头颈部恶性淋巴瘤误诊分析

目的 :提高对头颈部恶性淋巴瘤的诊断水平 ,降低该病的误诊率。方法 :回顾近 2 0年 34例头颈部恶性淋巴瘤的临床资料 ,分析其误诊因素。结果 :34例患者中误诊为鼻息肉、鼻窦炎 14例 ,鼻咽癌 3例 ,鼻咽纤维血管瘤 2例 ,慢性鼻前庭炎 1例 ,急慢性扁桃体炎 9例 ,慢性咽炎、咽部异感症 5例。结论 :头颈部恶性淋巴瘤临床并非少见 ,但临床症状无特征性表现 ,医师对该病认识不足是导致误诊的主要原因 ,而及时活检、手术标本送病理检查可以减少或避免误诊的发生     

头颈部皮肤恶性黑色素瘤研究新进展

引言头颈部皮肤的面积仅占全身表面积的9%,而头颈部原发性皮肤黑色素瘤(Cutaneous malignant melano-ma,CMM)大约占全身黑色素瘤的25%~30%[1]。本文就头颈部CMM的发病危险因素、术前检查、治疗以及随访复查等方面的近期进展作以下综述。1发病危险因素头颈部区域的好发可能源于多种因素,包括:日光曝射和皮肤黑色素细胞的区域性差异-头颈部区域皮肤黑色素细胞含量是其他区域的2~3倍[1]。日光曝射被认为是黑色素瘤形成和发展过程中最重要的因素。多年来,累积曝射和早期曝射(如儿童期的疱性晒伤)在CMM形成中何者更为重要,存在着争议。许多研究学者认为间歇性急性曝射更具危害性,尤其是儿童或青春期的此种曝射。长期以来,UVB(280~320nm)被认为是CMM成因中最关键的因素。最新的证据显示UVA(320~400nm)甚至可见光辐射也起关键作用。研究认为减少一定的日常曝晒(尤其是上午10点至午后2点这一时间段),穿戴衣帽防晒等,是一种有效的防护措施。因此,提高公众的认识和警惕性,对于降低CMM发病率,早期诊断CMM可能有一定益处[1]。一些间接证据支持一定表型的特征可能增加CMM发生的危险性...     

头颈部恶性周围神经鞘瘤22例

[目的]探讨影响恶性周围神经路瘤的诊治和预后因素。[方法]回顾性分析22例头颈部恶性周围神经鞘瘤的临床表现及治疗结果，共复习有关文献。[结果]头颈部恶性周围神经鞘瘤的预后较差，总的5年生存率为26．3％。肿瘤＞5cm者及伴有神经纤维瘤病Ⅰ型者预后较差。扩大手术范围能改善预后。[结论]头颈部恶性周围神经鞘瘤是一种较少见治疗较困难的恶性肿瘤。早期发现，包括对神经纤维瘤病Ⅰ型患者密切随访是提高生存率的关键。     

香港头颈外科的发展现状

头颈外科包括了头颈部肿瘤及相关疾病的诊断和治疗。香港头颈外科的起源可以追述到本世纪60年代中期。当时的香港大学玛丽医院外科学系主任王源美教授是开创这一领域的先驱。香港最初只有普外科医生涉及到这一区域肿瘤的治疗，经过多年来其它专科的发展，目前香港头颈部的疾病已经可以由三个外科次级专科处理，即耳鼻喉科、整形重建科和普外科。20年来，在外科、放射科及化疗科的共同努力下，头颈部肿瘤在诊断及治疗方面获得的迅速的发展，这就使病人的预后得到了很大程度的改善。     

The Emergence of Endoscopic Head and Neck Surgery

Endoscopic and minimally invasive techniques represent a natural evolution for the discipline of head and neck surgery. Endoscopic head and neck surgery (eHNS) encompasses transoral laser microsurgery, transoral robotic surgery, as well as video-assisted and robotic surgery of the neck and thyroid. In the next 5 years, with robotic surgery and laser technology as a common platform, we foresee the development and widespread use of eHNS procedures, via transoral and transaxillary approaches.     

耳鼻颌面部恶性黑色素瘤(附11例分析)

目的：探讨发生于耳鼻颌面部恶性黑色素瘤(恶黑)的诊疗方法。方法：对1986～2001年收治的11例恶黑患的临床资料进行临床病理分析。结果：男性6例、女性5例，年龄6个月～83岁；原发部位：牙龈粘膜2例，外耳道l例，耳廓2例，鼻腔筛蝶窦l例，鼻中隔l例，中耳l例，下睑腮腺l例，上唇2例；手术切除9例，术后化疗2例，术后放疗3例，未治疗2例。0．5～10年随访，死亡6例，生存期6个月～3年；健在5例，生存期1．0—15年。结论：恶黑在皮肤粘膜交界处的色素层或粘膜黑色素斑的基础上发生，肿块多呈黑褐色且常伴溃疡，诊断较易，而对于不含黑色素的恶黑容易误漏诊，须待病理确诊。瘤细胞内含大量黑色素颗粒为其病理特点，免疫组化显示VIM—HMB45和S-100蛋白及Vs38阳性反应均有助于不含色素的恶黑的确诊。本病恶性度极高，可采用手术、放化疗或免疫治疗，但预后差。     

