上颌窦鳞状细胞癌60例临床分析

Objective To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma. Methods The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively.The patients were treated with three therapy modalities including radiotherapy alone(22 cases) ,radiotheraphy and surgery( R +S, 29 cases)and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases).Results The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone ( λ2 = 15.62, P <0.01 ). The five year survival rate(51.7% ) of patients in R + S group was significantly higher than that (33. 3% ) of patients in CCR + S group ( λ2 = 4. 28, P < 0.05 ), and also higher than that ( 18. 2% ) of patients in radiotherapy group( λ2 =9.49 ,P <0. 01 ). Conclusions The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.     

鼻腔筛窦鳞状细胞癌146例治疗分析

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).     

鼻腔筛窦鳞状细胞癌146例治疗分析

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).     

Transoral robotic nasopharyngectomy for local recurrent nasopharyngeal carcinoma北大核心CSCD

Objective To investigate the safety, efficacy, locally control and survival results of transoral Da Vinci robotic surgery for salvage treatment of locally recurrent nasopharyngeal carcinoma. Methods This retrospective study included 33 patients with locally recurrent nasopharyngeal carcinoma (stage rT1‑2, partial rT3) underwent transoral Da Vinci robotic surgery between October 2017 and January 2020. There were 20 males and 11 females, with an average age of (47.9±10.5) years. The lesions were localized in nasopharyngeal cavity in 14 cases, with extending to parapharyngeal space in 6 cases and the floor of sphenoid sinus in 13 cases. Transnasal endoscopy was used to assist surgery if necessary. SPSS 25.0 statistical software was used for statistical analysis. Results Transoral robotic nasopharyngectomy was successfully performed in all cases without conversion to open surgery, of which 13 cases were combined with transnasal endoscopic surgery. The average operation time was (126.2±30.0) min, ranging from 90 to 180 min. The postoperative pathological margin was R0 (31 cases) and R1 (2 cases), with no tumor residue. Complications of surgery mainly included symptoms of headache, nasal dryness and velopharyngeal insufficiency without nasopharyngeal hemorrhage. Follow‑up time was from 3 to 54 months. One case had tumor recurrence 11 months after operation, 1 case had ipsilateral cervical lymph node metastasis 27 months after operation, 2 cases had distant metastasis and 1 case died of nasopharyngeal hemorrhage 3 months after operation. The 1‑year, 2‑year and 3‑year overall survival rates were 97.0%, 96.0% and 92.9%, respectively and the local recurrence free rates were 97.0%, 95.7% and 91.7%, respectively. Conclusion Transoral robotic nasopharyngectomy is safe and feasible for local recurrent nasopharyngeal carcinoma in selected patients, with higher local control rate and quality of life. © 2022 Chin J Otorhinolaryngol Head Neck Surg. All rights reserved.     

梨状窝癌术前同步放化疗对手术并发症影响的临床研究

目的 比较梨状窝癌术前同步放化疗与术前单纯放疗的术后并发症及喉保留率.方法 回顾性分析中国医学科学院肿瘤医院2002年3月至2009年3月治疗的梨状窝鳞癌,共46例,根据是否同步化疗分为两组:术前同步放化疗组,共23例,采用顺铂单药50 mg每周一次的方案,21～44 d(中位数31 d)后手术;术前单纯放疗组,共23例,17～40 d(中位数28 d)后手术.结果 术前同步放化疗组和术前单纯放疗组手术并发症发生率分别30.4%和39.1%,差异无统计学意义(χ2=0.099,P＞0.05).1年喉保留率两组分别为52.2%和17.4%,差异有统计学意义(χ2=6.133,P＜0.05);术前同步放化疗组和术前单纯放疗组的1年局部区域控制率和无瘤生存率分别为89.9%、56.3%和71.1%、47.1%,差异均有统计学意义(χ2分别为5.606和4.335,P值均＜0.05).结论 术前同步放化疗并未明显增加手术后并发症发生率,对增加局部缓解率和提高喉保留率有积极的作用;术前同步放化疗能提高局部和区域控制率,减少局部及颈部复发,但尚需积累更多的资料进一步分析.

