冷冻治疗儿童眼部良性肿瘤和瘤样病变的远期疗效观察

目的：探讨应用液氮冷冻治疗247例儿童眼部良性肿瘤和瘤样病变的远期效果。方法：以液氮为冷冻源,对直径＜3mm的眼部良性肿瘤及瘤样病变采用棉签法;对直径3mm-5mm的肿瘤及瘤样病变采用冷冻头法;5mm以上肿瘤及瘤样病变采用倾注法。结果：247例中,眼部肿瘤194例,痊愈187例（97．39％）,好转7例（3．61％）,有效率100％。瘤样病变53例,痊愈52例（98．11％）,好转1例（1．89％）,有效率100％。术后随访时间最长12年,最短6月。结论：液氮冷冻疗法简单、易行、经济、安全,对儿童尤为适宜,治疗后不影响美观。     

甲状腺乳头状腺癌152例治疗分析

对１９７４～１９８６年甲状腺乳头状腺癌１５２例的手术治疗进行分析。方法１．分型：包膜内型２３例（１５％），腺内型７１例（４７％）和腺外型５８例（３８％）；２．手术方式分为腺叶＋峡部切除和甲状腺癌联合根治术（功能性和根治性）。结果１０年以上无瘤生存率：总生存率为７４．３４％，其中包膜内型１００％，腺内型９１．５５％，腺外型４３．１０％。结论包膜内型仅行腺叶＋峡部切除即可，腺内型和腺外型拟行甲状腺癌联合根治术（功能性或根治性）。     

55例Ⅲ期乳癌综合治疗疗效对比分析

对比分析Ⅲ期乳癌各种综合治疗方法的疗效。材料与方法１９８４年２月～１９９０年１０月，５５例Ⅲ期乳癌非随机分为：单纯手术（Ｓ）、手术＋化疗（Ｓ＋Ｃ）、手术＋放疗（Ｓ＋Ｒ）及手术＋放疗＋比疗（Ｓ＋Ｃ＋Ｒ）４组。手术为乳腺单纯切除术、乳癌根治术或改良根治术，术后放疗对胸壁及淋巴引流区照射ＤＴ４５～５５Ｇｙ／２２～３０欢／５～６周。术后化疗用ＣＭＦ或ＣＡＦ／ＣＥＦ方案４～６周期。结果全组５年生存率为４７．２％（２６／５５），Ｓ组１４．２％（１／７），Ｓ＋Ｃ组３３％（２／６）．Ｓ＋Ｒ组４７．３％（９／１９），Ｓ＋Ｒ＋ｃ组６０．８％，Ｓ组与其他几组相比差异有显著性意义（Ｐ＜０．００５）。３年复发率Ｓ组２８．５％（２／７），Ｓ＋Ｃ组６６．７％（４／６），Ｓ＋Ｒ组１５．８％（３／１９），Ｓ＋Ｒ＋Ｃ组１７．４％（４／２３），Ｓ＋Ｃ组与Ｓ＋Ｒ组或Ｓ＋Ｒ＋Ｃ组比差异有显著意义（Ｐ＜０．０５）。结论（１）Ⅲ期乳癌应作包括手术、放疗和化疗在内的综合治疗。（２）术后放疗对降低局部和区域淋巴结复发有重要作用，是其他治疗手段不能代替的。     

194例超长食管癌不同治疗方法疗效分析

目的回顾性分析超长食管癌＞８ｃｍ不同治疗方法治疗后的疗效，探讨超长食管癌的治疗对策。材料与方法对１９８７年３月至１９９２年３月间１９４例超长食管癌单纯外放射治疗、外放射＋腔内放疗、单纯手术治疗、术后放疗和未治疗的患者的生存率采用Ｋａｐｌａｎ－Ｍｅｉｅｒ分析，Ｌｏｇ－ｒａｎｋ检验，其它结果采用χ２检验，探讨不同治疗方法的疗效及失败原因。结果超长食管癌术后放疗疗效最好，姑息术后放疗能明显提高５年生存率（Ｐ＜０．０５），根治术后放疗５年生存率比单纯手术提高１５．１％，术后放疗能明显降低淋巴结的转移率（Ｐ＜０．０５）。超长食管癌失败的主要原因为局部未控或复发和远处转移，外放射＋腔内放疗有降低局部未控或复发的趋势。结论对超长食管癌的治疗应采取积极的治疗措施，能够手术治疗的应尽可能地根治性切除，术后均应作放射治疗；不能手术治疗者应采用非常规分割外放射配合腔内放疗和全身化疗。     

