颈淋巴结择区清除联合~(131)I治疗cN_0甲状腺癌临床效果分析

目的 :探讨颈淋巴结择区清除联合~(131)I治疗cN_0甲状腺癌患者临床效果。方法:回顾性收集择期行手术治疗的cN_0甲状腺癌患者92例,根据手术治疗方式不同,将患者分为常规组(n=34)和联合组(n=58),常规组行甲状腺常规切除术,联合组行颈淋巴结择区清除联合~(131)I治疗;联合组又分为高剂量组(n=29)和低剂量组(n=29),于手术治疗7 d后,低剂量组治疗的累计剂量为20~30 mCiI,高剂量组治疗的累计剂量为80~100 mCiI。治疗后,分别检测各组患者血清甲状腺功能指标(TSH、FT3和FT4),以及血清Tg和TGAb水平,所有患者均随访至2016年3月31日,利用Kaplan-M eier生存分析对患者治疗后生存时间进行分析。结果:联合组首次清甲(清除残留甲状腺组织)成功率为86.2%(50/58),显著高于常规组的67.6%(23/34),差异有统计学意义(χ~2=4.506,P=0.034);联合组和常规组治疗总有效率分别为94.8%和79.4%,差异有统计学意义(P=0.022);联合组血清TSH、FT4、Tg和TGAb水平低于常规组,差异均有统计学意义(P0.05),高剂量组和低剂量组血清TSH、Tg和TGAb水平均低于常规组(P0.05),高剂量组血清TSH、FT3、FT4水平均低于低剂量组和常规组,差异均有统计学意义(P0.05);Kaplan-Meier分析显示,低剂量组和高剂量组治疗后生存时间分别为90.6个月和88.6个月,均高于常规组的70.5个月,差异有统计学意义(χ~2=7.887,P=0.019)。结论 :颈淋巴结择区清除联合~(131)I可提高cN_0甲状腺癌患者治疗效果,降低Tg水平,减少术后复发,尤其是低剂量~(131)I可有效减少对甲状腺功能的影响。     

术后131I治疗对甲状腺癌唾液腺功能与甲状腺球蛋白抗体影响

【摘要】 目的 探讨术后131I治疗对甲状腺癌唾液腺功能与甲状腺球蛋白抗体(TgAb)影响。方法〓我院甲状腺癌手术后接受131I治疗患者79例,其中40例患者给予150 mCi 131I治疗(150 mCi组),39例给予80 mCi8 131I治疗(80 mCi组),比较两组唾液腺功能和TgAb水平的差异。结果〓150 mCi组治疗有效率稍高于80 mCi组,但两组比较差异无统计学意义(P>0.05),150 mCi组唾液初始pH值与唾液缓冲pH值明显高于80 mCi组,唾液流率明显低于80 mCi组,两组比较差异具有统计学意义(P<0.05),131I治疗后3、6个月,150 mCi组平均TgAb水平明显低于80 mCi组(P<0.05)。结论〓术后131I治疗对甲状腺癌临床疗效显著,其中低剂量131I治疗对唾液腺不良反应程度较低,而高剂量131I治疗有助于TgAb水平的降低。     

功能性区域颈淋巴结清扫术对多发性颈淋巴结核核患者颈部功能及预后的影响

目的探讨功能性区域颈淋巴结清扫术对多发性颈淋巴结结核患者颈部功能及预后的影响。方法将81例多发性颈淋巴结结核患者随机分为分为2组。对照组40例行颈部结核病灶清除术,观察组41例行功能性区域颈淋巴结清扫术,比较2组颈部功能情况、住院时间、切口愈合时间与愈合良好率及复发率。结果观察组颈部功能正常率及切口愈合良好率高于对照组,复发率低于对照组,住院时间、切口愈合时间均明显短于对照组,差异均有统计学意义(P0.05)。结论功能性区域颈淋巴结清扫术治疗多发性颈淋巴结结核,术野清晰,彻底清除病灶同时对重要血管与神经进行保护,利于术后颈部功能恢复与切口良好愈合、复发率低、预后佳、效果满意。     

