包裹颈动脉的巨大颈部转移癌手术切除1例

高某某 ,男 ,5 6岁。 1996 0 2因左下牙龈癌在我院行左侧龈颌颈联合根治术 ,术后局部放疗约 60 0 0cGy。 2 0 0 1 0 9因左颈上部转移癌在当地医院行肿瘤切除术 ,术中见肿瘤与颈内动脉粘连 ,为避免损伤颈动脉 ,将肿瘤分块取出 ,术后局部再次放疗约 5 0 0 0cGy。放疗结束后左侧颈上部即出现渐进性肿胀疼痛 ,肿块表面皮肤破溃 ,遂再次入我院。查体 :左侧颈上部明显肿胀隆起 ,可触及约 5cm× 6cm肿块 ,边界不清 ,质地较硬 ,固定 ,与皮肤粘连 ;皮肤表面有一瘘口 ,有少量淡黄色液体流出。CT片示 :左侧颈上部边界不清肿块 ,包裹颈内、颈外动脉 ;…     

头颈部癌颈部淋巴结转移的CT诊断

综述了应用ＣＴ诊断头颈部癌颈部淋巴结转移的技术及方法，并综述了颈部淋巴组织的正常解剖、ＣＴ图像上正常淋巴结的形态及密度和头颈部癌颈部淋巴结转移的ＣＴ诊断标准。ＣＴ诊断与触诊法相比，ＣＴ是一种更为客观、准确、较为可靠的诊断头颈部癌颈部淋巴结转移的方法。     

头颈部癌颈部淋巴结转移的CT诊断

头颈部癌颈部淋巴结转移的ＣＴ诊断汪卫东，罗济程，邱蔚六，孙大熙恶性肿瘤的重要生物学特性之一是其能发生转移，就头颈部癌而言，主要向颈淋巴结转移。头颈部癌是否出现颈淋巴结转移对其预后的影响较大￣［１］，并影响肿瘤的分期及治疗。目前，临床医师主要采用触诊检...     

头颈部癌颈部淋巴结转移的CT诊断

综述了应用CT诊断头颈部癌颈部淋巴结转移的技术及方法,并综述了颈部淋巴组织的正常解剖、CT图像上正常淋巴结的形态及密度和头颈部癌颈部淋巴结转移的CT诊断标准。CT诊断与触诊法相比,CT是一种更为客观、准确、较为可靠的诊断头颈部癌颈部淋巴结转移的方法。     

舌鳞状细胞癌颈淋巴结转移的特点和评估处理

舌鳞状细胞癌位居口腔癌首位,颈淋巴结转移妨碍其治疗.颈淋巴结转移分为微转移和包膜外转移,前者与肿瘤预后较差相关,后者对患者的生存率影响更大.舌鳞状细胞癌的淋巴结转移多为Ⅰ～Ⅲ区,原发灶浸润深度对颈部隐匿性淋巴转移有较高的预测价值.舌鳞状细胞癌颈淋巴结转移存在着一定的规律性,与其病理分级、神经和血管侵犯、浸润深度等多方面因素相关.颈淋巴结转移的临床评估除需借助B超、CT、磁共振成像、正电子发射断层摄影术等影像学辅助检查技术外,还需借助细胞细针吸取活检和前哨淋巴结活检来确认.迄今有关舌鳞状细胞癌的颈淋巴结处理仍无定论,临床选择上存在着仁者见仁智者见智的现象.目前,舌鳞状细胞癌的颈淋巴结处理主要为颈淋巴结清扫和随访观察两种方式,早发现、早诊断、早治疗仍是解决其问题的主要方式.     

类似鳃裂囊肿的颈部囊性淋巴结转移癌

类似鳃裂囊肿的颈部囊性淋巴结转移癌温州医学院附属第一医院口腔颌面外科方一鸣，李智渊，徐纪为，汪春仙淋巴结转移癌多为实质性，然而一些原发灶位于头颈部癌，可呈囊性淋巴结转移，临床表现类似鳃裂囊肿，往往易误诊。１９８２年以来，我院共收治４例颈部囊性淋巴结转...     