冷冻治疗儿童眼部良性肿瘤和瘤样病变的远期疗效观察

目的：探讨应用液氮冷冻治疗247例儿童眼部良性肿瘤和瘤样病变的远期效果。方法：以液氮为冷冻源，对直径<3姗的眼部良性肿瘤及瘤样病变采用棉签法；对直径3mm～5mm的肿瘤及瘤样病变采用冷冻头法；5mm以上肿瘤及瘤样病变采用倾注法。结果：247例中，眼部肿瘤194例，痊愈187例(97.39％)，好转7例(3.61％)，有效率100％。瘤样病变53例，痊愈52例(98.11％)，好转1例(1.89)，有效率100％。术后随访时间最长12年，最短6月。结论：液氮冷冻疗法简单、易行、经济、安全，对儿童尤为适宜，治疗后不影响美观。     

初治颈淋巴结转移喉癌颈清除术后的预后相关因素

目的：探讨颈淋巴结转移（cN＋）喉癌颈清除术后颈部复发相关因素、治疗及预后情况。方法：回顾性研究1992～1999年我院收治的cN＋喉癌行颈清除术53例，对其颈部复发率、复发时间、淋巴结分布、局部治疗、复发影响因素及预后进行探讨。结果：cN＋喉癌颈清除术后颈部复发率为24．53％（13／53）；3和5年生存率为39．62％和35．52％，颈部复发组生存率与无复发组相比，差异无统计学意义，P=0．6717；复发主要位于清除侧颈部（9／13），复发淋巴结位于Ⅱ、Ⅲ和Ⅳ区84．62%（11/13）；颈部复发多在18个月内（12／13）；颈部复发行挽救手术者治疗效果好。病理分化程度（P=0．6717）、病变部位（P=0．966）、临床分期（P=0．244）、初治颈清除术式（P=0．579）、颈清除术后颈部是否放疗（P=0．457）不影响颈部复发率，N分期（P=0．042）影响颈部复发。结论：cN＋喉癌颈清除术后颈部有无复发与生存率无关；复发多位于行颈清除术侧颈部（Ⅱ、Ⅲ和Ⅳ区）；N分期影响颈部复发；出现颈部复发者行挽救手术治疗效果好。     

内镜引导下冷冻治疗30例食管癌临床研究

[目的]研究内镜引导下食管癌冷冻治疗后的进食缓解情况以及对免疫功能的调节作用。[方法]2004年1月至2004年4月内镜下对30例食管癌行食管腔内冷冻，再开胸手术切除，用光镜及电镜观察癌细胞变化及局部淋巴反应，同时检测血清免疫球蛋白和淋巴细胞亚群。[结果]冷冻治疗后进食缓解率63．3％（19/30）。食管癌周围淋巴结广泛肿大，呈滤泡增生反应，癌细胞坏死。冷冻前后血清免疫球蛋白IgG、Iga、IgM、补体C3和NK比较无显著性差异（P〉0．05）；冷冻后CD4^＋、CD19^＋较冷冻前增高，但是无统计学意义（P〉0．05）；冷冻后CD8^＋ 30．92％，低于冷冻前的34．98％（P〈0．05）。[结论]采用JT冷冻治疗机及其配套的食管腔内软管冷冻探头进行食管癌腔内冷冻，能杀伤癌细胞并调节机体免疫功能，操作方法方便快捷，并发症少。     

耳鼻咽喉部血管瘤的治疗

采用冷冻、硬化剂注射、手术切除及综合治疗等方法治疗耳、鼻、咽、喉部血管瘤１２１５例，门诊随访６２１例，痊愈５５５例（８９．４％），控制４９例（７．９％）。并论述了各种治疗方法的适应证，优缺点及注意事项。     

液氮局部冷冻治疗肝癌

液氮局部冷冻治疗肝癌１５２例，其中原发性肝癌（ＰＬＣ）１４５例，转移性肝癌（ＳＬＣ）．例，１４５例ＰＬＣ中，Ⅰ期４６例（３１．７％），Ⅱ期９１例（６２．８％），Ⅲ期８例（５．５％）。全组无手术死亡。１４５例ＰＬＣ患者冷冻后１、３、５年生存率分别为６９．２％、４９．２％、３４．８％；其中ＰＬＣ≤５ｃｍ４１例患者则分别为９１．０％、７６．５％、６４．２％。７例ＳＬＣ患者冷冻后平均生存２２．３个月（４～１１２个月）．文中提示，冷冻治疗肝癌是一种安全可行的局部治疗方法。冷冻治疗小肝癌，可达根治目的；对较大肝癌，冷冻可作为综合治疗的一个手段。     

耳鼻咽喉部血管瘤的治疗(附621例分析)

