气管造口复发癌的治疗

目的：探讨治疗气管造1：2复发癌的方法。方法：回顾分析37例气管造1：2复发癌的临床资料。按Sisson（1981）分型标准，Ⅰ型14例，Ⅱ型12例，Ⅲ型6例，Ⅳ型5例。结果：32例行手术治疗，其中Ⅰ型14例。随访3年以上7例，死亡4例；Ⅱ型12例，随访3年以上8例，死亡5例；Ⅲ型3例，Ⅳ型3例，35d～25月内死亡，平均11个月。5例未行手术治疗，其中Ⅲ型3例，Ⅳ型2例，2—10月内死亡，平均8．6月。Ⅲ、Ⅳ型手术患者的生存时间与未手术者比较差异无统计学意义（P〉0．05）。结论：气管造口复发癌预后较差．应根据患者的具体情况，行恰当的手术治疗可延长生命，提高生存质量。     

喉全切除后气管造瘘口复发癌缺损外科修复比较

目的探索喉全切除后气管造瘘口复发癌缺损外科修复的治疗效果。方法对18例喉全切除后气管造瘘口复发癌实施外科治疗。其中Ⅰ型7例,颈部单纯切口,胸大肌肌皮瓣修复颈部皮肤气管造瘘口缺损;Ⅱ型6例,颈肢或胸联合切口,前臂皮瓣或胸大肌肌皮瓣(游离前臂皮瓣5例,胸大肌肌皮瓣1例)修复部分喉咽切除;Ⅲ型3例,颈腹联合切口,游离空肠修复全喉咽、颈段食管;Ⅳ型2例,颈胸腹联合切口,胃上拉修复全喉咽、全食管。Ⅱ、Ⅲ、Ⅳ型的颈部皮肤气管造瘘口缺损均用胸大肌肌皮瓣修复。结果颈部缺损胸大肌肌皮瓣均成活;咽瘘4例(其中游离空肠1例,前臂皮瓣2例,胃上拉咽瘘出血1例);全部病例术后均能进食;随访6～74个月,3例出现不同程度吞咽梗阻。结论喉全切除后气管造瘘口复发癌外科治疗缺损,修复选择应根据原发肿瘤治疗的经过及气管造瘘口复发癌侵及范围来确定修复方法。     

喉癌术后复发及颈部转移临床治疗的远期疗效观察

目的：探讨治疗喉癌术后复发及颈部转移的有效方法。方法：回顾性分析我院1990年4月～1998年4月收治的喉癌术后复发及颈部转移患者70例，其中局部复发癌3i例，气管造口复发癌15例，颈淋巴结转移24例。结果：31例局部复发癌中，19例二次手术者术后15例生存，4例死亡；未行手术治疗的12例分别在1～3年内死亡。15例气管造口复发癌中，9例二次手术者术后5例生存，4例死亡；未行手术治疗的6例均在18个月内死亡。24例颈淋巴结转移者中，15例二次手术者术后8例生存，7例死亡；9例未行Ⅱ期手术者2年内死亡。结论：喉癌术后定期复查及系统的临床随访，有利于喉癌术后复发及颈部转移的早期发现和早期治疗；二次手术是喉癌术后复发及颈部转移临床治疗的重要措施；放射治疗或化学治疗作为综合治疗手段有一定疗效，但其疗效有限。     

全喉切除术后气管造口复发癌

目的 探讨喉癌、下咽癌全喉切除术后气管造口复发癌病因、诊断及治疗，提出气管造口复发癌预防措施。方法 回顾性分析16例喉癌、下咽癌全喉切除术后气管造口复发癌临床资料，对比手术和非手术治疗的效果。结果 16例气管造口复发癌全喉切除术前均有肿瘤声门下侵犯，5例术后绝缘阳性；手术治疗11例，5例术后病理证实为淋巴结转移；术后生存5－68个月，4例（4／9）存活3年以上；放射治疗或未治疗5例，生存3－7个月；手术明显延长生命（P＜0．01）。结论 气管造口复发癌病因可能与肿瘤残存、种植、淋巴结转移、肿瘤分化有关；预后差，应重在预防。全喉手术肿瘤的彻底切除，标本切缘的显微监控，精细的颈淋巴清扫手术是降低本病发生率的重要保证。     

全喉切除术后气管造口复发癌

目的探讨喉癌、下咽癌全喉切除术后气管造口复发癌病因、诊断及治疗,提出气管造口复发癌预防措施。方法回顾性分析16例喉癌、下咽癌全喉切除术后气管造口复发癌临床资料,对比手术和非手术治疗的效果。结果16例气管造口复发癌全喉切除术前均有肿瘤声门下侵犯,5例术后切缘阳性;手术治疗11例,5例术后病理证实为淋巴结转移;术后生存5～68个月,4例（4/9）存活3年以上;放射治疗或未治疗5例,生存3～7个月;手术明显延长生命（P<0.01）。结论气管造口复发癌病因可能与肿瘤残存、种植、淋巴结转移、肿瘤分化有关;预后差,应重在预防。全喉手术肿瘤的彻底切除,标本切缘的显微监控,精细的颈淋巴清扫手术是降低本病发生率的重要保证。     

