成人颈部淋巴管瘤的手术治疗

目的 探讨成人颈部淋巴管瘤的手术治疗及疗效。方法 回顾性分析2003～2011年收治的全部成人颈部淋巴管瘤的病历资料。结果 9例肿瘤完全切除, 未出现神经损伤等明显并发症, 随访6个月～8年无复发。结论 手术治疗成人颈部淋巴管瘤效果理想,可作为首选方法。     

BLM治疗囊性淋巴管瘤的经验

囊性淋巴管瘤为常见的良性肿瘤,好发于头颈部,邻近重要神经和血管,手术不易彻底切除及有神经麻痹等并发症,故注射硬化剂为首选。本文报告3例幼儿头颈部囊性淋巴管瘤局部注射博来霉素(BLM)乳剂,获良好效果。行肿瘤穿刺抽吸适量溶液后注入BLM乳剂,     

颈颌腭入路-下颌骨外旋在鼻咽癌挽救性手术中的应用

目的探讨鼻咽癌放射治疗后复发肿瘤的挽救性手术方法.方法回顾性分析应用颈颌腭-下颌骨外旋入路,手术治疗鼻咽癌放射治疗未控患者2例、鼻咽部复发病变8例;二程放射治疗后病变复发2例,共1 2例（rT1 4例、rT2 7例、rT3 1例）患者的临床资料、手术方法及随访结果.结果 12例患者通过颈颌腭（下颌骨外旋）入路切除肿瘤,10例术中用带蒂颌下组织瓣Ⅰ期修复鼻咽部缺损;2例用游离下鼻甲修复鼻咽顶部缺损,7例患者无瘤生存、1例带瘤生存、3例患者死于局部复发、1例死于远处转移;患者2年总生存率为75%（9/12）.结论颈颌腭-下颌骨外旋入路切除鼻咽部肿瘤手术视野显露良好;可在直视下切除鼻咽及咽旁肿瘤处理颈内动脉,肿瘤切除后用带蒂颌下组织瓣Ⅰ期修复鼻咽部缺损手术及术后并发症少,是鼻咽癌放射治疗后复发肿瘤挽救性手术的一种理想的手术入路.     

颈部囊性淋巴管瘤8例临床分析

目的 总结颈部囊性淋巴管瘤的临床特点和诊治过程。方法 分析8例手术效果。结果 8例术后随访1－5年，无1例复发，结论 早期彻底切除囊肿是本病有效的治疗方法。     

颈部囊肿与瘘管的诊断和治疗

目的总结颈部囊肿与瘘管的诊治经验.方法93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1～10年.结果93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症.结论颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查.B超、CT等是有效的辅助检查手段.治疗上应彻底切除囊壁与瘘管,避免复发.术中应避免损伤颈部的大血管和神经.甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键.     

上颌骨翻转径路手术在鼻咽癌治疗中的应用

目的探讨上颌骨翻转径路手术在鼻咽癌治疗中的临床应用和价值。方法回顾性分析20例应用上颌骨翻转径路手术治疗的鼻咽癌患者,其中15例为放疗后复发（4例为再程放疗后）,3例为放疗后未控,2例为首诊行手术治疗。总结其临床病理资料、手术方法、治疗及随访结果。采用Kaplan-Meier法行生存分析,并绘制生存曲线。结果全组患者均手术顺利,肿瘤根治性切除,无术中并发症。术后2例患者出现明显的张口困难,5例出现腭瘘,1例出现分泌性中耳炎,1例出现上颌骨坏死行再次手术,另11例患者无明显术后并发症。术后随访4-80个月,3例出现局部复发,1例颈部复发,1例远处转移,11例患者无瘤生存,1例带瘤生存,8例死亡。总的中位生存期为35个月,2年累积生存率为66．1％。结论经上颔骨翻转径路切除鼻咽部肿瘤术野暴露良好,直视下可操作性强,手术切除彻底,是鼻咽癌手术径路的一种理想选择。     

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.     