采用冷冻、硬化剂注射、手术切除及综合治疗等方法治疗耳、鼻、咽、喉部血管瘤1215例，门诊随访621例，痊愈555例（89．4％），控制49例（7．9％），无效17例（2.7％）。并论述了各种治疗方法的适应证、优缺点及注意事项。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中,22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术,4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9~60个月。1例术后30个月复发,其它25例未见复发,全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变,而对广泛病变则应采用鼻内镜联合鼻侧切开术,术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

鼻腔鼻窦肌上皮癌的生物学行为及诊治

目的 提高临床医生对鼻腔鼻窦肌上皮癌的认识。方法 回顾性分析我科近期收治的两例鼻腔鼻窦肌上皮癌临床资料，并复习文献。结果 1例为女性，47岁；1例为男性，54岁。临床表现为鼻塞、鼻腔暗红色肿物。鼻窦CT示鼻腔占位性病变。术前病理及免疫组化(S-100蛋白、平滑肌动蛋白、细胞角蛋白、波形蛋白等呈阳性染色)确诊“肌上皮癌”。两例均行鼻侧切开鼻腔肿瘤切除术，例1术后5月出现颈淋巴结转移，术后11月死于全身骨及肝转移。例2术后8月死于肺转移。结论 鼻腔鼻窦肌上皮癌极为罕见，迄今为止，仅8例报道。综合文献，该瘤具有生长迅速、广泛侵犯周围组织、颈部淋巴结转移率高、血行转移率高、治疗后易复发、预后差等特点。诊断依赖病理及免疫组化。治疗以根治性手术为主，对于cNO的患者,应行分区性颈淋巴结清扫术。     

Current advances in the basic research and clinical management of sinonasal inverted papilloma (review)

Inverted papilloma (IP) is a benign sinonasal lesion that has a known propensity for recurrence, local aggressiveness and an association with transformation to squamous cell carcinoma. Due to the high rate of recurrence, association with malignancy and a tendency of multicentricity, the surgical approaches to treatment are controversial. Over the years there has been a slow evolution from aggressive (en bloc) resection by lateral rhinotomy to endoscopic techniques. This progress corresponds to the advances that have been made in endoscopic sinus surgery over the past 15 years. Technological advances have allowed the detection of sinonasal IP before its extension beyond the sinonasal region, thus enabling minimally invasive techniques to be used in the treatment of selected cases of IP. Differences in recurrence rates were not observed for endoscopic management as compared with lateral rhinotomy or sublabial degloving approaches. In terms of aetiology there is certain evidence that the presence of HPV in IP could be predictive of malignant transformation. Although IPs are monoclonal proliferations, they do not fit the profile of a prototypic precursor lesion. In contrast, an increased EGFR and TGF-alpha expression is associated with early events in IP carcinogenesis. Parameters such as hyperkeratosis, squamous epithelial hyperplasia and a high mitotic index are negative prognostic indicators, which could be useful in the future follow-up of patients with IP. Present literature should encourage us to recommend the use of a uniformly accepted staging system. The propensity for delayed recurrences and the maximal 13% incidence of malignant transformation mandates careful, long-term follow-up.     

鼻侧切开术结合鼻内镜辅助治疗上颌窦癌30例临床观察

目的:探讨鼻侧切开术结合鼻内镜辅助下治疗上颌窦癌的手术方法及治疗效果。方法:回顾性分析30例上颌窦癌患者的临床资料,均采用鼻内镜辅助下鼻侧切开方式进行手术治疗,并与传统单纯鼻侧切开方式手术疗效进行比较。结果:所有30例患者癌肿病灶均顺利切除,术后随访5年以上,5年生存率达63.3%,优于传统手术疗效。结论:鼻侧切开术结合鼻内镜辅助治疗上颌窦癌可清除鼻侧切开术肉眼不易发现的病灶,有效的起到清除肿瘤的功效。     

Nasal Endoscope: An Armamentarium in the Management of Sinonasal Inverted Papilloma

Sinonasal inverted papillomas (SIP) are unique group of locally aggressive benign neoplastic lesions arising from mucosa of sinonasal tract with potential for recurrences and known association with squamous cell carcinoma in 5–15 % of cases. This study was conducted was to assess the efficacy and usefulness of the nasal endoscope in treating SIP. We reviewed 28 biopsy proven cases of SIPs that were treated at our hospital between June 2009 and September 2013. Average patient age was 46 years. Fourteen were treated by transnasal endoscopic excision of tumor with noted recurrence of 21.43 %. Thirteen were treated by endoscopic assisted open surgery which had 23 % recurrence. Three patients had malignant inverted papillomas, of whom two (7 %) were found to have synchronous squamous cell carcinoma and one (3.6 %) had metachronous squamous cell carcinoma. No evidence of recurrence was found in rest during our follow up. The endoscopic approach is the preferred method for the treatment of the majority of inverted papillomas. Powered instrumentation is extremely useful to achieve good results. Although significant number of cases was done by external approach by lateral rhinotomy, the endoscopic assistance is required to ensure complete removal of the tumour to reduce the recurrence rates. Close follow up of the patient for a longer period of time is necessary for the early detection of recurrence and to allow for surgical salvage.     

