测定可望作为评估预后的又一重要指标。     

Superimposed high-frequency jet ventilation for laryngeal and tracheal surgery

OBJECTIVE: To describe our experience with superimposed high-frequency jet ventilation (SHFJV), which does not require any endotracheal tubes or catheters, for performing laryngeal and tracheal surgery. DESIGN: A case series of 500 patients. SETTING: A university medical center. PATIENTS: Four hundred sixty adult patients and 40 children in a consecutive sample who required laryngeal or tracheal surgery under SHFJV. INTERVENTIONS: The SHFJV uses 2 jet streams with different frequencies simultaneously and is applied using a jet laryngoscope. Ventilation was performed with an air-oxygen mixture, and intravenous agents were used for anesthesia. Arterial blood gas values were analyzed. MAIN OUTCOME MEASURES: Reported values of oxygenation and ventilation during the application of SHFJV and laryngotracheal surgery. RESULTS: In 497 patients, adequate oxygenation with a mean +/- SD PaO2 of 91.8 +/- 22.9 mm Hg and ventilation with a PaCO2 of 29.7 +/- 5.5 mm Hg were achieved using SHFJV. The average duration of the application of ventilation was 27 minutes, and the longest duration was 118 minutes. No complications due to the ventilation technique were observed. Laser surgery was performed in 150 patients. CONCLUSIONS: The use of SHFJV in combination with the jet laryngoscope provides patients with sufficient ventilation during laryngotracheal surgery. Even in patients at high risk because of pulmonary or cardiac disease, this technique can be applied safely. In patients with stenosis, the ventilation is applied from above the stenosis, reducing the risk of barotrauma. The SHFJV can be used for tracheobronchial stent insertion, and laser can be used without any additional protective measures.     

大气污染中气态污染物致大鼠喉黏膜急性损伤的研究

目的 探讨大气污染中气态污染物对大鼠喉黏膜的急性损伤及可能机制。 方法 采用200 g左右健康SPF级SD大鼠12只,随机分为对照组和气态污染物暴露组,每组6只。对照组大鼠饲养于SPF环境中,气态污染物暴露组大鼠呼吸的气体为2016年北京市红色预警期间外界大气经HEPA滤膜过滤颗粒物后的空气,暴露时间为6 d。暴露后处死大鼠,取喉黏膜,检测大鼠喉黏膜的病理学改变及喉黏膜组织细胞因子IL-1β、IL-4、IL-5、IL-6、IL-10、IL-12、IL-13、IL-17a、IFN-γ、TNF-α的表达情况。 结果 与对照组相比,气态污染物暴露组大鼠喉黏膜上皮有不同程度的过度角化、基底细胞排列紊乱;IL-1β、IL-10、IL-13、IL-17a、TNF-α的表达增强(P<0.05);IL-12、IFN-γ的表达减少(P<0.05)。 结论 大气污染中的气态污染物可以引起大鼠喉黏膜损伤,其机制可能与Th1/Th2失衡,呈Th2优势应答有关。     

Effects of vitamin E on cigarette smoke induced oxidative damage in larynx and lung

OBJECTIVES: Cigarette smoke (CS) contains a large variety of compounds, including many oxidants and free radicals (also known as reactive oxygen species), that are capable of initiating or promoting oxidative damage, which leads to various degenerative pulmonary and cardiovascular diseases as well as cancer. Recent studies have established a strong relationship between CS and development of reactive oxygen species (ROS). The aim of the present study was to detect ROS levels in laryngeal and lung tissues of rats by measuring luminol-amplified chemiluminescence and to determine the changes in ROS levels in lung and laryngeal tissues induced by exposure to CS, with and without concurrent treatment with vitamin E. STUDY DESIGN: Prospective controlled animal study. METHODS: Male Sprague-Dawley rats were divided into three groups of eight animals each. The first group of rats was exposed to cigarette smoke. The second group of rats was exposed to cigarette smoke and concurrently treated with vitamin E. The third group was used as control. Animals were killed and chemiluminescence measurements were made for laryngeal and lung tissues. RESULTS: Reactive oxygen species levels were significantly increased in the first group of rats compared to the levels measured in control animals. ROS levels were statistically significantly decreased in the second group as compared to the first group. CONCLUSION: Our results indicate that vitamin E decreases CS induced ROS levels in laryngeal and lung tissues.     