胸大肌肌皮瓣修复气管造口复发癌术后的缺损

目的分析胸大肌肌皮瓣在修复气管造瘘口复发癌术后缺损中的应用。方法回顾分析1998~2003年随访资料完整的12例气管造瘘口复发癌患者,其中Ⅰ型4例,Ⅱ型5例,Ⅲ型3例,均用胸大肌肌皮瓣修补术后缺损。对复发癌灶扩大切除,缺损处单纯以胸大肌肌皮瓣修复9例,胸大肌皮瓣联合断层皮片修补3例。结果重建的喉咽腔无狭窄,无吞咽困难。8例皮瓣I期存活,1例肌皮瓣皮肤远端轻度坏死,3例出现咽瘘。随访3年以上,Ⅰ、Ⅱ型中各有3例无瘤存活,其余6例在1~2年内死亡。结论胸大肌肌皮瓣血供可靠、修复操作简单、组织量丰富,对挽救瘘口复发癌手术后巨大缺损应用价值较高。     

气管造口复发癌的处理

目的探讨气管造口复发癌的治疗方法.方法对中国医学科学院肿瘤医院1994年6月～2001年8月诊治的23例气管造口复发癌的临床资料进行了回顾性的分析.外院转来病例20例,本院3例.分析复发的原因,探讨不同手术的可行性,对比手术和非手术治疗的效果. 结果 23例气管造口复发癌中,未行手术病例5例,均在1～6个月死亡,平均存活5.7个月.接受手术18例中,随诊6个月～7年2个月,生存超过6个月的16例,1年生存率40.7%,3年生存率20.4%.术后咽瘘6例,其中1例伴有颈总动脉大出血,抢救成功;1例伴有皮瓣局部坏死,术后1周颈总动脉破裂大出血死亡;1例偏瘫昏迷后抢救成功,并同时皮瓣局部坏死.秩和检验,手术患者的生存时间与未手术者差异有显著性(t=17,P<0.05).结论气管造口复发癌预后极差,应注意预防.气管造口复发癌与声门下侵犯、喉前气管食管沟淋巴结转移、局部肿瘤残存和种植有关.对适合的病例行适当的手术治疗,可延长患者生命,减少痛苦,提高生存质量.     

上纵隔暴露术

头颈外科医生在肿瘤的治疗中难免会遇到这种情况:肿瘤向胸骨柄和锁骨扩展,累及上纵隔。不暴露上纵隔,则不能彻底切除肿瘤,使病人失去了手术救治机会。因此,有必要探讨上纵隔暴露的问题。本文综述国外有关上纵隔暴露术的文献如下。【上纵隔暴露术的指征】 1.喉癌术后气管造口周围复发(以下简称造口复发):其发生率为3～14%,后果严重,死亡率高,手术有治愈的可能。Sisson报告在行上纵隔暴露术的病人中,50%为造口复发,为主要的手术指征。氏将造口复发分为四型:Ⅰ型,肿瘤局限,位于气管造口上方,食管未受累;Ⅱ型,肿瘤亦位于气管造口上方,累及食管;Ⅲ型,肿瘤位于气管造口下方,扩展到上纵隔;Ⅳ型,肿瘤向气管造口外扩展,累及锁骨下。Ⅰ     

喉全切除后造瘘口复发癌危险因素的多因素分析

目的：探讨全喉切除后造瘘口复发癌的有关危险因素。方法：1978－1998年我院收治411例喉全切除的喉癌患者,其中58例造瘘口癌复发（14．1％0,可能造成造瘘口的复发癌的危险因素通过Cox模型分析。结果：声门下、跨声门侵犯和肿瘤T3、T4期与复发有关。结论：喉全切除后造瘘口复发癌是最严重的晚期并发症,其与声门下癌扩展以及原发癌喉外侵犯密切相关。     

气管造口复发癌的临床分析和治疗转归

目的探讨气管造口复发癌的原因及手术治疗的可行性。方法回顾分析13例气管造口复发癌的临床资料,分析复发原因,对比手术和非手术治疗的效果。结果13例气管造口复发癌中,未行手术治疗4例,除1例存活1年3个月,其余3例均在2～7个月死亡;接受手术治疗9例,6例存活1年以上,4例随访3年,有1例仍存活。手术组1年生存率显著高于非手术组。结论气管造口复发癌预后较差,适当的手术治疗可延长患者生命,提高生活质量。     