手术联合131碘治疗分化型甲状腺癌效果观察

目的：探讨手术联合131I治疗分化型甲状腺癌（DTC）的临床效果。 方法：选择2000年1月—2004年12月收治DTC患者142例, 均行甲状腺次全切除或甲状腺全切加颈淋巴结选择性清扫术。术后90例行131I治疗, 加甲状腺素片替代治疗清除剩余甲状腺组织或治疗转移灶（清甲）（A组）; 52例未行131I治疗, 仅予甲状腺素片替代治疗（B组）。 结果：A组在清甲1～4次后均获得成功, 首次清甲成功率为71.1%。A组131I转移灶治疗总有效率为91.1%, 有效率依次为：颈淋巴结转移（95.1%）>肺转移（88.9%）>骨转移（72.7%）; 不良反应发生率为：全切除42.0%, 次全切77.5%, 差异有统计学意义（P＜0.01）; A组术后10年复发转移率和生存率分别为6.7%和94.4%, B组10年复发转移率和生存率分别为19.2%和80.8%, 差异均有统计学意义（均P＜0.05）。 结论：手术联合131I加甲状腺激素替代治疗, 清甲和转移灶疗效显著, 能有效减低DTC术后复发和转移率, 有较好的远期疗效。     

不同甲状腺术式对患者术后甲状旁腺功能、血钙变化的影响

目的:探讨不同手术方式对患者术后甲状旁腺的功能、血钙变化方面的影响。方法:回顾性分析2005年3月—2015年2月1 000例行甲状腺手术患者的临床资料,根据其术式的不同分为7组:A组(甲状腺一侧腺叶切除),B组(甲状腺一侧腺叶切除结合同侧颈中央区淋巴清除术),C组(甲状腺两侧腺体切除术),D组(全甲状腺切除结合一侧颈中央区淋巴清除术),E组(全甲状腺切除结合单侧改良颈淋巴结清除术,单侧改良颈淋巴结清除术在操作时,将同侧II~VI区淋巴结也同时清除),F组(全甲状腺切除结合双侧改良颈淋巴结清除术),G组(单侧改良颈淋巴结清除术+对侧颈中央区淋巴结清除术+全甲状腺切除)。观察各组甲状旁腺激素和血钙水平。结果:各组术后血清甲状旁腺激素有下降趋势;A组和B组血钙下降不明显(P0.05),C组、D组、E组、F组、G组患者从术后72 h后均出现不同程度的低血钙,后4组术后72、120、168 h与治疗前比较,差异均有统计学意义(P0.05);除A、B组外,其他5组中,术前与术后甲状旁腺激素和血钙水平差值均较大,且低甲状旁腺激素、低血钙发生率较高。结论:低甲状旁腺激素、低血钙的高发率主要由甲状腺切除范围及颈部淋巴结清扫的范围大而引起,术中应注意甲状旁腺的保护。     

甲状腺乳头状癌区域淋巴结清扫与131I治疗的对比分析

目的:比较甲状腺乳头状癌中央组淋巴结清扫与131Ⅰ辅助治疗的临床效果.方法:选择5年半内收治的390例甲状腺乳头状癌cN0患者的临床资料行回顾性分析,患者分别行甲状腺全切除+中央组淋巴结清扫(A组),甲状腺全切除+术后131Ⅰ治疗(B组)和单纯甲状腺全切除术(C组).结果:中央组淋巴结清扫组(A组)与非清扫组(B+C组)各种术后并发症(喉返神经损伤、喉上神经损伤、甲状旁腺功能低下)发生率差异无统计学意义(均P＞0.05);B组131I治疗后放射病发生率为51.5％.3组术后5年复发率与转移率比较,A组中央区复发率分别为0,明显低于B组(7.7％)和C组(13.8％)(均P＜0.05);A,B,C组颈侧区转移率及无影像学证据血清甲状腺球蛋白升高率依次增高(1.5％,6.2％,9.2％;3.1％,7.7％,15.4％),其中A组与C组间差异有统计学意义(均P＜0.05).B组平均住院日最长,住院费用最高,与A,C组比较,差异均有统计学意义(均P＜0.05).结论:甲状腺乳头状癌患者常规行中央组淋巴清扫有助于降低复发率,且无增加手术并发症风险;131I治疗不能完全代替淋巴结清扫术,且患者并发症、住院日和费用增加.     