Effects of gastroesophageal reflux disease in laryngeal carcinoma

Gastroesophageal reflux disease is associated with various otolaryngological disorders. The aim of this retrospective study was to determine the role of gastroesophageal reflux disease in the development of laryngeal squamous cell carcinoma (SCC) in non-smoking and non-drinking patients. The study population consisted of 36 consecutive non-smoking and non-drinking patients with histologically confirmed SCC of the larynx. As a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects were selected. Patients with laryngeal cancer had a higher prevalence of gastroesophageal reflux disease than the control subjects (P < 0.0001). Our results confirm the fact that gastroesophageal reflux disease in itself is associated with an increased risk of laryngeal cancer.     

Expression of bcl-2 protein in lymphocytes of patients with laryngeal carcinoma

The aim of this study was to evaluate the expression of bcl-2 protein in lymphocytes of the peripheral blood of patients with laryngeal carcinoma. The protein product of the proto-oncogene bcl-2 is a physiological inhibitor of apoptosis or programmed cell death. Since we believe that apoptosis is involved in the regulation of an immune response to a cancer process, we tried to show how this mechanism works in laryngeal carcinoma in comparison with normal peripheral blood lymphocytes of healthy controls. To explain the significance of this molecule’s expression, we used flow cytometry to examine the expression of bcl-2 in T lymphocytes from the peripheral blood of 23 patients with laryngeal carcinoma and 20 healthy controls. Our study revealed that the expression of bcl-2 protein in T lymphocytes from the cancer patients was significantly higher than in the controls (P < 0.05). This difference in the expression of bcl-2 protein was found in both CD4 and CD8 subpopulations and was significantly higher than in the control group. In patients with laryngeal carcinoma expression of bcl-2 protein in T lymphocytes was higher in CD4 than in CD8 cells (P < 0.05). These results suggest that bcl-2 protein may interact in the regulation of apoptosis of lymphocytes, taking part in anti-cancer defence. Received: 26 September 1998 / Accepted: 17 February 1999     

心理干预对喉癌患者治疗过程中心理状态的影响

目的 调查喉癌患者心理状态,研究心理干预对喉癌患者治疗过程中心理状态的影响.方法 60例喉癌患者分为观察组和对照组,采用症状自评量表SCL-90及医学应对问卷(medical coping modes questionnaire,MCMQ)分别调查在常规治疗过程中和联合心理干预后不同时间点的心理状态.结果 与常模比较,...     

Cytotoxic T lymphocytes in peripheral blood and regional lymph nodes in laryngeal cancer patients

Cytotoxic T cells is an unique lymphocyte subpopulation able to recognize in specific manner and kill tumor cells. Therefore they constitute an important cells engaged in anti-tumor defense. The aim of the study was to determinate cytotoxic T cells frequency in peripheral blood and among lymphocytes isolated from regional lymph nodes. The study group consisted of twenty patients diagnosed with laryngeal cancer subjected surgical treatement. Cytotoxic T cells were estimated using three color flow cytometry based on CD3(+)CD8(+)CD28(-) GranzymeB(+) phenotype. Additionally TCR zeta chain expression and spontaneous apoptosis considered as a potential markers of immunosupressive effect exert by tumor were determined. In patients with laryngeal cancer significant increase of CD3(+)CD8(+)CD28(-) lymphocytes in peripheral blood in comparison to healthy control was observed. In lymph nodes the content of those cells was much lower, less than 10%, however in a group bearing metastases to regional lymph nodes higher than in a group without metastases. Cytotoxic T cells were also the main population subjected spontaneous apoptosis. The role and specificity of cytotoxic T cells in laryngeal cancer patients still remain to be elucidated, especially in respect to specificity of recognition tumor cell. Understanding details of this process may rise significant progress in an approach to diagnosis and therapy in laryngeal cancer patients.