Abstract：

Objective To compare the surgery complications and laryngeal function sparing rate after preoperative concurrent chemoradiotherapy and preoperative radiotherapy of pyriform sinus cancer.Methods Forty-six patients with squamous cell carcinoma of pyriform sinus from March 2002 to March 2009 were retrospectively analyzed.Concurrent chemotherapy with radiotherapy (CRT + S group) was conducted in twenty-three patients.Cisplatin (50 mg/weekly)was mostly applied.Twenty-three patients were treated with radiation only (RT + S group).Surgery was conducted after a break-time of 21 - 44 days (median,31 d)and 17 -40 days (median,28 d),respectively.Results The complication rate of CRT + S group and RT + S group were 30.4％ and 39.1％ respectively,no significant differences was found (χ2 =0.099,P ＜0.05).The one-year laryngeal function sparing rate of the two groups were 52.2％ and 17.4％ respectively ,with significant differences(χ2 = 6.133,P ＜ 0.05).The one-year local regional control rate and disease free survival rate for the CRT + S group were 89.9％,71.1％ ,and for RT + S group were 56.3％,47.1％,P level were 0.018 and 0.037,respectively.There was significant differences in one year local regional control rate and disease free survival rate between the two groups.Conclusion The addition of concurrent chemotherapy to preoperative radiotherapy in patients with pyriform sinus cancer does not increase the incidence of surgery complications.Chemotherapy improves the remission rate and appears to increase the laryngeal function sparing rate. Preoperative concurrent chemoradiotherapy can improve the local and regional control,and certainly,more investigations will be needed.     

The photodynamic therapy on Streptococcus mutans biofilms using erythrosine and dental halogen curing unit

The purpose of our study was to evaluate the effect of photodynamic therapy (PDT), using erythrosine as a photosensitizing agent and a dental halogen curing unit as a light source, on Streptococcus mutans in a biofilm phase. The S. mutans biofilms were formed in a 24-well cell culture cluster. Test groups consisted of biofilms divided into four groups: group 1: no photosensitizer or light irradiation treatment (control group); group 2: photosensitizer treatment alone; group 3: light irradiation alone; group 4: photosensitizer treatment and light irradiation. After treatments, the numbers of colony-forming unit (CFU) were counted and samples were examined by confocal laser scanning fluorescence microscopy (CLSM). Only group 4 (combined treatment) resulted in significant increases in cell death, with rates of 75% and 55% after 8 h of incubation, and 74% and 42% at 12 h, for biofilms formed in brain-heart infusion (BHI) broth supplemented with 0% or 0.1% sucrose, respectively. Therefore, PDT of S. mutans biofilms using a combination of erythrosine and a dental halogen curing unit, both widely used in dental clinics, resulted in a significant increase in cell death. The PDT effects are decreased in biofilms that form in the presence of sucrose.     

Levels of biological markers of nitric oxide in serum of patients with squamous cell carcinoma of the oral cavity

The aim of the study was a determination of the levels of nitric oxide（NO）and its biological markers such as malonyldialdehyde（MDA）and nitrotyrosine in the serum of patients with squamous cell carcinoma（SCC）of the oral cavity and identification of the relationships between NO and those markers.These studies were performed on patients with SCC of the oral cavity before and after treatment.Griess reaction was used for the estimation of the total concentration of NO in serum.The nitrotyrosine level in serum was assessed with an enzyme-linked immunosorbent assay（ELISA）kit,and MDA level using a spectrophotometric assay.Higher concentrations of NO in blood serum were determined in patients with stage IV of the disease before treatment in comparison to the control group and patients with stages II and III of the disease.Moreover,higher concentrations of MDA and nitrotyrosine were determined in the serum of patients in all stages of the disease in comparison to healthy people.After treatment,lower concentrations of NO in the serum of patients with stage IV of the disease were observed in comparison to the amounts obtained prior to treatment.In addition,lower levels of nitrotyrosine in the serum of patients with all stages of the disease were recorded,whereas higher concentrations of MDA were determined in these patients in comparison to results obtained before treatment.The compounds formed with the contribution of NO,such as MDA and nitrotyrosine,may lead to cancer progression in patients with SCC of the oral cavity,and contribute to formation of resistance to therapy in these patients as well.Moreover,the lack of a relationship between concentrations of NO and MDA,and between NO and nitrotyrosine in serum suggests that the process of lipid peroxidation and nitration in patients with SCC does not just depend on NO.     