68例颈淋巴结转移癌临床分析

本文通过６８例颈淋巴结转移癌的临床分析，查出原发灶４１例，原发灶较隐蔽，非常容易忽视、漏诊。所以全身拉网式检查及各种仪器检查，对颈淋巴结转移癌非常重要。因治疗中原发灶的去除与否直接影响着生存率。本组手术＋化疗＋放疗生存率高，所以颈淋巴结转移癌手术切除肿瘤是重要手段之一。     

腮腺癌颈淋巴结转移的处理

目的 探讨腮腺癌颈淋巴结的手术处理。方法 回顾作者所收治的244例腮腺癌病人,分析其颈收结转移、处理及转归。结果 发现全组颈淋巴结转移率为32．4％,首发癌为28．7％,复发癌为46．5％。不同病理类型颈淋巴结转移率为0％－73．3％不等。肿瘤T1－T4分期,颈收结转移率为10％－68．8％。160例NO病人颈淋巴结转移率为16．3％,84例N^ 病人颈淋巴结转移率为63．1％。结论 认为腮腺癌N^ 病人应作治疗性颈清术,NO病人是否作选择性颈清术,病理类型是主要依据,但还要结合临床分期及是否为复发病例。     

以鳃裂囊肿为特征的颈部淋巴结转移癌--附106例成人侧颈部囊性肿块的分析

成人颈侧部孤立性囊性肿块的诊断对颌面外科医生来说首先应考虑鳃裂囊肿可能 ,但某些癌转移到颈部淋巴结可以发生囊性变 ,表现为囊性肿块[1] ,因而容易作出鳃裂囊肿的错误诊断。本文对临床上如何区别鳃裂囊肿和囊性转移癌、囊性转移癌有何特点、发生率如何以及原发灶好发部位与鳃裂囊肿有何关系等 ,结合临床和文献进行研究分析报道如下 :1　临床资料1.1　性别、年龄男性 72例 ,女性 3 4例 ,年龄最大 76岁 ,最小 19岁 ,平均年龄 48岁。囊性淋巴结转移 12例 ,男 9例 ,女 3例 ;年龄最大 76岁 ,最小 43岁 ,平均年龄 5 2岁。1.2　原发肿瘤部位扁…     

颈内动脉扭曲1例报告

颈动脉可因发育或硬化等原因发生扭曲，在颈部形成搏动性肿块，临床上易误诊为颈动脉体瘤等疾病。本文报告1例76岁女性双侧颈动脉扭曲患者，经B超及螺旋CT血管成像确诊，左侧颈内动脉严重扭曲呈“L”形，长度达12cm；右侧颈内动脉经度弯曲，作者认为遇到颈部搏动性肿块时，应考虑到颈动脉扭曲的可能，进行B超和（或）影像学检查，明确诊断，切不可冒然手术。     

双侧颈动脉畸形合并假性动脉瘤介入治疗1例报告

双侧颈总动脉发育异常、左侧颈总动脉先天性闭锁、右侧颈外动脉在颈内外分杈处形成假性动脉瘤临床罕见。作者收治1例,经CT血管成像及DSA确诊,动脉造影术后假性动脉瘤体积明显增大,出现呼吸困难、呛咳、声音嘶哑、头晕、头痛等症状。将覆膜支架放至右侧颈动脉分杈处行介入治疗,成功地封堵假性动脉瘤,保持颈内动脉通畅,瘤体不显影。治疗随访14个月,无并发症发生,肿瘤未复发。     