腹腔镜全胃切除D_2淋巴结清除术治疗进展期胃癌的临床观察

观察腹腔镜全胃切除D_2淋巴结清除术治疗进展期胃癌的临床效果。选取2010年6月—2012年3月本院收治的进展期胃癌患者98例,根据手术方式分为对照组和观察组,每组49例。观察组行腹腔镜全胃切除D_2淋巴结清除术,对照组行常规开腹手术。比较两组各项临床指标、术后并发症及术后5年生存状况。观察组术后住院时间、肠道功能恢复时间、卧床时间、手术出血量等均少于对照组,差异有统计学意义(P0.05);观察组肠梗阻、肺部感染、腹腔感染、十二指肠残端瘘等并发症发生率显著低于对照组,差异有统计学意义(P0.05);术后3年复发率对照组稍低于观察组,但组间比较差异无统计学意义(P0.05);观察组术后1、3、5年生存期高于对照组,差异有统计学意义(P0.05)。腹腔镜全胃切除D_2淋巴结清除术治疗进展期胃癌术后并发症较少,术后生存期有所延长。     

颈前弧形小切口治疗甲状腺腺瘤的临床应用

目的:探讨颈前弧形小切口治疗甲状腺腺瘤的疗效和对术后美容的影响.方法:60例甲状腺腺瘤患者按手术方法随机分为对照组和观察组,每组30例.对照组采用传统手术方式,观察组采用颈前弧形小切口手术方式,观察两组患者的手术时间、术中出血量、术后并发症和美容效果以及住院时间.结果:两组患者均成功进行腺瘤切除术,术后切口均I期愈合,无喉返神经、喉上神经损伤及甲状旁腺、甲状腺功能低下.观察组的手术时间多于对照组,但无统计学意义,P>0.05;对照组的术中出血量、术后美容效果评分以及住院时间均劣于观察组,P<0.05.结论:颈前弧形小切口治疗甲状腺腺瘤临床疗效好,术后并发症少,美容效果佳.     

功能性区域颈淋巴结清扫术在治疗多发性颈淋巴结核中的临床研究

目的探讨功能性区域颈淋巴结清扫术组(研究组)患者和传统颈淋巴结核病灶清除术组(对照组)在多发性(多区)颈淋巴结核中的应用价值。方法选择2006年1月—2008年5月收治的经保守治疗无效,病灶出现液化或窦道的76例多发颈部淋巴结核患者,将患者随机分成研究组和对照组,对比两组术后复发率、颈部功能情况、平均住院时间、平均住院费用等。结果研究组术后3个月复发1例(2.56%,1/39),对照组术后3个月复发7例(18.92%,7/37)(P0.05);研究组术后3个月复查颈部功能全部正常,对照组术后3个月复查颈部功能不正常例数6例(16.22%)(P0.05)。研究组平均住院花费7 000元,对照组平均住院花费6 700元,两组差异无统计学意义;研究组平均住院天数11 d,对照组平均住院天数28 d(P0.05)。结论多发性颈淋巴结核患者保守治疗无效后施行功能性区域颈淋巴结清扫术,效果明显,优于颈部淋巴结核病灶清除术。     

碳酸锂联合131I 治疗分化型甲状腺癌术后肺转移

目的：探讨碳酸锂联合131I治疗分化型甲状腺癌（DTC）术后肺转移灶的临床疗效和不良反应。 方法：将44例DTC患者随机分为：治疗组,在131I治疗的同时服用碳酸锂（250 mg,3次/d）,共7 d;对照组,仅给予131I治疗。首次治疗3个月后随访并评价疗效,给与诊断剂量131I显像见肺部放射性摄取、TSH刺激状态的Tg>10 μg/L者,需再次行131I治疗。并同时观察他们的白细胞及肝肾功能在治疗前后的变化。 结果：对照组总治愈率22.7%,总有效率63.6%;治疗组总治愈率54.5%,总有效率90.9%,以上指标治疗组均高于对照组（P<0.05）;碳酸锂联合131I治疗对患者白细胞及肝肾功能均无明显影响。 结论：碳酸锂联合131I治疗DTC术后肺转移,不良反应少,可提高患者的治愈率,是一种经济、有效的治疗方法。     

