头颈部皮肤恶性肿瘤16例

目的 探讨头颈部皮肤恶性肿瘤外科治疗方法 和病损修复的疗效.方法 对包括基底细胞癌12例和鳞状细胞癌4例的16例头颈部皮肤恶性肿瘤患者,采用Mohs显微外科手术(MMS)和标准切除术切除肿瘤,术后选择不同的修复方法,分别是直接缝合6例、邻近皮瓣法修复9例、耳郭复合组织瓣法修复1例.结果 16例术后随访1～6年,复发1例为基底细胞癌(鼻背部)患者,其于术后5个月局部复发,经再次手术扩大切除后采用邻近皮瓣修复,随访2年未再复发;随访患者均存活良好,外形及功能满意.结论 头颈部皮肤恶性肿瘤的预后关键是早期诊断和治疗,结合肿瘤不同部位及大小采取不同手术方法,在彻底切除病变的基础上尽可能遵循功能和美观的原则行修复治疗.     

腭部肿瘤61例临床分析

目的 探讨腭部肿瘤的临床特征和治疗原则。方法 腭部肿瘤患者61 例行手术治疗,良性肿瘤44 例,其中腺源性良性肿瘤28例;恶性肿瘤17例, 腺源性恶性肿瘤11 例。良性肿瘤进行了局部切除,恶性肿瘤进行了局部扩大切除,部分使用局部或者颈部的组织瓣和脱细胞真皮基质进行修复,术后2例鳞状细胞癌患者进行放疗。结果 良性肿瘤44例未见复发;恶性肿瘤11例中1例混合瘤恶变,术后2年局部复发;1例鳞状细胞癌术后1年出现肺部转移。结论 腭部肿瘤以良性肿瘤为主,恶性肿瘤应根据情况进行放射治疗,并修复软腭的功能。     

晚期喉癌的局部转移

研究晚期喉鳞状细胞癌病人的局部转移手术后对局部、远端肿瘤复发、无复发、生存率等的影响。选择１５９例接受常规手术和放疗的病人，其中声门上癌９７例，声门癌６０例，声门下癌２例，多数肿瘤为Ｔａ（１０４例），Ｔ４（４１例），Ｎｏ（９１例），１５例临床上有阳性淋巴结，仅１５例声门上癌行水平部分喉切除，其余均行全喉切除术，Ｔ３Ｎ０肿瘤行全喉切除，若术中未发现阳性淋巴结则不施颈廓清术。Ｔ４Ｎ０肿瘤在行全喉切除时行改良或传统的根治性颈廓清，若发现阳性淋巴结均行根治性颈廓清。７９％切除标本组织病理学发现阳性淋巴结…     

晚期甲状腺癌累及颈总动脉的挽救性手术

目的:探讨累及颈总动脉的晚期甲状腺恶性肿瘤手术治疗的可能性。方法:回顾我院耳鼻咽喉科2006-07-2009-08期间收治的4例晚期甲状腺恶性肿瘤患者,CT示颈总动脉包裹于肿瘤中。其中低分化鳞状细胞癌2例,乳头状癌2例。3例行全甲状腺全喉切除双侧颈淋巴结清扫术,1例切除肿瘤及累及气管,保留全喉及切除气管段之气管膜部及软骨,永久性气管造瘘,颈胸部皮瓣转移修补上纵隔气管壁。术中1例颈总动脉破裂行修补术。术后2例乳头状癌及1例低分化鳞状细胞癌患者未作放、化疗,1例低分化鳞状细胞癌患者补充放、化疗。随访6个月～2年。结果:术后6个月,未放化疗的1例低分化癌患者脊柱转移,1年后仍生存,1年半后失访。其余3例随访6个月～2年未见局部明显复发或全身转移。结论:晚期甲状腺恶性肿瘤累及颈总动脉时仍可以考虑手术治疗,其中喉、气管结构应在不影响治疗效果的前提下尽量保存,缺损气管段的修复在这类病例应放在次要的地位。     

鼻根部基底细胞癌切除后局部缺损皮瓣Ⅰ期修复的临床观察

目的总结临床应用面部局部皮瓣对鼻根部基底细胞癌根治术后局部缺损进行Ⅰ期修复的经验。方法对2007年9月~2014年9月22例鼻根部基底细胞癌根治切除后行局部皮瓣Ⅰ期修复的临床资料进行回顾性分析。选择利用数种局部皮瓣进行Ⅰ期修复和重建。结果22例患者皮瓣均Ⅰ期存活。随访6~12个月均无肿瘤复发。术后外观患者满意。结论在根治性切除外鼻部基底细胞癌的基础上,根据肿瘤切除后遗留的鼻根部缺损的部位、范围和大小,可以选择和设计不同而较为合适的皮瓣进行修复。局部皮瓣具有血供确切、存活率较高、取材灵活、手术操作较为简便等多项优点。可以为鼻部肿瘤切除后缺损提供较好的治疗方案。     

