晚期甲状腺癌的预后分析

目的探讨影响晚期甲状腺癌预后的相关因素。方法1996年3月-2008年1月期间手术治疗为主的25例晚期甲状腺癌患者，术后随访，采用Kaplan-Meier法计算累积生存率，并在单因素分析基础上，进一步应用Cox回归模型进行预后的多因素分析。结果全组患者3年和5年生存率分别为86．4％、62．7％。单因素分析显示，年龄（P=0．0383）、周围解剖区域有无侵犯（P=0．0054）、临床分期（P=0．0033）、有无复发和转移（P=0．0041）以及术后是否坚持服用甲状腺素（P=0．0003）均为影响患者预后的相关危险因素，但多因素分析结果仅提示术后是否坚持服用甲状腺素（P=0．0076）是影响预后的独立因素。结论术后是否坚持服用甲状腺素对于晚期甲状腺癌患者预后有重要意义，应密切随访并督促其按时服药。     

侧颅底相关头颈部恶性肿瘤分析

目的侧颅底相关头颈部恶性肿瘤治疗难度大、预后较差,本研究旨在探讨其治疗方法及预后相关因素。方法回顾性分析55例侧颅底相关头颈部恶性肿瘤患者的资料。均采用手术为主的治疗,其中颈下颌入路23例,颞下窝入路24例,颅面联合入路6例,上颌骨外翻入路1例,Weber-Ferguson+Lynch延长切口1例。结果全组局部复发率41.8%,远处转移率14.5%,3年总体生存率为50.9%。单因素分析,初治患者3年生存率60.6%,复治患者3年生存率36.4%。Cox模型分析,初治复治与病理类型差异具有统计学意义。结论初治复治及病理类型是侧颅底相关恶性肿瘤的独立预后因素。应重视侧颅底相关恶性肿瘤的外科治疗,合理的手术方法以及必要的辅助治疗有望改善侧颅底相关恶性肿瘤的预后。     

择区性颈清扫术在头颈部鳞状细胞癌颈淋巴转移患者中应用的初步分析

目的 探讨择区性颈清扫术(selective neck dissection)在伴N1、N2期颈淋巴转移头颈部鳞状细胞癌(简称鳞癌)中的疗效.方法 回顾性分析36例伴N1、N2期颈淋巴转移的头颈部鳞癌患者行40侧择区性颈清扫术,16侧行全颈清扫术的临床资料,评价择区性颈清扫术的疗效.KaplanMeier法行累积生存率统计,Log-rank检验比较生存率差异;有无淋巴结包膜外侵犯病例复发率的差异分析采用Fisher精确概率法;采用Cox比例风险模型对可能影响患者生存时间的因素进行分析.结果 36例患者3和5年生存率分别为76.8%和54.3%.N1+N2a组3和5年生存率均为100%,N2b+N2c组3和5年生存率分别为59.4%和32.0%,Log-rank检验两组患者5年生存率差异有统计学意义(P=0.003).有无淋巴结包膜外侵犯分组的复发率分别为36.4%和3.4%,差异有统计学意义(P=0.015);3年生存率分别为45.5%和81.8%,5年生存率分别为39.7%和65.5%,差异均有统计学意义(P值分别为0.0148和0.0423).多因素分析证实淋巴结包膜外侵犯是影响患者生存时间的危险因素(P=0.042,OR=0.328,OR值95%可信限为0.112～0.959).结论 头颈部鳞癌N1期患者采用择区性颈清扫术可有满意的疗效,对N2期病变和伴有淋巴结包膜外侵犯的病例需谨慎处理,必要时扩大清扫范围甚至变更术式为全颈清扫术或改良全颈清扫术以提高术后颈部肿瘤控制率.     