头颈外科

20020850颈部续肿与痰管的诊断和治疗/蔡建峰…//山东医大基础医学院学报一2001,15(6)一356~357 目的:总结颈部囊肿与痪管的诊治经验。方法:93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘩管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌管囊肿37例,甲状舌管凄管25例,癌性淋巴液囊肿1例,随访1一10年。结果:93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂屡管2例3次手术,甲状舌管屡管1例复发,鳃裂屡管术后1例迟发性面瘫,一次手术治愈,无术后并发症。结论:颈部囊肿与痊管的诊断除依据术前检查外,主要是依据术…     

小儿头颈部囊状淋巴管瘤15例临床分析

目的:探讨小儿头颈部囊状淋巴管瘤的诊断和有效的治疗方法。方法:回顾分析我院15例经病理确诊的小儿头颈部囊状淋巴管瘤的临床资料,对其临床特点、治疗方法以及随访结果进行分析。结果:所有患者手术前均行B超或CT等检查,了解病变位置、大小和范围。15例皆经手术切除,其中14例完整切除,1例行次全切除。术后1例出现轻微口角偏斜,1例出现Horner综合征,1例气管切开患儿在出院前已拔套管。13例完整切除者随访6个月～8年,均未见复发;1例次全切除者随访2年未见复发;1例失访。1例轻微口角偏斜经康复治疗有所好转,1例Horner综合征患儿经康复治疗未能好转。结论:B超及CT检查是小儿头颈部囊状淋巴管瘤的有效诊断方法,也是术前手术安全性评估的依据;手术治疗是囊状淋巴管瘤的有效治疗方法,为了避免并发症产生,术中允许少量残留。     

小儿颈胸部淋巴管瘤的诊断与治疗(附3例报告)

目的:探讨小儿颈胸部淋巴管瘤的诊断与治疗。方法:3例患者均在全身麻醉下行颈胸联合进路胸骨正中劈开颈胸部淋巴管瘤切除术。结果:所有患者均病理诊断为淋巴管瘤,术后随访未见复发及手术并发症发生。结论:采用颈胸联合进路可以充分暴露瘤体,保证完整切除肿瘤,随访无复发。对于颈胸部的巨大淋巴管瘤,其他治疗手段不推荐采用。     

Extensive lymphangioma presenting with upper airway obstruction

OBJECTIVE: To describe the results of an outcome survey of 18 cases of pediatric lymphangioma with dyspnea from encroachment on the tongue base, parapharyngeal space, and/or larynx. DESIGN: Retrospective review of files from January 1983 to September 1998. SETTING: Pediatric otolaryngology departments from 2 referral centers. PATIENTS: Eighteen patients were treated. The average age at initial surgery was 22 weeks (median, 5 weeks). All presented with at least unilateral suprahyoid and infrahyoid cavernous (microcystic) lymphangioma. The tongue base was involved in 11 patients, the parapharyngeal space in 12, and the larynx in 8. INTERVENTIONS: Neck dissection was performed initially in all patients. Tracheotomy was performed in 9 patients (50%). Macroglossia was treated by V glossoplasty. Parapharyngeal extensions were treated by cervicotomy or endoscopy, and larynx and tongue base extensions by carbon dioxide laser photocoagulation. Supraglottic laryngectomy was performed in 2 patients. MAIN OUTCOME MEASURES: Residual disease, decannulation, duration of tracheotomy, and persistent respiratory symptoms. RESULTS: The average follow-up was 4 years postoperatively. One postoperative death occurred. Sixteen (94%) of the remaining 17 patients had residual lymphangioma. Eight (89%) of the 9 patients with tracheotomy underwent decannulation (average duration, 22 months). Ten patients had persistent symptoms, and 6 were asymptomatic. CONCLUSIONS: Involvement of the upper airway seems to be the determining prognostic factor in extensive lymphangioma. Patients with dyspnea by external compression of cervical lymphangioma on the airway responded well to surgery. Aggressive surgical treatment did not seem to significantly improve the prognosis in patients with intrinsic involvement of the upper airway. The natural evolution of untreated massive lymphangioma has not been documented. Less aggressive, symptomatic therapy may be an alternative to avoid mutilating surgery in patients with intrinsic involvement of the airway.     