右鼻旁基底细胞样鳞状细胞癌1例报道

目的探讨鼻基底细胞样鳞状细胞癌（BSCC）的临床特点及治疗方法，以提高临床医师对该病的诊疗水平。方法回顾性分析2017年2月手术治疗的1例BSCC患者的临床资料。患者，女，69岁，因发现“右鼻旁肿物渐进性增大4个月而入院，术前活检即确诊为BSCC，于2017年2月15日行气管切开+右择期性颈淋巴结清扫（I、II、III区）+右鼻旁恶性肿瘤切除+上颌骨部分切除+前臂皮瓣移植修复术，术后患者家属拒绝放射治疗。结果术后密切随访32个月，伤口愈合良好，未见肿瘤复发及转移迹象。结论BSCC是一种罕见的高度恶性肿瘤，具有独特的病理形态，预后较差，首选手术治疗，术后辅以放疗，需进行密切随访。     

鼻内镜下前颅底肿瘤切除术

目的探讨鼻内镜下前颅底区域肿瘤切除术的可行性及疗效。方法回顾性总结鼻内镜下鼻腔、筛窦及前颅底肿瘤切除术病例19例,其中筛窦鳞状细胞癌3例,嗅神经母细胞瘤3例,肾透明细胞转移癌1例,恶性黑色素瘤3例,浆细胞瘤1例,筛窦腺癌2例,腺样囊性癌4例,脑膜瘤2例。结果根据内镜下所见及术后影像学检查证实18例瘤全部切除,1例大部切除。3例恶性黑色素瘤患者中,1例术后1年死于脑转移,1例术后8个月后出现局部复发。1例腺样囊性癌患者术后17个月后复发,其余16例肿瘤患者随访12个月～3年未发现复发。结论对于局限于鼻腔、筛窦的恶性肿瘤,以及瘤体大部在鼻及鼻窦内的前颅底良性肿瘤,鼻内镜手术可以将其完整切除,对于恶性肿瘤应慎重选择病例,术后应辅以放疗。     

舌根鳞状细胞癌37例临床分析

目的 总结舌根癌的手术方法及功能重建经验。方法 回顾性分析1994年3月～2006年3月我院手术治疗的37例原发于舌根的鳞状细胞癌患者的临床资料。结果 37例患者均行颈淋巴结清扫术,病理报告颈淋巴结转移率达64.9％(24/37)。肿瘤切除的手术方式以咽侧径路为主,占59.5％(22/37),缺损修复主要采用胸骨舌骨肌肌筋膜瓣及胸大肌肌皮瓣修复。术后发生并发症共8例。患者术后经康复训练逐步恢复了饮食功能;除4例未拔除气管套管外,全部恢复了言语功能;3年、5年生存率分别为62.2％(23/37)、51.4％(19/37)。结论 术前对肿瘤范围及颈淋巴结转移情况进行准确评估,以选择合适的手术入路及缺损修复方式,是彻底切除肿瘤、进行功能重建并提高生存质量的重要前提。     

原发性颈段气管癌的手术治疗

目的　探讨原发性颈段气管癌的手术治疗途径与经验。方法　 1997年 1月～ 1999年 4月手术治疗 6例原发性颈段气管癌 ,手术切除肿瘤后 ,采用气管端端吻合、颈前肌皮瓣 +胸舌骨肌筋膜瓣、带蒂胸锁乳突肌肌骨膜瓣及胸大肌肌皮瓣修复气管缺损。病理类型 :腺样囊性癌 3例 ,鳞状细胞癌 2例 ,腺癌 1例。 2例鳞状细胞癌患者术后放射治疗剂量为 6 0Gy。结果　 6例患者分别在术后2 3d～ 3个月拔除气管套管 ,无术后并发症。随访 3年以上 ,除 1例鳞状细胞癌患者术后 2年死于肺转移 ,其余 5例患者呼吸、发音良好 ,纤维支气管镜检查未见复发 ,气管管腔黏膜光滑。结论　手术治疗颈段气管癌可以一期切除肿瘤 ,根据缺损不同采用气管端端吻合或自体组织移植如颈前肌皮瓣 +胸舌骨肌筋膜瓣、带蒂胸锁乳突肌肌骨膜瓣及胸大肌肌皮瓣重建气管。     

甲状腺癌再次手术的探讨

目的 探讨甲状腺癌再手术的必要性和方式.方法 总结1991年1月～2006年1月检查甲状腺癌局部切除术后再次手术治疗的126例患者临床资料.第1次对原发灶只进行单纯肿瘤切除或腺叶部分切除者,再手术时切除残叶及峡部,或加对侧叶部分或近全切除;颈淋巴结转移者,行经典性或改良性颈清扫术.结果 术后病理检查残叶有癌残留52例,无癌残留74例,癌残留率41.3%,术后病理检查证实淋巴结转移癌67例,颈淋巴结转移率72.8%.喉返神经损伤发生率3.2%.5年、10年累积生存率分别为93.2%、82.4%.结论 由于误诊等原因致甲状腺癌术后残留率高,积极合理的再手术是必要的.     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.