高低剂量131I去除甲状腺癌术后残留功能性甲状腺组织的疗效与安全性评价

目的：用Meta分析的方法评价低剂量（1 100 mBq）与高剂量（3 700 mBq）131I去除分化型甲状腺癌术后残余甲状腺组织的疗效及安全性。 方法：计算机检索国内外数据库中关于低剂量与高剂量131I去除分化型甲状腺癌术后残余甲状腺组织的相关随机对照试验（RCT）研究,按照纳入与排除标准进行文献筛选和质量评价后,利用Cochrane中心提供的RevMan 5.0软件对数据进行分析。 结果：共纳入6篇RCT研究,共1 411例患者,其中低剂量组715例,高剂量组696例。低剂量组与高剂量组比较,去除残余甲状腺组织的疗效（OR=0.78,95%CI=0.58~1.06,P=0.11）;干眼症的发生率（OR=0.77,95%CI=0.53~1.12,P=0.18）;口干的发生率（OR=0.69,95%CI=0.47~1.01,P=0.06）均无统计学差异;胃肠道反应的发生率与颈部疼痛的发生率低剂量组均低于高剂量组（OR=0.32,95%CI=0.18~0.55,P<0.001;OR=0.49,95%CI=0.31~0.78,P=0.003）。 结论：两种剂量分化型甲状腺癌术后行131I去除疗效近似,但低剂量131I方案不良反应较少。     

Elective neck dissection versus observation in primary parotid carcinoma.

OBJECTIVE: To evaluate the efficacy of elective neck dissection in the clinically negative neck of patients with primary carcinoma of the parotid gland. Study design and setting A retrospective analysis was undertaken at a university Department of Otorhinolaryngology-Head and Neck Surgery on 83 previously untreated patients with primary carcinoma of the parotid gland and a clinically negative neck. The reliability of fine needle aspiration cytology, frozen section, and the clinico-pathologic findings of patients with occult neck metastases were analyzed. The regional recurrence rate and the outcome were compared among 2 groups; one with elective neck dissection (N = 41) and one without elective neck dissection (N = 42). RESULTS: The diagnosis of malignancy was known preoperatively in 59 (71%) cases, the exact histologic tumor type in 36 (43%) and the grade in 37 (44%) of 83 cases. Occult metastases were detected in 8 (20%) of 41 cNO patients, in 5 cases associated with a high-grade and in 3 cases with a low-grade carcinoma. Recurrence of disease developed in 5 (12%) patients in the elective neck dissection group and in 11 (26%) patients in the observation group. All of the 7 neck recurrences occurred in the observation group. The 5-year actuarial and disease-free survival rate was 80% and 86% for patients with elective neck dissection and 83% and 69% for patients without neck dissection. Conclusion and significance A routine elective neck dissection is suggested in all patients with primary carcinoma of the parotid gland. The efficacy of elective neck dissection, nevertheless, has never been evaluated prospectively.     

基于涎腺超声评价中医药治疗原发性干燥综合征的临床疗效

目的:评价涎腺超声作为中医药治疗原发性干燥综合征临床疗效指标的可行性.方法:选取30例原发性干燥综合征患者为治疗组,15例健康体检者为正常对照组,筛选2组间涎腺超声的差异性指标.治疗组给予4个月的撤热存津颗粒治疗,从中医证候积分、欧洲抗风湿病联盟干燥综合征患者报告指数评分(ESSPRI评分)、欧洲抗风湿病联盟干燥综合征...     

甲亢131I治疗前后骨密度测定的临床分析

目的 探讨甲亢患者131I治疗前及治疗后临床缓解持续时间的长短及其骨密度的变化情况。方法 70例甲亢患者于131I治疗前和其中37例于131I治疗后临床缓解小于6个月、9-12个月和大于18个月,分别用双能X线骨密度仪(DEXA)进行骨密度(BMD)测定,并分别与年龄匹配正常健康者95例进行对照分析。结果 (1)甲亢131I治疗前和治疗后临床缓解小于6个月、9-12个月的L2-4BMD均明确低于正常对照组,差异有非常显著性,股骨上段各区(股骨颈、Ward's区、大转子区)虽低于正常对照组,但差异无明显性;(2)131I治疗后临床缓解大于18个月的L2-4及股骨上段各区的BMD改善至接近正常人的水平,差异无显著性;(3)131I治疗后临床甲低组L2-4及股骨上段各区(尤其Ward's区)的BMD均明显低于正常对照组,差异有非常显著性。结论 甲亢经131I治疗后临床缓解6-12个月骨矿含量改善不明显,至18个月逐渐增加接近正常对照组水平;131I治疗后临床甲低持续时间大于6个月者,同样会导致骨矿含量的降低。     