Cystic Hygroma/Lymphangioma: A Rational Approach to Management

Objective To outline a rational approach to the management of cystic hygroma based on the authors' experience, the natural history of the disease, and the results of surgical treatment. Study Design and Methods A retrospective review of all patients with the diagnosis of lymphangioma or cystic hygroma from 1958 to 2000 was performed. Results Seventy‐four patients were identified with 46 cases confined to the cervicofacial region. Surgical excision was performed on 60 of the 74 cases involving all regions of the body and 34 of the 46 patients with head and neck lesions. The location of the malformation is the most important determinate for surgical success. While surgical excision was the main treatment modality, 11 of 12 untreated patients were noted to improve, with 8 patients showing complete resolution. Conclusions In the treatment of lymphangiomas, the physician should be experienced in the management of such lesions, be aware of spontaneous resolution, and recognize the limitations and potential harm of surgery in certain instances.     

Cystic lymphangioma: trauma may be a significant cause?

Cystic lymphangioma is a rare congenital anomaly of the lymphatic system. Its embryopathogenesis is still controversial. Most lesions present in infancy or early childhood with a swelling found in the head and neck region. We report the case of a woman who presented with a cystic swelling in the left supraclavicular region that appeared after left side thyroidectomy. Surgical excision achieved complete removal. Histology showed the lesion to be a cystic lymphangioma. It can be hypothesized that an embryogenetic origin of the adult lymphangioma is associated with some precipitating trauma such as surgery.     

Cervical cystic lymphangioma in children

INTRODUCTION: Cervical cystic lymphangioma are rare and benign, but the prognosis can be serious in terms of its development and management. OBJECTIVES: To describe the epidemiological, clinical and therapeutic characteristics. MATERIALS AND METHODS: A retrospective study of eight cases. RESULTS: The mean age was 7 years, with a slight female predominance. Ultrasound scanning was sufficient to establish the diagnosis. CT scan or MRI scan was used if parapharyngeal or a mediastinal extension was suspected. All patients in this series underwent surgical excision. There were no postoperative complications or recurrence at one year post-surgery. DISCUSSION: These lesions present as soft compressible cervical swellings of variable size. Radiological imaging (CT, MRI) aid diagnosis and demonstrate extent, however final diagnosis is made by histopathological examination. The treatment of choice is surgical excision. Another option is the use of sclerosing agents. These are used by some surgeons as a first line treatment and also for surgical recurrence.     

OK-432 therapy for cervical lymphangioma

OBJECTIVE: To describe our experience with sclerosing treatment of lymphangiomas in the head and neck region by intralesional injections of OK-432. STUDY DESIGN: Case series. METHODS: Patients with the diagnosis of a macrocystic-type cervical lymphangioma were treated by one to three intralesional injections of OK-432 (0.01 mg of OK-432/1 mL of lymphangioma fluid, up to a maximum of 0.2 mg in the first injection and 0.3 mg in the second or third injections). All injections were performed under ultrasound guidance. Children were injected under sedation. RESULTS: Eleven patients were treated with injections of OK-432: 7 children and 4 adults. They were followed up for a period of 5 to 68 (mean 30) months. Eight (73%) patients had complete or subcomplete resolution of the lymphangioma after one or two injections. In three (27%) cases, no response was obtained (2 cases) or the lymphangioma recurred (1 case) after two to three injections. In two cases, surgical excision was performed. There was no evidence of fibrosis around the cysts. There were no complications to OK-432 injections. CONCLUSION: Intralesional injection of OK-432 is an effective treatment modality for macrocystic-type lymphangiomas in the head and neck region. It has no complications, and surgical excision in case of failure is not compromised by fibrosis. Sclerosing of macrocystic-type lymphangiomas with OK-432 should therefore be considered before surgical excision.     

A gigant cystic lymphangioma of the neck

The cystic lymphangiomas are congenital pathology of lymphatic system which concern 90% of children population, adults suffer very seldom. The authors present the case of giant cystic lymphangioma of the neck in the 37-year-old man with symptoms of tumor of the neck. The USG, CT and MRI confirm the presence of polycystic tumour with feature of bleeding into one of the cavities. Surgical treatment was performed. The patient is controlled without any relaps. The authors remind this rare pathology that should be considered in case of neck tumours.     

Congenital cervical choristoma of the neck mimicking cystic lymphangioma

IntroductionChoristoma is a mass presenting normal histology, but in an abnormal location. Cystic choristoma is rarely reported in the head and neck region. Neonatal cystic masses in the neck suggest usually correspond to a diagnosis of cystic lymphangioma.Case reportWe report a case of a congenital cystic choristoma of the neck clinically and radiologically mimicking cystic lymphangioma.DiscussionCongenital cystic choristoma is an extremely rare lesion, essentially described in neonates, composed of various types of tissues. The diagnosis of congenital cystic choristoma may be suggested on imaging and must be confirmed by histopathological examination. Treatment consists of complete surgical resection.     

