鼻咽癌放疗后颈部淋巴结残留复发的手术治疗

目的:探讨鼻咽癌放疗后颈部淋巴结残留或复发的治疗方法。方法:对我科1994~2002年21例鼻咽癌放疗后颈部淋巴结残留或复发的病人手术治疗总结,18例行改良根治性颈淋巴结清扫术,2例行扩大根治性颈淋巴结清扫术,1例行姑息性颈淋巴结切除术。结果:21例病人3年生存率52.4%,5年生存率33.3%。结论:鼻咽癌放疗后颈淋巴结残留复发手术治疗能提高患者生存率。     

鼻咽癌放疗后颈部残留或复发挽救性手术治疗23例临床分析

目的观察鼻咽癌放疗后残留或复发颈部转移灶采用手术治疗的疗效及对相关问题进行探讨。方法对23例鼻咽癌患者放疗后残留或复发颈部转移灶进行手术治疗，术后随诊，切除标本送病理检查。结果3例患者手术治疗的5年生存率为52.2%，未发生严重的并发症。结论鼻咽癌患者放疗后颈淋巴结残留或复发者手术治疗的术式应采用根治性颈清扫术或区域性颈清扫术较合适。     

鼻咽癌放疗后颈部残留淋巴结清扫术的疗效观察

目的:分析鼻咽癌根治性放疗后残留颈淋巴结采用颈淋巴结清扫术治疗的疗效及影响因素.方法: 回顾性分析2001年-2005年住院的36例鼻咽癌患者,根治性放疗后颈淋巴结残留者行手术治疗资料.结果:术后3年、5年生存率为69.4%和38.9%,残留颈部淋巴结大小,是否包膜外侵犯与患者的预后有关(P<0.05),而性别、年龄与患者生存率无明显差异(P>0.05).结论: 鼻咽癌根治性放疗后颈淋巴结残留行手术治疗是治疗有效方法.     

喉癌颈淋巴结转移行颈清扫术后的疗效观察

目的:评估喉癌颈淋巴结转移行颈清扫术后的疗效.方法:统计分析我院1990年6月至2000年6月资料完整的喉癌病例356例,病理均为鳞状细胞癌,其中全喉切除73例,近全喉切除11例,喉部分切除256例,拒绝手术而接受放疗或放弃治疗16例(其中3例行气管切开术).术前颈部触诊、超声、CT、MR、细针穿刺及术中冰冻等方法确定转移淋巴结,同时或之后行颈淋巴清扫术共48例,其中N1 35例、N2 9例、N3 4例,术式:根治性颈清扫8例,改良根治性颈清扫13例(Ⅰ型1例、Ⅱ型4例、Ⅲ型9例,其中双侧清扫2例),选择性颈清扫27例(颈侧清扫17例, Ⅱ、Ⅲ区清扫10例 ),术后放疗60Gy5例,50Gy23例,40-46Gy8例, 12例未行放疗.结果:随访3年以上42例,随访5年35例.术后肿瘤原发部位复发3例,颈部复发6例(术侧5例,对侧1例) ,远处转移2例(肺和纵隔各1例),死亡5例(2年1例,3-5年4例).结论:根据肿瘤位置、范围及颈部淋巴结转移情况选择不同的颈清扫术式加术后放射治疗,虽然仍存在复发,但在减少创伤、预防颈清扫术的并发症和疗效等方面收到了较好的效果.     

甲状腺乳头状癌颈侧区清扫术治疗现状

甲状腺乳头状癌容易发生颈部淋巴结转移,侧颈部是常见受累部位之一.颈部清扫术是治疗甲状腺癌颈转移的标准手段,但其清扫范围存在争议,应视颈部淋巴结转移的不同区域而定.广泛的侧颈部转移,建议治疗性的改良根治性颈清扫;颈部淋巴结转移不广泛者,特别是术前影像学检查或查体未发现ⅡB区和ⅤA区转移者,建议行ⅡA、Ⅲ、Ⅳ、ⅤB区的择区性颈清扫;cN0患者不主张行预防性颈清扫术.建议同时采用cN分期和pN分期来区别对待颈部淋巴结.     

鼻咽癌放疗后颈淋巴结残留或复发的手术治疗

目的 探讨颈淋巴结清扫术治疗鼻咽癌放疗后颈淋巴结残留或复发的应用价值及效果。方法 对36例鼻咽癌放疗后颈淋巴结残留或复发的患行颈淋巴结清扫术，应用Kaplan—Meier法计算颈部局控率和总生存率，对影响生存率的有关因素采用Cox模型进行分析。结果 术后3年、5年颈部局部控制率为44．1％和23．5％，3年、5年总生存率为47％和26．4％。多因素分析结果表明：颈淋巴结≥3cm、淋巴结包膜外侵预后差。结论 颈淋巴结清扫术是治疗鼻咽癌放疗后颈淋巴结残留或复发的有效方法，能明显提高患的颈部局控率及总生存率。颈淋巴结大小、淋巴结包膜外侵是影响颈部局控率和总生存率的独立预后因素。     