Response to paclitaxel and carboplatin in metastatic salivary gland cancer: a case report

BACKGROUND: Malignant tumors of the salivary gland are rare entities that are treated primarily by surgical resection. For patients with recurrent or unresectable disease, options include radiation therapy or chemotherapy; however, responses are few and of short duration. Patients with metastatic disease have been treated with chemotherapy, but, again, response rates have been low and of short duration. METHODS: A 52-year-old man was seen with a mass on his tongue. A biopsy revealed adenocarcinoma of a minor salivary gland. Ten months after surgical resection, neck dissection, and radiation therapy, the patient was found to have metastatic disease to the lung. Chemotherapy was initiated with carboplatin and paclitaxel. RESULTS: The patient obtained a complete response after six cycles of carboplatin and paclitaxel. CONCLUSIONS: The use of carboplatin and paclitaxel in the setting of metastatic salivary gland cancer is a viable option.     

Preservation of the facial artery in excision of the submandibular salivary gland.

BACKGROUND: The accepted method for submandibular gland excision traditionally includes ligation of the facial artery (FA) as suggested by a host of surgical atlases. Preservation of the FA may be significant in reconstructive procedures of the head and neck and its ligation may altogether be obviated. OBJECTIVE: Prospective feasibility study of FA preservation in submandibular gland excision. MATERIALS AND METHODS: Patients undergoing excision of the submandibular salivary glands from September 1999 through August 2001 were prospectively included. The FA was dissected and only its glandular branches ligated. Exclusion criteria were primary benign or malignant tumors of the submandibular salivary gland or metastatic disease involving the gland or level I of the neck. In cases where the primary tumor involved the floor of mouth, anterior tongue or mandible, resection of level I contents included the FA even in N0 necks. RESULTS AND CONCLUSIONS: 104 patients (116 procedures) were included in the study. 81 patients underwent resection of the gland with preservation of the FA. The vessel was sacrificed in 35 necks because of metastases or primary tumor and in two cases of chronic sialadenitis. One patient had a postoperative hematoma following neck dissection requiring re-exploration. The source of bleeding was not found to be related to the FA. Contrary to accepted methodology, the FA may readily be preserved in surgery of the submandibular salivary glands. We suggest preservation of the FA in all cases of procedures for benign disease and in selected cases of malignancy.     

Treatment for T1-2 Oral Squamous Cell Carcinoma with or Without Perineural Invasion: Neck Dissection and Postoperative Adjuvant Therapy

Background

Although perineural invasion (PNI) has been a poor prognostic factor for head and neck cancers, few studies have focused on oral squamous cell carcinoma (OSCC). The independent significance of PNI in early T1-2 OSCC and the benefit of treatment modification based on PNI status have not been assessed. This study investigated the role of PNI in T1-2 OSCC patients, with focus on the controversial issues of neck management and postoperative adjuvant therapy.

Methods

PNI status was re-reviewed under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients. Oncologic and survival outcomes were analyzed by univariate and multivariate analyses.

Results

PNI was identified in 84 (27.4%) patients, correlating with several established poor prognostic factors. In multivariate analysis, PNI remained an independent predictor for neck metastasis, neck recurrence, and a worse 5-year disease-specific survival. Elective neck dissection contributed to a significantly better 5-year disease-specific survival only in cN0 patients with PNI-positive tumors (P?=?0.0071) but not in those with PNI-negative tumors (P?=?0.3566). In low-risk patients who were treated by surgery alone, including neck dissection, the 5-year disease-specific survival rates were almost the same in those with PNI-positive tumors and those with PNI-negative tumors (92.0 vs. 92.9%; P?=?0.9104).

Conclusions

Elective neck dissection is indicated for cN0 patients with PNI-positive tumors for the efficacy of improving disease-specific survival as well as neck control. However, low-risk PNI-positive patients who undergo neck dissection do not need postoperative adjuvant therapy, because the residual risk from PNI is minimal.