Juvenile nasopharyngeal angiofibroma—our experience at a referral hospital

Nasopharyngeal angiofibroma is a rare, highly vascular locally invasive tumor with a strong tendency to bleed. It usually occurs in young adolescent males. This is a retrospective study of 53 patients with nasopharyngeal angiofibroma. All the cases were treated surgically by different conventional approaches depending upon the extent of the mass. Transpalatal approach was used in 32 cases, lateral rhinotomy in 13 cases and a combination of transpalatine + lateral rhinotomy + caldwel-luc in 8 cases. There is no recurrence in 49 cases till date. However, recurrence was noted in four cases within six months. Three out of four patients with recurrence had to undergo repeat surgery for the removal of angiofibroma within six months while the remaining one was referred to radiotherapy as the mass was invading the cavernous sinus. The various clinical presentation and treatment modalities are discussed.     

Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma

We reviewed all studies (since 1945) reporting recurrence rates for treatment of recurrent (previously treated) basal cell carcinomas (BCC) using surgical excision, radiotherapy, cryotherapy, curettage and electrodesiccation, and Mohs micrographic surgery. The 5-year recurrence rate for Mohs micrographic surgery is 5.6%. The recurrence rate for non-Mohs modalities of 19.9% is nearly four times higher. Individual recurrence rates for the non-Mohs modalities are 17.4% for surgical excision, 40.0% for curettage and electrodesiccation, and 9.8% for radiation therapy. There are no studies reporting 5-year data for cryotherapy. However, the recurrence rate is 13.0% for cryotherapy when the follow-up period is less than five years. The data support the following conclusions: (1) Mohs surgery is the treatment of choice for recurrent BCC; (2) if the patient is not a surgical candidate and the lesion is small, radiation therapy is an alternative that offers a better chance for cure than the other non-Mohs modalities; and (3) curettage and electrodesiccation should not be used to treat recurrent basal cell carcinoma.     

Surgery of far-advanced colorectal cancer--extension of surgical indications and its results

As there has been much progress in pre- and post-operative management, the safety of aggressive surgery has been improved, making this approach more widely available. Total pelvic eviscerations were performed for fifty-one patients with far-advanced rectal cancer which involved adjacent organs. The results were a 33% 5-year survival rate and 2 operative deaths. Even for patients with distant metastasis elsewhere, total pelvic evisceration may be acceptable for the good control of local pelvic symptoms (severe pain, infections, etc.). This operation is not, however, indicated for cases in which complete removal of the cancerous mass seem to be impossible. For advanced rectal cancer with a high degree of lymph-node metastasis, extension of lymph-node dissection up to the para-aortic region or ileo-pelvic lateral dissection en bloc with the internal iliac vessels were effective for decreasing the incidence of local recurrence. For forty-nine patients with liver metastasis, radical surgery with removal of liver metastatic lesions was carried out and the resulting 5-year survival rate was 30%. Removal of pulmonary metastatic lesions was also performed in thirty-four patients and the 5-year survival rate was 45%. The surgical results were poor in cases of multiple metastatic lesions in the liver or lung or of peritoneal dissemination. Extended surgery for far-advanced colorectal cancer may thus be actively undertaken unless multiple metastatic lesions are present.     

ESTHESIONEUROBLASTOMA: A report of seven cases

The biologic behavior of esthesioneuroblastoma in seven patients, treated from 1978 to 1989, is reviewed. The patients were initially treated with surgical resection (2 cases), radiation alone (1 case) or a combination of radiation and surgery (4 cases). The radiation dose ranged from 30 to 62 Gy. Operations were performed via a transmaxillary approach (2 cases), lateral rhinotomy approach (3 cases) and craniofacial approach (1 case). Four of the seven patients experienced local recurrence, occurring after disease-free intervals as long as 6 years. The other three patients died of distant metastasis within one year after initial treatment. The effectiveness of radiation therapy varied, and in some patients a dose of 60 Gy was not enough to control microscopic disease. One patient developed bone marrow metastases which was fatal due to the ensuing pancytopenia. One patient developed a brain metastasis. Hyams' histopathologic staging of the tumor appeared to be related to prognosis.