头颈部鳞状细胞癌远处转移的相关因素分析

目的探讨头颈肿瘤远处转移的相关影响因素.方法对532例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析.选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素,用χ2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对发生远隔部位转移患者进行生存分析.结果在532例头颈部原发鳞状细胞癌患者中,60例(11.3%)发生远处转移.单因素分析显示,临床分期(P=0.0126)、T分级(P=0.0082)、原发癌部位(P=0.0011)、原发癌浸润深度(P=0.0005)、有无颈淋巴结转移(P=0.0057)、颈阳性淋巴结数目(P=0.0149)、颈淋巴结转移累及区域(P=0.0034)、颈阳性淋巴结破膜情况(P=0.0118)与发生远处转移有关.多因素分析结果表明,仅原发癌部位、原发癌浸润深度与发生远处转移明显相关.用Kaplan-Meier法进行生存分析,结果显示60例发生远隔部位转移患者的1年生存率、3年生存率、5年生存率分别为51.7%、13.3%、6.5%.结论原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素.而原发癌临床分期、T分级和有无颈淋巴结转移是头颈鳞癌远处转移的影响因素,但不是导致远处转移的初始和根本因素.喉癌、下咽癌以及原发癌侵犯肌肉、骨或软骨患者易发生远处转移.     

原发性腮腺鳞状细胞癌的诊治

目的探讨原发性腮腺鳞状细胞癌（简称鳞癌）的临床特点、治疗和预后因素。方法回顾性分析中国医学科学院肿瘤医院头颈外科1990年1月～2008年8月24例原发性腮腺鳞癌,总结其临床资料、病理结果、生存情况和预后因素。结果Kaplan-Meier法计算全组5年生存率达35.9%,手术肉眼切净肿瘤的患者（n=18）5年生存率达47.9%。初治（n=15）和复发挽救（n=9）患者的5年生产率分别为44.2%和22.2%（P=0.132）,治疗失败的原因主要是局部区域复发。多因素分析提示二次治疗和肿瘤肉眼残存是预后不良的因素。结论原发性腮腺鳞癌恶性程度较高,首次治疗是关键,切除的肿瘤可获得较好的效果,肿瘤肉眼残存或二次治疗的患者预后较差。     

内镜经鼻入路切除前颅底恶性肿瘤的疗效观察

目的分析内镜经鼻入路切除前颅底恶性肿瘤的可行性,并分析其预后及影响因素。方法回顾性分析2015年6月至2019年4月间在复旦大学附属眼耳鼻喉科医院就诊的42例前颅底恶性肿瘤患者的临床资料,其中男性31例,女性11例;年龄20~78岁,平均49岁。42例患者中包括鼻腔鼻窦鳞状细胞癌(鳞癌)15例(14例T4bN0M0,1例T4bN1M0)、嗅神经母细胞瘤27例(均为Kadish C期)。前颅底切除后采用大腿阔筋膜和带蒂鼻中隔黏膜瓣进行重建。患者术后第1天行头颅CT平扫排除蛛网膜下腔出血、严重颅内积气和脑水肿,同时行鼻窦增强MR检查判定肿瘤切除情况。使用Kaplan-Meier法统计分析总体生存率,Cox回归分析影响预后的因素。结果 42例患者的平均手术时间452 min。术后增强MR明确显示:36例(85.7%)肿瘤全切;2例(4.8%)因侵犯眶内容物且患者强烈要求保留眼球行次全切;1例(2.4%)患者因术中发生颈内动脉损伤而终止手术;1例(2.4%)患者术后MR显示肿瘤残留再次手术切除;2例(4.8%)患者可疑眼眶内侧残留。术后随访2~52个月,平均20个月,中位随访时间17个月;失访2例。术后1、2、3年总体生存率分别为86.5%、76.9%、64.5%;鼻腔鼻窦鳞癌术后1、2、3年的总体生存率分别为86.2%、86.2%、57.4%;嗅神经母细胞瘤1、2、3年的总体生存率分别为86.9%、75.3%、67.8%。多因素分析表明:肿瘤残留(P=0.001)和复发(P<0.01)是影响患者生存的独立危险因素。结论内镜经鼻入路切除前颅底恶性肿瘤可行,预后较好。肿瘤残留和复发是影响患者预后的因素。     