Transoral approach for plunging ranula—10‐Year experience

Objective/Hypothesis:

Plunging ranulas (PRs) are infrequently encountered. The origin of PRs is mostly from the sublingual gland (SLG). Different routes to manage PRs include marsupialization, simple SLG excision, and combined SLG and submandibular gland (SMG) excision either transcervically or transorally. In this study, we demonstrated our experience managing PRs via transoral excision of the SLG with marsupialization.

Study Design:

Retrospective study.

Methods:

We retrospectively reviewed 20 patients at Chang Gung Memorial Hospital, Linkou, between January 1999 and April 2009. All patients received preoperative computed tomography or magnetic resonance imaging and were clinically diagnosed with PR. At surgery, the SLG was excised transorally with preservation of Wharton's duct and lingual nerve. The mucus contents of the PRs were drained through the posterior edge of the mylohyoid muscle.

Results:

Two patients were found to have final diagnosis of lymphangioma. Eighteen patients were eligible for analysis. The age distribution ranged from 6 to 48 years old. Sexual distribution was equally distributed. The successful rate was 17/18 (94.4%) with a lingual nerve paresthesia rate of 2/18 (11.1%). The paresthesia persisted for 3 and 6 months, respectively. One recurrent patient was salvaged by excision of the SMG and ranula. The other two recurrent patients received excision of the SMG and cyst and had a final diagnosis of lymphangioma.

Conclusions:

Transoral approach with excision of the SLG alone provides a high success rate (94.4%) with minor complications and could be the first choice in managing PRs. The results of this study confirm PRs mostly originate from the SLG. Laryngoscope, 2010     

Nasal and paranasal sinus endoscopy, computed tomography and microbiology of upper airways and the correlations with genotype and severity of cystic fibrosis

OBJECTIVE: Many studies have assessed clinical and functional aspects of lower airway affections in cystic fibrosis. Conversely, few studies have been performed to assess the clinical and functional affections of upper airways. The objective of the present study was to correlate the variables obtained by nasal and paranasal sinuses endoscopy, paranasal sinus laboratory and computed tomography (CT) scan findings, and to check the association with severity and genotype of cystic fibrosis patients. METHODS: Clinical and laboratory study of 50 patients with cystic fibrosis at a university center. All patients were submitted to CT scan, nasal and paranasal endoscopy and bacterioscopy of maxillary sinus, trachea and oropharynx secretion. Severity of cystic fibrosis was assessed by Shwachman score and the most frequent genetic mutations were identified. RESULTS: The prevalence of polyposis in the studied population was 36% and it was greater among homozygote for DeltaF 508. Shwachman score was correlated with age (p=0.003). The genotype was correlated with presence of nasal polyposis (p=0.006). There was no association between affections in CT scan and severity of cystic fibrosis (CF). Patients presented high prevalence of early colonization of Pseudomonas aeruginosa. CONCLUSIONS: Sinus disease in CF patients presents several clinical, endoscopic and tomographic affections. Although most of them are not correlated with severity and disease genotype, severity of CF is correlated with age and presence of polyposis is genotype-dependent.     

瘤内注射平阳霉素治疗脉管瘤

目的 总结平阳霉素治疗脉管瘤的结果和经验.方法 用平阳霉素瘤内注射治疗血管瘤、淋巴管瘤116例,其中毛细血管瘤13例,海绵状血管瘤86例,混合性血管瘤3例,毛细淋巴管瘤5例,囊性淋巴管瘤9例.116例中男59例,女57例,年龄6个月～75岁.116例患者共有脉管瘤159处,多发性血管瘤27例,占23.3%.头颈部病变149处,占全部病变的93.7%(149/159).结果 平阳霉素治疗脉管瘤治愈率87.1%(101/116),好转率8.6%(10/116),副作用有发烧、局部肿胀、黏膜溃疡、局部组织坏死、肌肉萎缩和过敏反应.结论 平阳霉素治疗毛细血管瘤、海绵状血管瘤和淋巴管瘤疗效高,是一种简便、安全的方法.