颈静脉鼓室球瘤的治疗

目的 探讨颈静脉鼓室球瘤的手术方法。方法 回顾性分析１９８２～１９９８年１１例手术治疗的颈静脉鼓室球瘤（鼓室球瘤Ⅱ型１例、Ⅲ型１例及Ⅳ型３例;颈静脉球瘤Ⅰ型１例、Ⅲ型５例）术式及治疗效果。结果 肿瘤均予以完全切除,术后均一期愈合。１例术后喉返神经麻痹。术后随诊１～８年,平均３年９个月,无复发者。结论 鼓室球瘤宜采用耳一切口入路;颈静脉球瘤Ⅰ型采用耳后切口向下延长至颈部,Ⅲ型采用耳后大Ｃ形切口行颞骨     

Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years

CONCLUSION: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. OBJECTIVE: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. PATIENTS AND METHODS: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma - arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60-66 Gy) and twice-daily hyperfractionated radiotherapy (70-74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. RESULTS: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment.     

不同临床时期鼻咽血管纤维瘤的手术方式选择

目的探讨如何选择恰当的手术方式切除不同临床时期的鼻咽血管纤维瘤。方法2003年6月—2006年7月中南大学湘雅医院耳鼻咽喉科手术治疗的22例鼻咽血管纤维瘤，患者均为男性，年龄9～30岁，中位年龄16岁。按鼻咽血管纤维瘤Fiseh分期，6例临床Ⅰ期患者采取单纯经鼻内镜下肿瘤切除；6例临床Ⅱ期和2例临床Ⅲ期患者采取内镜下经中鼻道上颌窦后壁入路切除肿瘤；3例临床Ⅲ期和2例临床Ⅳ期患者采取内镜下经中鼻道一下鼻道扩大上颌窦后壁入路切除肿瘤；1例Ⅳ期患者采取显微镜下经耳前颞下窝入路联合内镜下经中鼻道．下鼻道扩大上颌窦后壁入路切除肿瘤；2例Ⅳ期患者采取鼻外上颌骨入路切除肿瘤。结果21例患者肿瘤全切，1例肿瘤次全切除，术后9个月再次经鼻内镜手术全切肿瘤残灶。无手术并发症，术后随访9个月至3年无复发病例。结论以鼻咽血管纤维瘤的临床分期为基础，分别以肿瘤是否占据整个鼻腔、是否达颞下窝外侧区及是否侵入颅内为依据，选择恰当的手术方式，对减少手术损伤，提高手术疗效具有重要意义。     

成人颈部囊性水瘤外科治疗（附9例报道）

 目的回顾性分析9例成人颈部囊性水瘤患者的临床病例资料，总结对该病的外科治疗。方法收集2014年4月~2017年6月首都医科大学附属北京友谊医院耳鼻咽喉头颈外科诊治的9例成人颈部囊性水瘤患者的临床资料，其中男5例，女4例；年龄18-63岁。均为单侧发病，其中左侧4例，右侧5例。根据de Serres分期Ⅰ期5例，Ⅱ期及Ⅲ期各2例；水瘤位于咽旁间隙7例，颈后三角1例，舌骨前下方1例。结果所有患者均经颈外径路完整切除，随访5~38个月未见复发。2例出现Horner征，自行恢复，无其他严重并发症。结论对于成人颈部囊性水瘤患者，手术应作为治疗的首选方式，完整剥离并切除囊壁是减少复发的关键。     

中央区窦镰旁大型脑膜瘤的显微外科治疗

目的探讨显微外科治疗中央区窦镰旁脑膜瘤的临床疗效，并进一步总结该病的显微外科治疗经验及体会。方法回顾性分析我科2010~2015年40例中央区窦镰旁大型脑膜瘤患者的临床资料。结果术后按照Simpson分级 40例患者其中位于中央区侵犯大脑镰及矢状窦壁者22例行Simpson I级切除16例，Simpson II级切除6例；位于中央区侵犯大脑镰及矢状窦腔者6例行Simpson I级切除4例（肿瘤致窦腔完全闭塞），Simpson IV级切除2例（肿瘤未使窦腔完全闭塞）；位于中央区皮层深部只侵犯大脑镰者5例均为Simpson I级切除；位于中央区皮层凸面只侵犯矢状窦者7例，其中只侵及窦壁者5例Simpson I级切除3例，Simpson II级切除2例，侵入窦腔者2例均行Simpson IV级切除。以上40例患者随访3个月至5年，Simpson I级切除的28例患者均无复发；Simpson II级切除8例者其中7例无复发，1例随访半年后肿瘤复发，予以伽马刀治疗后肿瘤消失；Simpson IV级切除4例随访1年后肿瘤均有所增长，均予以伽马刀治疗，之后失访。术后出现偏瘫者10例，随访1年后完全恢复者6例，4例部分恢复。无死亡病例。结论静脉窦等的血管影像及熟练的显微外科技术能有效地保护功能区皮层结构及回流静脉，从而减少术中出血，提高全切率，降低致残及复发率，避免死亡。     