甲状腺髓样癌预后影响因素分析

目的 探讨影响甲状腺髓样癌预后的因素.方法 本研究采用统计学多因素分析方法,回顾性分析1980年1月至2000年12月中山大学肿瘤防治中心同期收治的102例甲状腺髓样癌预后影响因素.结果 根据Kaplan-Meier法统计生存率,102例患者5年、10年、15年累积生存率分别为87.4%、74.6%和54.2%.单因素分析示:性别、年龄、原发灶累及双侧、原发灶最大直径＞4 cm、甲状腺包膜外侵犯、远处转移、手术彻底程度(以距肿瘤2 em肉眼切除干净为手术彻底的标准)均影响预后.多因素分析发现,影响甲状腺髓样癌生存率的独立因素有原发灶最大直径＞4 cm(X2=7.43,P=0.0035),远处转移(X2=23.50,P=0.0000)和手术彻底程度(X2=25.90,P=0.0000).结论 当原发灶过大、行姑息性手术及出现远处转移时,甲状腺髓样癌患者的生存率显著下降;选择合理的外科手术治疗可取得较满意的疗效,减少并发症.早期诊断和早期治疗能显著改善甲状腺髓样癌患者的预后.     

鼻咽癌颅底骨质破坏放射治疗后预后因素分析

目的 评价分析鼻咽癌颅底骨破坏在首程放射治疗后无期疗效及预后因素。方法 1985-1986年100例经病理证实为鼻咽癌,均为鳞状细胞癌,其中低分化96例,高分化4例。所有病例经CT扫描证实颅底骨质被破坏,胸部X线摄片及腹部B型超声检查未见异常。采用^60Co或直加单纯外照射,总剂量66-80Gy/6-8周,2Gy/次。所有患者均定期随访,平均随访22.3个月（2-174个月）。采用Kaplan-Meier统计生存率,Cox模型分析各种预后因素,包括侵犯海绵窦、蝶窦、筛窦、上颌窦,咽旁间隙侵犯、头痛、颅神经损害,治疗后头痛缓解入颅神经损害的修复等。结果 1、3、5、10年生存率分别为78.8%、38.0%、26.9%、13.0%,但伴有前组颅神经（Ⅰ-Ⅷ）和后级颅神经（Ⅸ-Ⅻ）同时侵犯者5年生存率仅为7.7%。死亡原因包抱局部复发59例,远处转移21例,局部复发加远处转移1例,非肿瘤原因死亡5例。经多因素分析：影响预后的独立因素为颅神经损害、放射治疗后颅神经修复及头痛缓解。结论 鼻咽癌颅底骨质侵犯患者的长期访结果分析,发现颅神经损害、放射治疗后颅神经修复及头痛缓解。结论 鼻咽癌颅底骨质侵犯患者的长期随访结果分析,发现颅神经损害、放射治疗后颅神经修复及头痛症状的缓解对预后有重要意义。     

内镜经翼突入路切除中颅底恶性肿瘤30例临床分析

目的 探讨内镜经翼突入路切除中颅底恶性肿瘤的疗效。 方法 回顾分析30例经鼻内镜翼突入路切除累及中颅底恶性肿瘤患者相关资料,总结该手术相关技巧和经验,用Kaplan-Meier法进行生存分析,探讨肿瘤累及颈内动脉对预后影响。 结果 手术均为全身麻醉下进行。平均手术时间145 min,平均术中出血470 mL,术中脑脊液漏6例;术后颅内感染2例、脑脊液漏1例,均痊愈。病理分别为复发性鼻咽癌21例、腺样囊性癌3例、黏液表皮样癌2例、脊索瘤1例、癌肉瘤1例、鼻咽滤泡树突状细胞肉瘤1例和颅底淋巴上皮瘤样癌1例。30例颅底恶性肿瘤患者术后1年、2年、3年、5年生存率分别为92.9%、79.6%、48.6%和36.5%;复发性鼻咽癌中位生存期为29.00［35.00,23.00］个月,其他恶性肿瘤38.00［38.00,38.00］个月,生存曲线之间差异有统计学意义(χ2=4.248; P=0.039);颈内动脉累及和未累及患者中位数分别为16.00［23.00,14.00］个月和36.00［80.00,31.00］ 个月,生存曲线差异有统计学意义(χ2=9.421; P=0.002);而且颈内动脉受累是影响患者预后的危险因素,颈内动脉受累及患者的死亡风险是未受累患者的9.678倍(HR=9.678,P=0.011)。 结论 内镜翼突入路是部分中颅底恶性肿瘤外科治疗的合理方案,颈内动脉累及侵犯是影响疾病预后的危险因素。     