血管结扎在治疗晚期头颈肿瘤颈动脉破裂 出血的应用

0引言 引起动脉破裂出血的原因很多,如肿瘤的直接侵犯、切口感染、血管放疗损伤、手术创伤等,对于晚期头颈部恶性肿瘤而言,这些因素往往同时存在.因此,颈动脉破裂是此类患者潜在危险并发症.而对此类患者行预防性颈动脉结扎往往因手术的严重后遗症而不能为患者及家属所接受.临床上医生往往所面临的是对颈动脉破裂出血的危急处理.现将就我科近十余年处理颈动脉破裂出血的一些经验做以下交流.     

Morphometric Analysis in Potentially Malignant Head and Neck Lesions: Oral Submucous Fibrosis

Objective: The objective of this study is to analyze cases of oral submucous fibrosis (OSMF) Grade I, II, IIIand IV morphometrically with regard to epithelium, vasculature and fibrosis and determine any correlationwith histological grading after Pindborg and Sirsat. Materials and methods: Eighty three oral submucous fibrosiscases were analyzed morpometrically using an interactive image analysis system in the Department of Pathology,M.L.N Medical College, Allahabad, U.P, India. Paraffin embedded sections of 3-4 μm thickness were stainedwith hematoxylin/eosin, Van Gieson’s picric acid and acid fuchsin stain and Masson’s trichrome stains. Imageanalysis was performed with specific software (Image –Pro Plus 6.0) and data obtained were finally transportedto Excel sheets for calculation of average values for each parameter. Results:With the grading criteria applied,9 cases of OSMF were grade I, 32 grade II, 39 grade III and 3 grade IV. Clinical trismus was most frequent inGrade IV followed by Grade III, II and I respectively. OSMF Grade I cases did not show any measurableamount of collagenization, whereas it showed a significant increase with OSMF I and II grades [Pearson’s χ2test= 85.72; p= 0.051] and OSMF-III and IV [Pearson’s χ2test=188.74; p< 0.001]. Numbers of endothelial cellsper low power field consistently decreased with the increasing grade. Conclusions: We concluded that meanblood vessel area and the mean vessel diameter showed a marked increase in grade II and a marker decrease ingrade IV and the grade III, collagen thickness (μm) increases according to increasing grade while density ofendothelial cells decreases .     

头颈部恶性纤维组织细胞瘤临床和预后分析

目的　探讨头颈部恶性纤维组织细胞瘤 (MFH )的临床病理特点、治疗方法 ,分析影响预后的相关因素。方法　回顾性分析 40例头颈部恶性纤维组织细胞瘤的临床资料 ,用Kaplan Meier法进行生存分析 ,对可能影响预后的 12项因素进行单因素和多因素分析 ,组间比较用Log rank检验 ,多因素分析采用Cox模型 ,不同因素间相关关系分析用 χ2 检验。结果　头颈部MFH 5年累积生存率为 42 .0 % ;局部复发率约 3 7.1% ;影响预后的因素主要为 :肿瘤发生部位、治疗方式、颈淋巴结转移、病理分级、肿瘤局部复发 (P <0 .0 1) ;病理分级与肿瘤发生部位相关 ;以手术为主的综合治疗者较单纯手术、放疗和化疗者预后佳 (P <0 .0 5 )。结论　头颈部MFH患者预后差、复发率高 ,颈淋巴结转移、病理分化差、局部复发患者预后差 ,以手术为主的综合治疗方案有助于提高患者局部控制率和生存率     

Intensity-modulated Radiotherapy in the Treatment of Head and Neck Cancer

Intensity-modulated radiotherapy (IMRT) is a newer method of radiotherapy that uses intensity-modulated beams that can provide multiple intensity levels for any single-beam direction and any single-source position, allowing concave dose distributions and dose gradients with narrower margins than those possible using conventional methods. IMRT is ideal for treating complex treatment volumes and avoiding close proximity organs at risk that may be dose limiting and provides increased tumour control through an escalated dose and reduces normal tissue complications through organ at risk sparing. Given the potential advantages of IMRT and the availability of IMRT-enabled treatment planning systems and linear accelerators, IMRT has been introduced in a number of disease sites, including head and neck cancer. This systematic review examined the evidence for IMRT compared with two-dimensional external beam radiotherapy (EBRT) in the treatment of head and neck cancer in order to quantify the potential benefits of this new technology and made recommendations for radiation treatment programmes considering adopting this technique. Findings were in favour of IMRT compared with two-dimensional EBRT where avoidance of the adverse outcomes xerostomia, osteoradionecrosis and blindness are the main outcomes of interest, based on a review of 15 papers including 1555 patients. There are insufficient data to recommend IMRT over two-dimensional EBRT if treatment-related outcomes are the main outcomes of interest. Future research should focus on additional normal tissue preservation, and the role of IMRT in the treatment of recurrent head and neck cancer, as well as its use in combination with surgery, chemotherapy and/or brachytherapy.