39例环后癌的外科治疗及临床疗效分析

目的探讨环后癌的外科治疗方法及临床疗效。方法回顾性分析2010~2018年行外科治疗的39例环后癌患者,其中男38例,女1例;年龄39～70岁。根据2002年UICC分期规定：I期7例,II期7例,III期8例,IV期17例。行保留喉功能者25例,不保留喉功能者14例;在完整切除肿瘤后进行咽喉功能的修复重建。术前诱导化疗+手术+术后辅助放疗者15例,手术+术后辅助放疗者14例,术前诱导化疗+手术者8例,单纯手术者2例。结果术后出现咽瘘5例,下咽狭窄2例,分别予换药和食管镜下扩张后II期愈合。随访时间5～65个月,随访5年及以上者5例 ,健在1例;随访3年以上者18例,健在7例,其余未随访至3年,7例失访。经Log rank检验,是否保留喉功能组间、进行术前诱导化疗联合术后辅助放疗的患者与仅进行术后辅助放疗的患者组间、患者有无淋巴结转移组间、及I II期与III IV期组间生存率差异均无统计学意义（P＞0.05）。结论随着环后癌外科治疗的发展,在安全切除癌灶的基础上可酌情保留中晚期喉功能,结合外科综合治疗可一定程度提升患者生活质量。     

Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 53 patients and prognostic factors

CONCLUSIONS: Salvage surgery is a justified treatment for primary recurrence of nasopharyngeal carcinoma (NPC). Skull base surgery can play a role in rescuing patients with more advanced local recurrence of NPC. OBJECTIVES: The purpose of this study was to report the local control and overall survival outcome of patients with (NPC) with local failure who received salvage nasopharyngectomy and to identify prognostic factors. PATIENTS AND METHODS: Fifty-three consecutive patients who had primary recurrence of NPC and underwent salvage surgery with curative intention from July 1993 to December 2006 were retrospectively reviewed. The follow-up time ranged from 5.1 to 142.2 months. The numbers of cases of recurrent NPC stage were as follows: stage I, 26; stage II, 9; stage III, 10 and stage IV, 8. Fifty patients had one course of radiation therapy while 3 had two courses of radiation therapy before the salvage surgery. For the nasopharyngectomy, 2 patients underwent endoscopic approach and 33 underwent facial translocation, while 18 had craniofacial resection. Postoperative adjuvant treatment included radiation therapy, 4 cases; radiosurgery, 8 cases; concurrent chemoradiation therapy, 7 cases; and chemotherapy, 2 cases. RESULTS: The 5-year local control rates were T1, 58.3%; T2, 27.8%; T3, 53.3%; T4, 75.0%; and all stages, 53.6%. The 5-year overall survival rates were stage I, 64.8%; stage II, 38.1%; stage III, 25.9%; stage IV, 46.9%; and all stages, 48.7%. Multivariate analysis revealed that gender, margin status, adjuvant treatment type and parapharyngeal space involvement were significant impact factors of local control, whereas dura or brain involvement, local recurrence and adjuvant treatment type were significant impact factors of survival.     

Translabyrinthine removal of large acoustic neuromas in young adults

OBJECTIVE: the authors reviewed the clinical manifestations and the surgical outcomes in a series of young patients who underwent removal of large acoustic neuromas via the translabyrinthine approach. METHODS: 40 young adults who underwent a translabyrinthine removal of acoustic neuromas 3 cm or greater in size were analyzed. The patient's age ranged from 17 to 30 years. The mean size of tumor was 4.25 cm. RESULTS: the primary symptoms are similar to those in adult but usually less intense. The average interval time between the primary symptom and the diagnosis was 17 months. A high percentage of preoperative normal hearing (35%) and good facial function (100%) were noted. Translabyrinthine approach was used in all cases. Total removal was realised in 39 patients (97.5%). The facial nerve was anatomically preserved in 37 patients (92.5%). Twenty-six patients (65%) had a good facial function (House-Brackmann grade I or II) immediately or at 1 month after surgery, 11 patients (28%) achieved grade III or IV. Three patients underwent an immediate nerve repair after tumor removal. All of them recovered to grade III or IV 1 year after surgery. Postoperative complications were minimal. CONCLUSIONS: young adults may have a rapid growth rate but usually have minimal symptoms even with a large acoustic neuroma. The translabyrinthine approach has been used successfully in removal of large acoustic tumors of young patients, with the good result of facial nerve preservation and long-term tumor control.