前颅底手术—术式及适应证探讨

31例头颈部肿瘤因累及前颅底而行前颅底切除术，包括多种部位和类型的肿瘤．大多数为鼻腔、鼻窦肿瘤，其中良性肿瘤4例，恶性肿瘤27例。手术分为经颅底咬除术和额面联合切除术两种不同方式。各种手术并发症发生率为32．3％（10／31），无手术死亡。恶性肿瘤患者3年生存率33.0％。5年生存率16.5%。对头颈部晚期肿瘤施行前颅底切除术是安全可接受的，建议以颅颌面手术入路，选择肿瘤未侵破颅底骨板至硬脑膜为主的手术适应证。     

Comparative study on the morphology and the composition of the otoliths in the teleosts

Conclusion. Saccular otoliths of teleosts were mostly larger than utricular otoliths, which might relate to the three-dimensional movement. The large and heavy otolith may be better suited in saccules of the bottom and reef fishes. The quantities of iron in lagenar otoliths were found to be lower than those of birds. The function of the fish lagena remains to be elucidated by further studies. Objective. To evaluate the morphological characteristics and the chemical composition of the otoliths in fishes as related to behaviour and habitat. Materials and methods. We studied the morphology of the otoliths of 18 genera of fishes (81 samples) divided into 3 groups: saltwater fish (13 genera), freshwater fish except for the carp family (3 genera) and carp family fish (2 genera). The otoliths and the living environments were compared. The chemical composition was analysed using a synchrotron X-ray fluorescence analyser. Results. Bottom fishes generally have larger saccular otoliths, and migrating fishes have smaller saccular otoliths. In comparing the bottom/reef fishes and the migrating fishes in salt water, the former tended to have larger saccular otoliths. In saltwater bottom fishes the tendency was found that the thinner the head, the larger was the saccular otolith. We found significant quantities of iron, zinc and manganese in the lagenar otoliths.     

On the High Frequency Transfer of Mechanical Stimuli from the Surface of the Head to the Macular Neuroepithelium of the Mouse

Vestibular macular sensors are activated by a shearing motion between the otoconial membrane and underlying receptor epithelium. Shearing motion and sensory activation in response to an externally induced head motion do not occur instantaneously. The mechanically reactive elastic and inertial properties of the intervening tissue introduce temporal constraints on the transfer of the stimulus to sensors. Treating the otoconial sensory apparatus as an overdamped second-order mechanical system, we measured the governing long time constant (Τ_L) for stimulus transfer from the head surface to epithelium. This provided the basis to estimate the corresponding upper cutoff for the frequency response curve for mouse otoconial organs. A velocity step excitation was used as the forcing function. Hypothetically, the onset of the mechanical response to a step excitation follows an exponential rise having the form Vel_shear = U(1-e^−t/TL), where U is the applied shearing velocity step amplitude. The response time of the otoconial apparatus was estimated based on the activation threshold of macular neural responses to step stimuli having durations between 0.1 and 2.0 ms. Twenty adult C57BL/6 J mice were evaluated. Animals were anesthetized. The head was secured to a shaker platform using a non-invasive head clip or implanted skull screws. The shaker was driven to produce a theoretical forcing step velocity excitation at the otoconial organ. Vestibular sensory evoked potentials (VsEPs) were recorded to measure the threshold for macular neural activation. The duration of the applied step motion was reduced systematically from 2 to 0.1 ms and response threshold determined for each duration (nine durations). Hypothetically, the threshold of activation will increase according to the decrease in velocity transfer occurring at shorter step durations. The relationship between neural threshold and stimulus step duration was characterized. Activation threshold increased exponentially as velocity step duration decreased below 1.0 ms. The time constants associated with the exponential curve were Τ_L = 0.50 ms for the head clip coupling and T_L = 0.79 ms for skull screw preparation. These corresponded to upper −3 dB frequency cutoff points of approximately 318 and 201 Hz, respectively. T_L ranged from 224 to 379 across individual animals using the head clip coupling. The findings were consistent with a second-order mass-spring mechanical system. Threshold data were also fitted to underdamped models post hoc. The underdamped fits suggested natural resonance frequencies on the order of 278 to 448 Hz as well as the idea that macular systems in mammals are less damped than generally acknowledged. Although estimated indirectly, it is argued that these time constants reflect largely if not entirely the mechanics of transfer to the sensory apparatus. The estimated governing time constant of 0.50 ms for composite data predicts high frequency cutoffs of at least 318 Hz for the intact otoconial apparatus of the mouse.     