口底鳞状细胞癌颈淋巴结转移规律及处理的探讨

背景与目的：口底癌颈淋巴结转移规律方面的研究较少,本研究探讨口底癌颈淋巴结转移的分布特点和合理的治疗方法。方法：回顾性分析经根治性治疗的79例口底鳞癌病例,比较其临床和病理阳性淋巴结分布差异;比较临床淋巴结阳性组经根治性颈清扫术,上半颈清扫术术后颈部的复发率和临床淋巴结阴性组经根治性颈清扫术,上半颈清扫术,颌下三角清扫术的复发率,及临床观察组颈部的复发率。结果：临床和病理阳性淋巴结分布都以Ⅱ区为主,分别占61.8%和40.0%。其次是Ⅰ区和/或Ⅲ区,而Ⅳ,Ⅴ,Ⅵ区则极少;临床淋巴结阳性组中根治性颈清扫术术后颈部的复发率低于上半颈清扫术者,但无统计学意义（X^2=3.403,P=0.065);临床颈淋巴结阴性组中上半颈清扫术,颌下三角清扫术,临床观察等方法处理的颈部复发率分别是11.1%(1/9),40.0%(2/5)和23.5%(4/17),组间差异无统计学意义（X^2=1.554,P=0.46)。结论：口底鳞癌颈淋巴结转移的分布主要在Ⅰ、Ⅱ、Ⅲ区;临床颈淋巴结阴性者宜进行Ⅰ、Ⅱ、Ⅲ区（上半颈）淋巴结清扫术。     

鼻咽癌首程放疗后578例颈部淋巴结复发因素分析

[目的]研究鼻咽癌首程放疗后颈部淋巴结复发的相关因素.[方法]3124例鼻咽癌初诊患者采用60Co分段放射治疗和连续放射治疗后分析淋巴结分期、照野布野、放射剂量及分段治疗问题与颈部淋巴结复发的相关性.[结果]治疗前淋巴结分期高与颈淋巴结复发有关,N0、N1、N2、N3期复发率分别为12.8%、12.2%、23.7%和27.5%(P＜0.001).全颈和半颈照射的复发率分别为19.3%和16.9%(P＞0.05).在终止剂量为60Gy和65Gy时,消退剂量45Gy复发率均较55Gy低,分别为12.4%对24.1%(P＞0.001)和11.5%对23.3%(P＜0.001).连续放疗复发率11.9%,低于分段放疗组的21.8%(P＜0.001),分段放疗间隙时间长也与高复发有关(P=0.038).[结论]鼻咽癌放疗后颈淋巴结复发与N分期高以及疗程长成正比,靶区漏照或剂量不足也是复发的重要因素.     

鼻咽癌首程放疗后颈部淋巴结复发因素探讨

目的研究鼻咽癌首程放疗后颈部淋巴结复发的相关因素。方法对3 124例鼻咽癌初诊患者采用60Co分段放射治疗和连续放射治疗后,分析淋巴结分期、照射布野、放疗剂量及分段治疗间歇与颈部淋巴结复发的相关性。结果治疗前淋巴结分期高与颈淋巴结复发有关,N0,N1,N2,N3期复发率分别为12.8 %,12.2 %,23.7 %和27.5 %(P<0.001)。全颈和半颈照射的复发率分别为19.3 %和6.9 %(P>0.05)。在终止剂量为60 Gy和65 Gy时,消退剂量为45 Gy时复发率均较55 Gy低,分别为12.4 %,24.1 %(P<0.001)和11.5 %,23.3 %(P<0.001)。连续放疗复发率为11.9 %,低于分段放疗组21.8 %(P<0.001),分段放疗间歇时间长也与复发有关(P = 0.038)。结论鼻咽癌放疗后颈淋巴结复发与N分期高以及疗程呈正比,靶区漏照或剂量不足也是复发的重要因素。     

择区性颈清扫在喉癌(声门上型)cN0中的应用

背景与目的:声门上型喉癌有较高的隐性淋巴结转移率,目前尚无法在手术治疗前判断其是否有潜在转移.因此,如何正确处理声门上型喉癌潜在隐性淋巴结转移成为影响声门上型喉癌疗效的重要因素.本文旨在研究择区性颈清扫术(selective neck dissection,SND)在喉癌(声门上型)cN0治疗中的应用.方法:125例行择区性颈清扫的喉鳞状细胞癌声门上型cN0的病例进行回顾性分析.结果:125例cN0患者行择区性清扫术后发现pN+39例(31.2%);清扫标本中共发现64枚阳性淋巴结,其在颈部的分布如下:Ⅰ区1.6%、Ⅱ区70.3%、Ⅲ区25.0%和Ⅳ区3.1%,3年生存率为87.2%.结论:声门上型喉癌患者cN0病例行择区性清扫术能有效清除头颁部癌患者颈部潜在淋巴结转移;与根治性颈清扫比较,可以达到同样的疗效,同时能避免行全颈清扫造成手术范围过大,术后并发症多的缺点;应对声门上型喉癌cN0患者重点行Ⅱ和Ⅲ区颈淋巴结清扫术尤其是Ⅱb区.     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

miRNA与肿瘤侵袭转移

目前,microRNA (miRNA)已成为肿瘤研究中最基本的参与者,主要通过与靶标基因3 'UTR(非翻译区)的完全或不完全配对,降解靶标基因mRNA或抑制其翻译,从而参与调控个体发育、细胞凋亡、增殖及分化等生命活动.miRNA作为调控基因表达的重要分子在肿瘤侵袭转移中的作用越来越受到重视,表明miRNA在肿瘤侵袭和转移中的作用机制具有重要的理论意义,同时也可为肿瘤的诊断和治疗提供新方法.本文就miRNA通过调控上皮间质转化及肿瘤干细胞导致肿瘤侵袭转移的最新研究进展作一综述.     