神经导航及内镜辅助下经鼻蝶显微切除无功能性 垂体大腺瘤的近期疗效分析

ObjectiveTo investigate the short term effect of neuronavigator and endoscope assisted endonasal trans sphenoidal surgery for patients with nonfunctioning pituitary macroadenomas.MethodsClinical data of 62 patients with nonfunctioning pituitary macroadenomas received surgical treatment in our department from Jan 2013 to Sept 2014 were retrospectively analyzed. 62 patients were divided into two groups by whether to use neuronavigator and endoscopic technology or not, i.e. study group (32 cases) and control group (30 cases). Pituitary adenoma resection was performed with assistance of endoscope and neuronavigation in the study group. The indexes including surgery time, postoperative hospitalization duration, postoperative complications, changes of serum endocrinology, MRI, the residual and recurrence rates in the two groups were recorded and analyzed.ResultsThe time of hospital stays (6.6±0.7 d) in the study group was significantly less than that in control group (8.1±0.8 d). The postoperative complication rate (including transient diabetes insipidus, cerebrospinal fluid rhinorrhea, electrolyte disturbances, postoperative bleeding in the tumor cavity,hypopituitarism) in study group was also significantly lower than that in the control group (P<0.05). The postoperative remission rate of study group was significantly higher than that of the control group. The residual (2 cases) and recurrence (0 cases) rates in the study group were significantly lower than those in the control group (9 cases and 5 cases). According to the Knosp grade, the residual rate of the patients with Knosp grade=2 in the study group was lower than that of the control group, and the difference was statistically significant (P<0.05).ConclusionThe neuronavigator and endoscopic technology contribute to decrease the occurrence of the postoperative complications, to reduce residual and recurrence rate, and to improve the gross total resection of tumor, is therefore effective for the treatment for patients with nonfunctioning pituitary macroadenomas.     

喉癌单纯放疗失败挽救性喉切除术远期疗效及预后分析

目的 探讨喉癌单纯放疗后原发灶及颈部淋巴结残留和复发患者实施挽救性手术治疗的远期疗效及预后影响因素.方法 对72例患者进行回顾性分析,包括:放疗后原发灶及颈部复发22例,放疗后原发灶及颈部残留50例.均实施喉全切除术+经典性颈清扫术或改良性颈清扫术.应用Kaplan-Meier法计算手术后总生存率,采用Log-rank检验单因素分析临床因素对预后的影响,对影响生存率的有关因素采用Cox模型进行多因素分析.结果 实施挽救性手术的并发症发生率41 7%,其中咽瘘发生率20 8%.术后5年内肿瘤再次复发率34 7%(25/72),远处转移率22 2%(16/72),第二原发癌发生率6.9%(5/72).术后的3、5年生存率为45 8%和36 1%.复发癌N分期(rN)、肿瘤放疗失败类型、切缘情况、浸润深度、有无颈淋巴转移、淋巴结包膜侵犯和颈部非淋巴结构侵犯与患者的预后有关(P值均<0.05).多因素分析结果表明:肿瘤放疗失败类型、切缘情况、肿瘤浸润深度是影响患者预后的独立危险因素.结论 喉癌患者单纯放疗失败后应以手术挽救为主.对于术前及术中发现肿瘤侵犯肌肉及软骨的病例,特别是对根治性放疗效果不佳而肿瘤残留者,术中应充分估计肿瘤的范围,并冰冻病理检查切缘,以保证足够的安全切缘,提高挽救性手术的成功率.

Abstract：

Objective To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone. Methods A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model. Results Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15 (20. 8 % ) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7% , 22. 2% and 6. 9% , respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45. 8% and 36. 1% ,respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy,surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphatic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion. Conclusions Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.     

langerhans' cell histiocytosis (histiocytosis x) of the temporal bone

Objectives Langerhans' Cell histiocytosis (LCH) is a rare disease, which remains poorly understood and whose cellular origin remains unknown. To increase understanding of temporal bone LCH, it is necessary to study recent advances in the diagnosis and treatment of this disease. Methods The long term(5 to 30 years) results of 21 temporal bone LCH cases treated between 1973 and 2003 were reviewed. Surgery, radiotherapy, pharmacologic therapy or a combination of these treatments were employed in these cases. Results Eighteen patients were cured(18/21, 85%). Six patients developed residual diabetes insipidus (DI) and dwarfism (28%). Three patients died(14%). Conclusions The Alessi classification system for LCH based on the extent of disease accurately predicts prognosis and is a useful guide in selecting treatment methodologies. X-ray, computed tomography and magnetic resonance imaging have proved useful in defining the extent of osseous and soft tissue diseases. Diagnosis of LCH is based on clinical presentations, radiographic findings and histopathological results. Surgery and radiotherapy are the main treatment modalities. Pharmacologic therapy should be used in patients with aggressive, disseminate, and refractory lesions. LCH has a predilection for children and prognosis depends on age and extent of vital organ involvement.