Observations on the stria vascularis of the guinea pig cochlea and the changes resulting from the administration of the diuretic furosemide

An electron microscope examination of the stria vascularis of guinea pigs and the structural changes occurring after administration of furosemide has been made. The use of ruthenium-red, which stains cell coats, has shown that the stria is impermeable to the passive diffusion of material from both the endolymph and the spiral ligament. The first changes after administration of furosemide are observed 4 hours after injection; small spaces develop between the cells. After 5–6 hours the spaces have enlarged but the tight junctions between marginal cells remain intact. The intermediate cells show signs of atrophy. In severely affected animals the intermediate cells have so shrunk that the spaces are very large and the marginal cells clearly resolved. These latter cells show no structural damage. In this severely affected tissue it is seen that the blood vessels are entirely surrounded by marginal cell extensions. It is suggested that the intermediate cells may have a regulatory function. The damage appears to be recoverable, since 6 hours after injection the spaces have decreased in size although some signs of intermediate cell atrophy are still apparent.     

Contact between the tectorial membrane and the cochlear sensory hairs in the human and the monkey

European Archives of Oto-Rhino-Laryngology - The surface structure of the organ of Corti and the overlying tectorial membrane were studied in human and monkey cochleas under a scanning electron...     

胃镜联合食管镜取出胃内异物1例

患者,男,49岁,因＂反复中上腹疼痛6年＂于2012年6月12日就诊于我院消化内科。患者有反复胃痛、胃部不适症状,长期按胃病治疗效果不佳。既往有吸毒史、丙型肝炎病史。6年前患者毒瘾发作时曾吞入牙刷,在当地医院复查未发现异物,未进一步诊治。     

膈神经与面神经吻合的解剖学研究

目的:探讨膈神经移位与面神经干吻合的解剖学基础。方法:解剖11具22侧成年尸体头颈部,观察并测量:①膈神经根与面神经总干腮腺区分叉处之间的距离;②膈神经干在颈部可利用长度;③面神经总干腮腺区分叉处游离至水平半规管下缘可利用长度,面神经总干腮腺区分叉处游离至水平半规管下缘较游离至茎乳孔处增加的面神经干可利用长度;④面神经总干腮腺区分叉处至水平半规管下方切断处膈神经干及面神经干神经移位后并列放置重合长度。结果:①膈神经根与面神经总干腮腺区分叉处之间的距离为(7.2±0.9)cm。②膈神经起点至锁骨下静脉上缘平面为(7.2±1.6)cm。③面神经总干腮腺区分叉处至水平半规管下方切断处的长度2.7~3.5 cm,较面神经干自茎乳孔下方切断增加1.0~1.5 cm。④神经移位后重合长度为0.4~1.8 cm。结论:在锁骨下静脉上缘平面切断20侧标本膈神经可与自乳突内切取的面神经干无张力吻合,两侧膈神经不能与自乳突内切取的面神经干无张力吻合。