芦荟大黄素及芦荟提取物的诱变性和抗诱变性

目的:用L5178Y小鼠淋巴瘤细胞体外微核试验评价芦荟大黄素和芦荟提取物的诱变和抗诱变作用,为其安全性评价提供依据。方法:设溶剂对照、阳性对照和抗诱变对照,芦荟大黄素和芦荟提取物诱变和抗诱变试验各设4个剂量组,处理L5178Y细胞12 h后按常规方法进行体外微核试验分析。结果:较高浓度(6.67μg/ml)的芦荟大黄素可致微核细胞率增加,与对照组比较,差异有统计学意义(P0.05);而芦荟提取物未见此效应。在一定剂量范围内,芦荟大黄素(0.22～6μg/ml)和芦荟提取物(20～180μg/ml)对甲磺酸甲酯(MMS)所致微核细胞率均有一定程度的拮抗作用,与对照组比较,差异有统计学意义(P0.01)。结论:芦荟大黄素具有一定的诱变作用,而在本实验剂量范围内的芦荟提取物未见遗传毒性。两种受试物在一定范围内均能较好地拮抗MMS所致的染色体损伤。     

甲状腺手术的技巧及副损伤的预防和处置

鉴于甲状腺手术是普外科的常见手术，为求其日渐完美，以有益于病人，现根据作者的体会，并结合阅读相关文献，就其手术操作、喉返神经处理、甲状旁腺处理进行扼要阐述。     

Erythrocyte levels of cadmium and lead and risk of B-cell non-Hodgkin lymphoma and multiple myeloma

Cadmium and lead are persistent environmental toxins that are known or probable carcinogens, based on evidence for causality for nonhematologic cancers. Associations of these metals with risk of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are unknown but biologically plausible. To examine the associations of circulating levels of lead and cadmium exposure with risk of B-cell NHL (B-NHL) and multiple myeloma, we conducted a nested case-control study among 299 incident B-cell NHLs and 76 MM cases within the Cancer Prevention Study-II Nutrition Cohort (CPS-II NC). Each case was incidence-density matched to two eligible controls on age, race, sex and blood draw date. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for lymphoid malignancies overall and stratified by subtype. We observed a significant positive association between high erythrocyte lead concentration and risk of lymphoid malignancies overall (RR = 1.16, 95% CI: 1.02-1.33 per 17.6 μg/L (1 standard deviation [SD])) and follicular lymphoma in particular (RR = 1.80, 95% CI: 1.15-2.80 per SD). In contrast, there was no association between erythrocyte cadmium and risk of B-NHL (RR = 0.89, 95% CI: 0.75-1.06 per 0.37 μg/L [1 SD]), or any B-NHL subtypes; but a strong inverse association with MM risk (RR = 0.59, 95% CI: 0.38-0.89, per SD). Results from our study suggest a positive association between erythrocyte lead level and risk of lymphoid malignancies and a possible inverse association between cadmium and myeloma. Additional research is needed to confirm and further explore these findings.     

甲胎蛋白与自噬在肝癌发生发展中的作用及其相互关系

甲胎蛋白（AFP）作为临床诊断肝癌最常用的肿瘤标志物,有抑制免疫、促进细胞生长、抑制癌细胞凋亡的作用。自噬是一种维持细胞生存的重要途径之一,其与肝癌的发生发展及治疗有着密切联系,对肝癌既有抑制又有促进作用。PI3K/AKT作为两者共有的信号通路,它们是否有着相互关系来促进肝癌的发展尚需进一步研究。     

Comparison of the Efficacy and Safety of Ceftibuten and Cefaclor in the Treatment of Pneumonia and Bronchiectasis

Summary

In a multicentre, international study of 187 adult patients with bacterial pneumonia or bronchiectasis, the safety and efficacy of a regimen of 200 mg ceftibuten administered twice-daily was compared with cefaclor given in a dosage of 500 mg three times a day. Of the 94 evaluable patients, 66 received ceftibuten and 28 received cefaclor. The overall bacteriological response was similar in the two treatment groups with elimination of the original pathogen in 91% and 89% of the patients receiving ceftibuten and cefaclor, respectively. The overall clinical response mirrored the bacteriological results with a successful clinical outcome in 92% of ceftibuten-treated patients compared with 93% in patients receiving cefaclor. Adverse experiences were, in general, few and mild, being reported in 8% and 17% of patients receiving ceftibuten and cefaclor, respectively.