颈动脉手术35例临床分析

【摘要】 目的 回顾分析35例颈动脉手术，探讨其术前评价方法、手术方式及并发症防治措施。方法1999年1月—2004年12月，共进行各类颈动脉手术35例，其中颈动脉体瘤16例、恶性颈动脉体瘤1例、恶性肿瘤累及颈动脉17例、外伤性动-静脉瘘1例。手术包括颈动脉修补术（7例）、颈动脉结扎或切除术（17例）、颈动脉切除重建术（11例）。术前采用数字减影血管造影术（DSA）、DSA＋暂时性球囊导管阻断（TBO）＋单光子发射计算机体层摄影术（SPECT）、经颅多普勒超声（TCD）等方法评价脑侧支循环状况，术后随访4个月一4年，评价并发症及手术效果。结果27例接受颈动脉阻断试验，10例阳性（不能耐受），17例阴性（可耐受）。7例行颈动脉修补，其中1例术后大出血死亡。17例行单侧颈动脉结扎或切除，术后2周内，4例出现脑血管并发症；3例恶性肿瘤患者死亡，1例颈动脉体瘤术后言语不清，1例术后同侧上肢无力，运动受限，5例自觉头晕。11例行颈动脉切除、重建，术后均未出现明显的神经功能障碍，1例因肿瘤复发死亡，1例颈动脉体瘤对侧肢体运动不便、言语不清。颈动脉彩色超声检查显示，移植血管均畅通。结论TBO＋SPECT是目前比较可靠的脑侧支循环评价方法。颈动脉结扎近、远期并发症发生率较高。在条件具备时，提倡对颈动脉体瘤或累及颈动脉的恶性肿瘤患者行颈动脉切除重建术。     

Computed tomography (CT) of cervical lymph nodes in patients with oral cancer: comparison of low-attenuation areas in lymph nodes on CT images with pathological findings

Objectives  To clarify the histopathological features of low-attenuation areas in computed tomography (CT) images of cervical metastatic and benign lymph nodes in patients with oral squamous cell carcinoma (SCC). Methods  CT images of 230 lymph nodes from 37 patients with oral SCC were classified into four categories and compared with histopathological findings. Metastatic lymph nodes were evaluated in terms of focal necrosis, keratinization, fibrous tissue, and the proportion of the lymph node showing focal necrosis. Benign lymph nodes were evaluated in terms of adipose tissue, follicular hyperplasia, sinus histiocytosis, hyperemia, focal hemorrhaging, and the amount of adipose tissue. Results  Histopathologically, all 13 metastatic lymph nodes with rim enhancement on CT images included focal necrosis. However, most of the lymph nodes showed no focal necrosis. In addition, tumor cells, keratinization, and fibrous tissue were observed in the lymph nodes. Of the 26 metastatic lymph nodes with a heterogeneous appearance on CT images, four did not show focal necrosis. These lymph nodes showed keratinization or accumulation of lymph fluid. Histopathologically, 20 of 24 benign lymph nodes with a heterogeneous appearance on CT images (83.3%) had accompanying adipose tissue. Conclusions  Focal necrosis was the most important factor contributing to low attenuation in metastatic lymph nodes. However, other factors, such as tumor cells, keratinization, fibrous tissue, and accumulation of lymph fluid, also contributed. In benign lymph nodes, the presence of adipose tissue was a contributing factor in low-attenuation areas, as was focal hemorrhaging.     

颈外动脉危险吻合血管造影研究

目的：研究颈外动脉与颈内动脉，椎动脉间存在的危险吻合，方法：分析了250例颈外动脉造影图像中存在的危险吻合现象（包括烟雾病35例，头颈部高血运病变216例，其中7例已行戏外动脉结扎）。结果：烟雾病中14侧病脑中动脉，11例颞浅动脉，7例枕动脉参与颅内供血；颈外动脉结扎病例均丰在咽枕吻合，此外，还发现3例（3／250）眼动脉由脑膜中动脉异常起源，结论：颈外动脉与颈内动脉，椎动脉间存在多种危险吻合途径，栓塞治疗时应高度注意并予以适当处理，以避免造成颅内误栓。     

Resection and replacement of the carotid artery in metastatic head and neck cancer: literature review and case report

Metastases of advanced tumours of the oral cavity sometimes affect the cervical segments of the carotid arteries. The situation is worse in the 5-10% of cases in which the metastasis involves the common or internal carotid to such an extent that resection and replacement of the artery become necessary. Following clinical, CT/NM, and angiographic examinations, a surgical plan for the resection and reconstruction of the affected vascular segment is formulated. In preparing a treatment plan, emphasis must be placed on the expected quality of life, and careful consideration must be given to the extent of the operation.A survey of the international literature reveals that the reported mean 1-year complaint free survival rate after resection and reconstruction varies between 0 and 44%. In our experience, the wall of the carotid vessels is very resistant to tumour invasion in a large majority of patients. When radical surgery and reconstruction are carried out in the same session, does this increase the long-term cure rate and lengthen patient survival? A number of authors agree that radical interventions do not alter the survival indices significantly, but may improve the quality of life and regional control of the disease. The controversy over this topic is illustrated by means of a case report.     

Stent repair of an anastomotic pseudoaneurysm of the carotid artery after free fibula transplantation

We describe an anastomotic pseudoaneurysm of the carotid artery as a complication after free fibular transplantation. The treatment of choice was endovascular placement of a stent, although this could have occluded the arterial supply to the graft. In our case, the graft remained vital.     

颞浅动脉逆行栓塞治疗颈外动脉结扎后的口腔颌面部动-静脉畸形探讨

目的 总结颞浅动脉逆行栓塞治疗颈外动脉结扎后口腔颌面部动-静脉畸形经验.方法 2005年5月至2007年6月7例颈外动脉结扎后的口腔颌面部动-静脉畸形患者进行颞浅动脉逆行栓塞治疗.治疗前行血管造影,详尽了解包括双侧颈动脉、椎动脉以及甲状颈干情况.介入治疗采用颞浅动脉切开、逆行引入管腔外经为4F(1F=0.333 mm)的动脉鞘进行栓塞,栓塞材料选用不可吸收组织胶--二氰基丙烯酸正丁酯(N-butyl-2-cyanoacrylate,NBCA).结果 7例均成功进行双侧颈动脉、椎动脉以及甲状颈干的血管造影,造影期间未发生并发症.颈外动脉阻断后的口腔颌面部动-静脉畸形仍呈异常血管团样改变,颈部回流静脉提前显示.血管造影所见:颈外动脉阻断后,病变由颈内动脉的眼动脉供血;椎动脉通过枕动脉与结扎远端的颈外动脉相通;甲状颈干增粗并为病变供血;健侧的颈外动脉扩张后为患侧供血.结论 治疗口腔颌面部动-静脉畸形严禁行颈外动脉永久性结扎,否则不仅不能治疗疾病,相反会促进疾病的发展,同时使该类病变的介入治疗风险加大.颞浅动脉切开、逆行栓塞是有效的治疗途径,适于动-静脉畸形急性出血且无其他有效治疗手段的病例.     

Distinctive CT appearance of cervical lymphadenopathy in clinically suspected Cat-scratch disease affecting father and son

This is the presentation of the disitinctive CT manifestation of supracervical and submandibular lymphadenopathy of 2 cases of clinically suspected Cat-scratch disease (CSD) which affected two members of the same family. The characteristic CT appearance of this disease was similar to that of tuberculous adenitis and it must be distinguished from this by its benign self-limiting nature.     

Diagnostic analyses of cervical lymph nodes in patients with oral squamous cell carcinoma using CT and US

CT and US images of 24 patients with oral squamous cells carcinoma were studied retrospectively to clarify the characteristics finding of metastases in cervical lymph nodes. CT images of 201 lymph nodes were analyzed for patterns in appearance and maximum diameter on axial images. US findings of 45 lymph nodes were investigated with regard to internal echo. The metastatic nodes were found to be characterized by rim enhancement on CT and an heterogeneous appearance on US, while the features of non-metastatic nodes were an homogeneous appearance on CT with a density lower than that of the sternocleid mastoid muscle, and spot or septum patterns on US. Based on these results, we suggest new diagnostic criteria for metastatic cervical nodes in oral squamous cell carcinoma combining CT and US examinations.